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2. Where, under exceptional circumstances, the Medical
Officer of Health deemed it desirable that he should
make a personal examination of the patient, that
could only be done with the consent of the patient,
and with the co-operation of the Medical Practitioner
in attendance on the case.
This is professional etiquette, which I have always rigorously
followed.
I have always held it to be part of the duty of a Medical
Officer of Health to assist the Medical Practitioners practising
in his district in diagnosing cases of infectious disease,
and I have acted officially upon that opinion. During the
Smallpox outbreak of 1902-3, I examined many (the great
majority of) patients with, or for, Medical Practitioners, and
have acted in a similar way in connection with other diseases.
In this connection, the Bacteriological Laboratory has been
of great service to Lambeth. To suggest that the Medical
Officer of Health should verify, in all cases, the diagnoses
of infectious disease is, in my opinion, out of reason, and
in every way contrary to the spirit of the Infectious Diseases
Notification Acts. To help Medical Practitioners is one
thing, to act as their censor is another, and totally different
one. It is in the interest neither of the public nor of the
profession that this latter course should be adopted.
"Doubtful" cases must be isolated—in fact, the stricter
the isolation, the less chance there is of infectious diseases
spreading. We are at times inclined to think the Isolation
Hospitals are for the treatment, and not for the isolation, of
infectious cases. One thing is certain, as far as London is
concerned—the want of a proper and complete system of observation
wards for all infectious diseases, wherein the
doubtful cases may be watched and a correct diagnosis arrived
at; indeed, some such system as at present exists in
London in the case of Smallpox. The majority of the
"wrong diagnoses" are, undoubtedly, bona fide, and no
one with experience in practically dealing with infectious
disease will regard the 10 per cent. errors as a large one.
With regard to the Holborn Borough Council's suggested
Conference on the subject, there can be no objection to
such a Conference taking place. The freer the discussion,
the better. The medical profession has nothing to lose by
a free and open discussion on the subject. The facts as
mentioned above, and the well-known difficulties must, however,
be, at all times, borne in mind.
Joseph Priestley.
October 30th, 1905.