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Thus the total number of cases notified in these districts was 3,106. During the year there
occurred in these districts 4,330 deaths from phthisis, so that the notifications fell far short of the deaths
resulting from this disease. In the remaining districts where the system of voluntary notification
was not in operation the deaths numbered 1,976. These figures suffice to show how limited is as yet
the practice of notification of cases of phthisis in London. There is, however, some hope that this
practice will be extended through the operation of hospitals to which phthisical patients resort for
treatment.
Arrangements have been made by the Brompton Hospital for Consumption by which cases
attending that hospital are, with the patients' consent, notified to the County Medical Officer of
Health, who distributes the certificates of notification to the several medical officers of health in
whose districts the patients are resident. The hospital, moreover, invites the medical officers of
health to send for examination and treatment any other members of the patient's family who may
be found to present symptoms of phthisis. St. Thomas's Hospital employs almoners who visit the
homes of patients suffering from phthisis, with a view to giving advice and securing, as far as possible,
the attendance at the hospital for treatment of other members of the family who may be affected.
Phthisical patients attending Guy's Hospital are notified to the local medical officer of health.
During the year I have communicated with other hospitals to which such patients resort with a
view to the adoption of the system in operation at Brompton Hospital, a system which obviously
is deserving of extension throughout London. So far as poor law cases are concerned, an Order of
the Local Government Board requiring the notification of cases of phthisis in London occurring in
poor law practices, which came into force on the 1st January, 1909, brings to the knowledge of the
medical officers of health many of the cases occurring in that class of the community who most need
his services.
London, however, is but very imperfectly provided with the opportunities which are needed for
utilising the knowledge thus gained. Phthisis mortality occurs especially among the poor, and measures
for its reduction must largely include those which afford assistance, not only to the sufferer, but often
to the families of invaded households. It is here that extension of philanthropic effort is greatly
needed. The notification of phthisis without the ability to ameliorate the condition of the sufferer
is not calculated to effect the main object in view. Thus the female sanitary inspectors of Kensington
write : " It appears to us hopeless to expect any material benefit when the sufferer is compelled to live
with others in one or two rooms, and the advice to sleep alone is a counsel of perfection very rarely
capable of being followed."
In a few districts (Battersea, Hampstead, St. Marylebone, Paddington, Stepney, Southwark
and Westminster) voluntary health societies render useful aid, and indeed their services and the
services in London generally of the Charity Organization Society and of Children's Care Committees
deserve recognition, but it is a much wider development of the services which can thus be rendered in
connection with the work of the medical officers of health that is needed.
At the present time, when cases of pulmonary phthisis are brought to the knowledge of the
medical officer of health, the home of the patient is visited, and advice is given as to the course which
should be adopted in the invaded home. In a few districts the medical officers of health themselves
undertake this work, but for the most part the visits are made by sanitary inspectors or by health
visitors where these exist. Where there is a voluntary health society the case is handed over to it,
but in many districts the notification is not followed by more than the giving of advice and the offer
of sputum bottles and of disinfection. In Paddington, it deserves to be noted, a Dispensary for
the Prevention of Consumption has been instituted, of which Dr. Reginald Dudfield thus writes :—
" Not only will patients receive that advice, both medical and hygienic, which is necessary for the
treatment of their disease and the prevention of the spread of infection, but they will be visited in
their homes by doctor and nurse, who will instruct the patients how to give effect to the hygienic
measures prescribed, and do their best to see that they are carried out. The dispensary system,
however, requires the help of notification to achieve the best results." Dr. Dudfield's report also
contains the following paragraph which shows what it is practicable to do in a district where voluntary
notification has been adopted :—
" After notification advice is given as to precautions to be observed, and as to the best method of living, etc.
Frequent communications are addressed to the medical practitioners in charge of the patients, to learn what rules they
desire their patients to adopt, and to ascertain whether the cases are in need of and suitable for treatment in sanatoria
or country. In the last direction, the help of the Local Health Society and Committees of the Invalid Children's Aid
Association and Charity Organisation Society has been sought. The Charity Organisation Society has given material
relief in suitable cases. Twenty-one adult and twenty children patients were sent away to sanatoria or country through
the co-operation of the agencies mentioned. In the majority of the cases the results were satisfactory, but certain
patients refused to remain a sufficiently long time under treatment to obtain its full benefit. Records of all cases are
in the possession of the Department."
As stated in the last report, Dr. Bulstrode's inquiries on behalf of the Local Government Board
have emphasized the need for early detection of and early treatment of the disease, and it is in this
direction that improvement of London administration is especially needed. It is not claiming too much
to say that there should be skilled enquiry as to the health of all members of invaded families, and
provision for this is still wanting in London generally. That it is often impracticable for the medical
officer of health, in view of his other duties, to undertake this work personally is obvious to those
who are familiar with the duties which now devolve upon him. The institution of dispensaries will
not only render useful service in the treatment of recognised cases, but will in some degree provide
the necessary opportunity for early diagnosis, if the medical staff of such dispensaries act in effective
co-operation with the medical officer of health.