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Report of the County Medical Officer—General.
47
been studied, and second, there should be noted the heavy incidence of cancer at the special cancerages
(40-60) in Prussia as compared with the other countries. As in the case of tuberculosis this
represents in all probability not a natural but an artificial difference, and if that be so it is important
to recognise in the case of cancer as in that of tuberculosis how variable are the connotations of this
word as used in different places and at different times.
During the year 1911 the system of compulsory notification of pulmonary tuberculosis was completed
and it was in operation during the whole of 1912. This scheme was begun on the 1st January,
1909, as the result of the Public Health (Tuberculosis) Regulations, 1908, issued by the Local Government
Board on the 18th December of that year. These regulations provided for the notification of cases of
pulmonary tuberculosis by Medical Officers of Poor Law Institutions, District Medical Officers, Superintending
Officers of Poor Law Institutions and Relieving Officers. The respective duties of these
officers in connection with notification are prescribed in Articles IV to VIII of the Regulations.
Further Regulations were made on 22nd March, 1911, extending the system of notification to
cases occurring among the in-patients or out-patients at hospitals, or other similar institutions for the
treatment of the sick, which are supported wholly or partially otherwise than by the contributions of
the patients (or of their relatives or guardians) and otherwise than from rates and taxes. These
Regulations are described as the Public Health (Tuberculosis in Hospitals) Regulations, and came into
force on 1st May, 1911.
A further stage in the system of notification of pulmonary tuberculosis was reached by the issue
of the Local Government Board Order of the 15th November, 1911. This Order provided that from the
1st January, 1912, every Medical Practitioner should notify within 48 hours every case of pulmonary
tuberculosis occurring in the course of his public or of his private practice, but it relieved the medical
practitioner of the duty of notifying a case which had to his knowledge already been notified to the
proper authority. The Order was not a consolidating Order but supplemented and to some degree
extended the Poor Law and Hospital Regulations. These three orders were consolidated, and extended
to apply to all forms of tuberculosis, by a new order of the Local Government Board dated 19th
December, 1912, which came into force on 1st February, 1913.