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43
In connection with the recommendations contained in the foregoing Report of the Public
Health Committee (page 39), a letter was addressed to the Local Government Board stating that—
"The Borough Council have decided to adopt voluntary notification of Phthisis, and have given
instructions to the Medical Officer of Health to take such consequential measures for the
prevention of the spread of the disease as he may deem necessary.
"Among other matters in connection with this subject to which the attention of the Council
has recently been given, is that of accommodation, in suitable sanatoria, for the treatment
of poor consumptive persons. The Council have observed with satisfaction the arrangements
made by the Kensington Guardians for the separation, at the infirmary, of sufferers
from consumption from other inmates; but being strongly impressed with the value of the
open-air treatment of the disease in its early and more hopeful stages, they would very
earnestly represent to the Board the desirability of steps being taken to give effect to the
resolution of the Conference of Poor Law Authorities, held on the 15th October, 1900, to the
following effect:—
"That this Conference of Poor Law Authorities, having discussed the question of the
open-air treatment of consumption, are of opinion that the time has come when provision
should be made for the treatment by this method of the sick poor of the
Metropolis suffering from phthisis, and it recommends the matter for 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 proposal.
"The Council understand that the holding of the Conference was in a measure the outcome of
the Board's general approval of the course proposed to be taken; and further, that the
views expressed in the resolution received the unanimous support of the delegates of practically
all the Metropolitan Boards of Guardians: these views, moreover, are in harmony
with the resolution adopted at the recent Congress on Tuberculosis. The Council therefore
feel assured that the Board will agree with them as to the desirability, with the least practicable
delay, of provision being made, by some central authority, of sanatoria for the openair
treatment of consumptive persons chargeable to the rates in the Metropolis."
Formal acknowledgment only of the above communication has, so far, been received.
Should the Board not see their way to further the formation, or appointment, of a central
authority to make provision of Sanatoria for Consumptives (the Asylums Board are willing to undertake
the duty if called upon to do so), it must be remembered that this is a matter with which
the sanitary authorities themselves can deal, under Section 75 of the Public Health (London) Act,
1891. The Council might lead the way, either by promoting joint action or on independent lines.
The treatment of consumption should be placed on the same footing as the treatment of other infectious
diseases; i.e., it should, for the generality of people, be dissevered from association with
poor-law relief. As already indicated, Boards of Guardians could, if they thought fit—with
the sanction of the Local Government Board, which there is reason to believe would be given—
provide for those actually dependent on the rates; but for people above that status, and who, but
for sickness and inability to work, would have no occasion to "go on the rates," the sanitary
authorities could make provision. It might well be deemed a worthy object of ambition to be first
in such a cause.
A final remark may illustrate the importance of the whole question here dealt with. The
sub-committee of the Public Health Committee referred in their report to the greater mortality
in the borough from consumption, compared with the diseases more popularly regarded as
"infectious." It will suffice to mention that, whilst in the three years, 1898-1900, the deaths
from scarlet fever, diphtheria and "fever" totalled 183, the deaths from consumption in 1900
alone, were 27 in excess of that number.
Payment of Fees for Voluntary Notification.—A question having been raised as to the
legality of payments for voluntary notification of phthisis, the matter was referred to the Local
Government Board by the Council of the Borough of Southwark, to the courtesy of whose
Medical Officer of Health and Town Clerk I was indebted for a copy of the correspondence
between that Council and the Board. The said Council being, as was stated, "desirous of carrying
out the principle of voluntary notification," instructed the Town Clerk "to inquire whether,
in the event of their so doing, the Local Government Board would be prepared to sanction the
expenditure of monies in payment of the usual lees to medical practitioners?" The Board in
their reply, dated 31st October, 1901, stated that "the Council of the Borough of Southwark
have power, without any sanction on the part of the Board, to pay a reasonable fee to medical
practitioners for the voluntary notification of cases of phthisis occurring in their respective
practices." In this connection, it may be mentioned that the late Vestry of Kensington, upon my
recommendation, adopted a system of voluntary notification of what are now called the "notifiable
diseases," in 1887, two years before the passing of the Compulsory Notification Act, and that
no question of the legality of the payment of fees for certificates was ever raised by the auditors.
A suggestion was thrown out at a meeting of the Council that notification of phthisis should be
made compulsory, but the general consensus of opinion was adverse to the proposal which,
moreover, there is reason to believe would not be favourably entertained by the Local Government
Board.