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61
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 a greater degree 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 to hospital and institutional isolation, to the advance of
sanitation, improvement of housing, the raising of the standard of
personal hygiene, cheap food, 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 this Borough Council concurred in the views of the
Kensington Borough Council as to the desirability of the unused
accommodation provided by the Metropolitan Asylums Board for
small-pox at Dartford. being utilised for the treatment of persons
suffering from consumption; and further, that the cost of the provision
and of the administration of such treatment be a charge upon
the Metropolis generally. The resolution was laid before the Local
Government Board. Owing to lack of unanimity among the Metropolitan
Boroughs, the Metropolitan Asylums Board wrote in January
1904, adjourning the whole question for 12 months. Subsequently