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It may be well to consider the advantages of notification.
They comprise the localising of the cases of the
disease, thereby discovering anything likely to be a cause of
the disease in the lodging or circumstances of the patient,
and the taking of subsequent measures, designed to prevent
its spread. In this connection notification enables the
public health authority to take up the work of tracing the
infection and also ascertaining the part played in the spread
of disease by occupation or residence. This latter might
be advanced as an argument for compulsory notification, but
it would give rise to absolutely false conclusions if only a
certain number of cases were reported and inquired into, as
they would be were notification only voluntary.
The whole value of notification of any disease rests on
the early recognition and reporting of the cases, a fact that
can readily be seen if we study the history of those diseases
which have been notifiable since the beginning of 1892.
We shall see that neither scarlet fever nor diphtheria have
shown a marked diminution in prevalence although they have
in mortality; while diseases such as smallpox, which are
more often recognised in the initial stages, have been
much more brought under control. In the same way if
enteric fever be notified early it may be possible to prevent
the distribution of the milk that is liable to be contaminated
with the specific poison; to obviate the infection of the
water supply, and in many other directions. In the case, however,
of phthisis we have .a disease of totally different character
in that it pursues a chronic course, and may for some time
present merely the ordinary signs of a cough, or which may
only appear to be a case of gradually failing health, yet which,
during this time must be giving off large amounts of the
specific micro-organism; and, from the purely bacteriological
point of view, be spreading the disease far and wide. It is fair
to suppose notification would in most cases not be made until
the disease had made marked progress.
I cannot help repeating what I have inferred above, viz.,
that the consensus of opinion among medical officers of
health appears to be in favour of the notification of phthisis,
which, quoting the resolutions passed at the Tuberculosis
Congress, "has been attended by a, promising measure of
success and should be encouraged in districts in which
XIII.