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60
Most of these 178 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. In the first
place, voluntary notifications, if only of advanced cases, come too
late to render very much service to the patients 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. 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.
It, may be that the way out of the difficulty as to notification
is a system of compulsory notification as in force in New York
and in Sheffield (for a period of seven years from 1903). The
advantages of such 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