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In some cases the patients, before they died, suffered from Tubercular
diseases of other organs, and these facts were inserted in the death certificates.
Phthisis, or Tubercular diseases of the Lungs, may then have been mentioned
as a secondary cause. A phthisical patient may contract Pneumonia, and the
latter disease may be the immediate cause of death. Inasmuch as the patient
was actually suffering from Phthisis at the time of death, I have entered the
cause of death under Phthisis.
The above probably accounts for the fact that the death-rate from
Phthisis, according to my enumeration, is slightly higher than that given by
the Registrar-General, which was 212 per 1,000. The death-rate from Phthisis
was the fourth highest of the Metropolitan Boroughs.
The annual average for the previous 3 years was 2 08 per 1,000. Admitted
to be a preventible disease, the question of taking steps to lower the high
death-rate was discussed by the Public Health Committee on several occasions
During the latter part of the year, a sub-committee was appointed to enquire
into, and report on the advisability of making Phthisis a notifiable disease.
The sub-committee requested me to communicate with the Medical Officers of
Health of those Districts that have adopted voluntary notification, and to
find out what success has been attained thereby. I sent out circulars asking
for particulars under the following headings: —
Voluntary Notifcation of Pulmonary Tuberculosis.
(1) Name of District.
(2) Population.
(3) What has been the average death-rate from Pulmonary Phthisis
for the last 5 years ?
(4) How long has voluntary notification been in force, and what fee
is offered ?
(5) What has been the average annual cost of notifications ?
(6) Do you find that the same case is notified more than once ? If so,
have any means been adopted to check this possible abuse ?
(7) Has the system caused any friction between the Medical men and
their patients—better class as well as poorer?
(8) What means are adopted to show that the patient consented to
notification ? Do you issue a special form ?