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5
of existing cases. In one of the Boroughs, for instance, the cases of pulmonary tuberculosis voluntarily
notified year by year show as follow, the total yearly deaths from pulmonary tuberculosis being
given for comparison.
The figures are taken from the report of the Borough Medical Officer of Health.
Year.
Cases of pulmonary tuberculosis
voluntarily notified.
Deaths from pulmonary
tuberculosis.
1902
315 (7 months)
521
1903
339
435
1904
306
447
1905
293
416
1906
332
411
1907
322
465
1908
373
441
It is seen that the cases notified in each year are fewer than the total number of
recorded deaths from that disease. There is thus an obvious deficiency in the notifications. Probably
the total deficiency is very extensive; it may be roughly gauged in this way. The number
of annual deaths in a district is believed to stand for at least five times as many living cases,
and there is reason to think that tenfold the number of deaths would give a closer approximation for
the pulmonary tuberculosis cases of some districts. If five, however, be taken as the factor and the
deaths multplied bv it. a conservative, if very rough, estimate of existing cases will be obtained.
The above table will then appear as follows:—
Year.
Cases of pulmonary
tuberculosis voluntarily
notified.
Deaths from pulmonary
tuberculosis.
Estimated
minimum number of
existing cases of pulmonary
tuberculosis.
Percentage of
notifications to
existing
cases.
1902
315
521
2,605
12.0%
1903
339
435
2,175
15.5%
1904
306
447
2,235
13.6%
1905
293
416
2,080
14.0%
1906
332
411
2,055
16.1%
1907
322
465
2,325
13.8%
1908
373
441
2,205
16.9%
On this showing, only about one-seventh, or about 14.5% of the existing cases of pulmonary
tuberculosis in a district are disclosed by the system of voluntary notification.
The following table shows similar figures for the London districts in which voluntary notification
has been and is in force.
The figures are taken from the reports of the respective City and Borough Medical Officers of Health.
Year.
Cases of pulmonary
tuberculosis voluntarily
notified.
Deaths from pulmonary
tuberculosis.
Estimated
minimum number of
existing cases of pulmonary
tuberculosis.
Percentage of
notifications to
existing
cases.
1902 (11 districts)
1,328
2,383
11,915
11.1%
1903 (14 „ )
1,978
2,969
14,845
13.3%
1904 (16 „ )
2,488
3,437
17,185
14.4%
1905 (17 „ )
2,180
3,576
17,880
12.2%
1906 (21 „ )
2,964
4,463
22,315
13.3%
1907 (21 „ )
3,136
4,418
22,090
14.2%
1908 (21 „ )
3,080
4,386
21,930
14.0%
Thus, in the year 1908, of not less than about 22,000 cases existing in 21 voluntary notification
areas, 86%, or about 19,000 cases, were unknown to sanitary authorities; this is a conservative
estimate, the number being probably higher; and it also takes no account of the areas in which a
further number of not less than about 9,000 cases remained undisclosed, no system of notification
being in force.
It is convenient now to examine why voluntary notification has disclosed such a small
proportion of the existing cases. Analysis of a year's notifications prior to the year 1909 shows
that, in the main, the only members of the medical profession who availed themselves of
voluntary notification were those in the Poor Law service. By the staff of chest hospitals and of
other institutions, and by private practitioners few cases were notified. An analysis of the