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Most of these 210 notifications are of inmates in the Highgate
Infirmary, and are of cases in an advanced stage of the disease.
These are two characteristics which greatly reduce the advantage
of the system, which is to obtain notifications of the disease in all
classes of the community, and in the early stages of the disease as
well as the later. It is, I think, matter for regret that we do not
receive more notifications in all classes of the community. I fully
recognise the difficulties which occur in general practice in relation
to the notification of this disease and which are common to all
districts. On the other hand I am satisfied that the utility of
notification is in proportion to the number notified. The advantages
of the system are (a) the giving of advice as to precautions
and arranging for disinfection of houses, etc., in order to prevent
dissemination of the virus of infection during the life of the
patient; and (b) the collection of some facts, even if they be not
complete, respecting the incidence of the disease. Unfortunately
these advantages fall short of what is really needed. Voluntary
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notification comes too late to render very much service to the
patient or indeed to the community. It ought not to be so, but in
practice it works out so. Secondly, there is no system of isolation
for cases notified, and thirdly, "removals" are so frequent that it
is almost impossible to trace infection or to follow up the case.
For these reasons reliable deductions cannot be drawn on the data
obtained by voluntary notification as it works out in a district like
Finsbury.
Probably the way out of the difficulty as to notification is a system
of compulsory notification as in force in New York and in Sheffield