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69
It is worthy of note that the death-rate from pulmonary
tuberculosis, though still far higher than that resulting from any
other disease to which the principle of Notification has hitherto
been applied, has nevertheless shown a marked decline in the
last thirty years. In 1881, the death-rate per 1,000 of the (population
was 18.25, in 1891 it was 15.99, in 1901 it was 12.64 and
in 1909 it was 10.93. This decrease has coincided with a marked
increase in the activities of local authorities including greatly
improved sanitary administration and the treatment of the sick
under more satisfactory conditions. It is impossible to estimate
precisely the influence of these causes on the diminution of the
death-rate, but there can be no doubt that they have been powerful
factors in bringing about the reduction.
With the information by means of general notification local
authorities will be able to take action with a view to preventing
the spread of infection or removing conditions favourable to infection.
Powers and Duties of Councils.
In a disease such as tuberculosis the prevention of infection
and the treatment of the patient frequently cannot be separated
The Board have by the Order given a general power to the
local authority on the advice of their medical officer of health to
supply such medical assistance, facilities and articles as may be
necessary for detecting pulmonary tuberculosis, for preventing the
spread of infection and for removing conditions favourable to
infection. The local authority are also empowered to appoint any
additional officers.
Finance.
The financial aspect of the problem has been considerably
altered by proposals which have been recently laid before Parliament.
Under the Finance and National Insurance Bills (now Acts) it is
proposed that a capital sum of one and a half millions shall be
made available for grants for the provision of sanatoria and other
institutions. The National Insurance Bill (Act) also makes provision
for defraying expenses of sanatorium treatment of insured
persons and it is proposed in certain circumstances to enable this
treatment to be given to the dependents of the insured.
The Position of Persons Notified.
The circular letter of the Board lays particular stress on this
matter. It is of course, it goes on to state, unnecessary and undesirable
that notification should involve publicity. The Board
have no doubt that local authorities and their officers will avoid doing
anything which could cause pain or annoyance to patients or their
friends.