In Western European countries, as in other countries where the incidence of tuberculosis is low, the disease is primarily a problem in large cities. London, with a population of approximately 7.1 million, is, like most major urban areas, a place of stark contrasts between economic prosperity on the one hand and poverty and social exclusion on the other. The populations most affected by tuberculosis—such as the homeless, immigrants arriving from countries with high tuberculosis incidence, and people living with HIV—are more prevalent in large cities than in less urbanized areas. After declining for more than two centuries, the incidence of tuberculosis has risen since 1988 in England and Wales. This change has been accompanied by a concentration of the disease in the most urban areas, particularly in London. The proportion of cases reported there accounted for 44% of cases reported in England and Wales in 2002, compared with 28% in 1987. The case rate has increased in London, while it has remained stable in the rest of the country. This article describes the epidemiological situation of tuberculosis in London as well as the efforts made to date to control tuberculosis in the city. (R.A.)