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Tuberculosis—Notification of Phthisis.
We report having again had this question under consideration. The Council
agreed to a recommendation of this Committee on the 4th March, 1902, that a leaflet
should be printed containing a short account of the nature of tuberculosis, its curability,
the methods by which it is principally spread, and the best means of preventing it, and
that this should be circulated among phthisical patients in the Borough as we become
aware of them, and in order that the necessary information might be obtained so as to
distribute the leaflet, give personal instruction and advice where necessary, disinfect the
rooms, etc., the Local Government Board were asked to sanction a payment of 2s. 6d.
to medical practitioners for every fresh case of phthisis notified to the Council.
The Local Government Board replied, stating that, in their opinion, the Borough
Council have the necessary powers to make reasonable payments in respect to the
notification of cases of infectious disease occurring in this district. The Committee,
owing to the small-pox epidemic, decided then to let the question stand over for six
months.
In bringing this matter again before us, the Medical Officer emphasises the great
prevalence of the disease, and states that the average death-rate is 2.01 for the last ten
years in Bermondsey, which is greater than that of the six principal zymotic diseases
put together.
It was stated by the Medical Inspector of the Local Government Board, who was
present unofficially at a conference on the subject of Sanatoria on July 7th, 1900, that
there were 1,562 consumptive patients in "Metropolitan institutions" (workhouses and
infirmaries), of whom 1,000 could be moved to a sanatorium or sanatoria within 50 miles
of London, and of these, 400 were in the initial (and therefore curable) stages of the
disease. This, in itself, is a strong argument for the equipment of sanatoria. As a step
towards this, it is highly important to have some idea of the number of cases of phthisis,
and this can only be done by voluntary notification.
The following Metropolitan Sanitary Authorities have already adopted voluntary
notification of phthisis:—
The Corporation of London,
Lambeth Borough Council,
Finsbury Borough Council,
Southwark „
Greenwich „
Stoke Newington „
Hammersmith „
Wandsworth „
Hampstead „
Woolwich „
Kensington „
On February 17th, 1903, the Council, on the recommendation of the Public Health
Committee, definitely decided to adopt the notification of phthisis, paying a fee of 2s. 6d. for
every fresh case notified in private practice, and 1s. for those notified in connection with a public
body or institution.
I was then instructed to make arrangements for carrying out this resolution, and, as a
consequence, sent the following letter to the practitioners in the Borough:-
Town Hall, Lower Road, S.E.,
Dear Sir,
May, 1903.
As you have no doubt already been informed by the Clerk to the Metropolitan
Borough of Bermondsey, the Council has decided to adopt the voluntary notification of
phthisis.
I send, under separate cover, the notification form to be used. I would draw your
attention to the heading of the certificate that it refers to phthisical patients with
infective sputum.
It is most desirable that in doubtful cases the sputum should be examined for
tubercle bacilli, and I would remind you that facilities for this have been provided by
the Council.
In the footnote you will see that no case is to be notified which has already been
notified by another practitioner, and as it has to be done with the consent of the
patient, I do not anticipate that there will be any difficulty in this matter.
Yours faithfully,
R. K. Brown, Medical Officer of Health.
I also drew up a leaflet to be posted to the houses in which phthisical patients lived, and
adopted a special notification form.
I hope to give a further report on the working in my next annual report.
In connection with the various reports, I still adhere to the opinions expressed in them,
and hope that the time will soon come when sanatoria will be provided free of cost, to at least
the poorer inhabitants of the Metropolis, and other parts of the British Isles. The opinion,
which has been known to medical men for a very long time, is gradually gaining ground amongst
the laity that consumption is both preventable and curable. It makes terrible ravages at the
most useful period of life, and there is no doubt that if cases are diagnosed early, removed to
suitable surroundings at once, and for sufficient length of time, a cure follows which is permanent
in proportion to the way the individual can live after he leaves the sanatorium. For the
Metropolis there is, in my opinion, no more suitable body to undertake this work than the
Metropolitan Asylums Board. Looking at it from an economic point of view, the suggestion of
sanatoria is pre-eminently a business proposal. Many families are at present pauperised, and
have support from the rates, because the bread winner is afflicted with phthisis. The adoption
of this principle would therefore be a saving in the long run, not to speak of the comfort and
happiness produced by the diminution in the prevalence of this disease.
Overcrowding.
My attention was drawn to the following cases visited in 1902: —
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