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(for a period of seven years). The advantages of snch a system are
the obvious ones of having a complete, or nearly complete, return
of the most infectious cases in a district among all classes, and of
earlier notification. The disadvantages are chiefly two—(a) that
the disease is of long duration, and in its early stages difficult of
diagnosis; and (b) that the notification of all persons suffering from
the disease might lead to some degree of hardship. It must, however,
be remembered that notification is mainly beneficial in the
case of those who are too poor to be able to adopt the necessary
measures to protect others. Better-class patients are relatively few.
Dr. Scurfield, the Medical Officer of Health of Sheffield, informs me
that the compulsory notification clauses for Phthisis have worked
quite smoothly in Sheffield up to the present time, and he has not
heard of any hardship whatever being inflicted by the system.
During 1904 he received 840 notifications (the population of
Sheffield is 432,940). Two inspectors are engaged in visiting
consumptives, in distributing leaflets of advice, supplying pocket
spittoons, disinfecting, etc.
In respect to isolation, it must be said that some kind of isolation
is an indispensable part of the measures necessary if we are to
secure a more marked diminution of tuberculosis than has occurred
in the past. It must not, of course, be forgotten that the disease
has diminished more than one-half during the last fifty years, due
not to any hospital or sanatorium isolation, but to the advance of
sanitation, improvement of housing, the raising of the standard
of personal hygiene, and the social and physical condition of the
people. And broadly it is still upon these conditions that we must
rely for further diminution. Nevertheless it cannot be doubted
that the absence of suitable sanatorium treatment is blocking the
way of municipal authorities in London in their dealings with
consumption. Further, it should not be forgotten that there is a
double need to be met by isolation. First, it is important that
there should be sanatoria for the repair of consumptive patients in
the early stages of the disease. Secondly, institutions are required
where advanced cases can be isolated, in order thus to remove the
most dangerous sources of infection from the rest of the community.
In 1903 the Borough Council concurred in the views of the