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4. An appeal to the Local Government Board to give effect to the opinion of the aforementioned
Conference of Poor Law Authorities, viz.:— 'That the time has come when
provision should be made for the open-air treatment of the sick poor of the Metropolis
suffering from consumption,' the recommendation of the Conference being, that the
matter should receive 'the consideration of the Local Government Board, with a view
to the necessary steps being taken by that Board for the carrying out of the proposals.'
"We have not thought it necessary to deal with the question of the transmissibility of tuberculosis
from animals to man, through the agency of meat or milk, this being the subject about
to be dealt with by the Royal Commission adverted to in the letter of the Local Government
Board to which reference was made at the beginning of this report.
"We conclude by stating, as evidence of the importance of the subject referred to us, that in this
borough consumption alone—apart from all other diseases of the tuberculous class—destroys,
year by year, very many more lives than small-pox, scarlet fever, diphtheria, and 'fever'
combined."
The report having been unanimously adopted by the Council, on November 13th, the
necessary steps were forthwith taken to give effect to the scheme of voluntary notification of
phthisis therein recommended ; primarily by the issue of a circular letter to medical practitioners
within the borough, as follows:—
"The enclosed report of the Public Health Committee, on The Prevention of Consumption,
having been adopted by the Borough Council, 1 am instructed to inform you: —
(а) That the Council desire to receive, on and after January 1st, 1902, notifications—
given with the consent of the patient or those in charge of the patient—of cases of
consumption attended with tuberculous expectoration, and will pay for each such
notification, but for one notification only in respect of each case, the same fee as is
paid for compulsory notification certificates under the Public Health (London) Act,
1891.
(b) That the Council have entered into an arrangement with the Jenner Institute for the
bacteriological examination of expectoration suspected to be tuberculous, and will,
when necessary, defray the cost of such examination.
(c) That at the discretion of the Medical Officer of Health, a visit will be paid by one of
his staff to give verbal advice and instruction as to precautions to be taken to prevent
the spread of disease through the sputum, the utmost pains being taken to act in
complete agreement with the medical attendant.
(d) That copies of an enclosed leaflet on 'The Prevention of Consumption' will be placed
at the disposal of the notifying medical practitioner for the use and information of
the consumptive person, and the members of his or her family.
(e) That the Council will disinfect, free of cost, any room vacated by the death or removal
of a consumptive person, and that bedding, clothing, etc., will, if desired, be removed
for disinfection, no charge being made.
"In requesting your assistance, I think it right to state that there will be no official interference
with the patient, as the result of notification, either at his home or in connection with his
employment. The measures to be taken on behalf of the Council will be confined, mainly,
to inspection of the house, disinfection, and the distribution of information with reference
to the disposal of sputum, and the general precautions proper to be observed with a view to
prevent the spread of disease.
"Duplicate notifications cannot be accepted, excepting in case of a change in the patient's abode.
"Notification of moribund cases is not necessary: registration of death supplies the required
information.
"Notification is especially to be desired in cases where public good may be expected to arise
therefrom—that is, in cases where the sanitary authority can co-operate with the medical
attendant, by measures for removing or ameliorating insanitary conditions at the home of
the sufferer, and generally by improving his surroundings.
"The importance of correct and early diagnosis in doubtful cases need not be emphasised. The
best means to assure this is by the examination of sputum. The sputum outfit, provided by
the Council, can be obtained at the Town Hall: but the specimen must be forwarded direct
to the Jenner Institute, Chelsea-gardens, S.W., by the medical attendant, to whom the
result of the examination will be communicated forthwith on receipt of the report.
"In offering the services of the Council's disinfecting staff, T would point out that, whatever
care may be taken to ensure safe disposal of sputum, disinfection of a house or a room
vacated by a consumptive person should invariably be carried out before reoccupation.
Disinfection will be carried out, whenever desired by the medical attendant, whether the
case has been notified or not. In this connection, I may observe that periodical wet cleansing
of the floor and the washable surfaces of the sick room, with a view to prevent spread of
disease by dust-infection, cannot be too strongly insisted on.
"The Council earnestly hone that in this new departure they may receive your sympathy and
support. For myself, I can only say that I shall be happy at all times to co-operate, with
you in preventive measures. The remarkable reduction in mortality from consumption, and
tubercular diseases generally, during the last fifty years, encourages the hope that, by the
adoption of the means above indicated, still further improvement to the public health may
be secured.
"I trust you may find the information contained in the enclosures of practical use in connection
with any case of consumption that may come under your care."