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44
THE PREVENTION OF CONSUMPTION.
This subject was dealt with fully in the annual report for 1905, in which the preventive
measures adopted by the Council, since 1899, and the formation of the National Association, were
described. Disinfection of infected premises has been consistently practised, so far as allowed by
occupiers, or permitted by circumstances. What has to be said on the general subject in this report
mainly concerns the two subjects of notification, and sanatorium treatment.
Compulsory Notification.—As regards notification, it is satisfactory to observe that medical
(and public) opinion inclines more and more to the view that in order to be effective it must
be compulsory, as in the case of other dangerous infectious diseases. This view is not
yet accepted by the Local Government Board, who, in response to an application from
the Barnstaple Rural District Council, urging that, pulmonary phthisis should be included
amongst the list of notifiable diseases, intimated that it was not a disease to which compulsory
notification could with advantage be applied. On the other hand, the Local Government
Board for Scotland, in a circular letter to Local Authorities (on the " Administrative Control
of Pulmonary Phthisis ".) issued last year, expressly stated that " for the effective application of
the public Health Act to pulmonary phthisis, a system of notification is essentialthat " it is open
to the Local Authority, with the approval of the Board, to add pulmonary phthisis to the list of
(notifiable) diseases," and that the Board " will be prepared to give favourable consideration to
any application for their approval, provided they are satisfied that the Local Authority are in a
position, and are ready, to deal effectively with the cases notified to them." In other words, the
Board will authorize notification being made compulsory when such a course is likely to be useful.
In this connexion it may be mentioned that the Town Council of the City of Edinburgh decided,
in December, to apply fo the Board for sanction to add consumption to the list of diseases
scheduled in the Infectious Diseases (Notification) Act, 1899. The Council would appear to be in
a "position," and are "ready," to comply with the condition laid down by the Board, having made
provision for the isolation and treatment of patients by setting apart beds in special wards in the
City Hospital. The voluntary system had been tried in Edinburgh and proved a failure—as also
in Glasgow, the Corporation of which city have also resolved to add consumption to the list of
compulsorily notifiable diseases. The International Congress on Tuberculosis, held in London in
1901, it is true, did not do more than pass a resolution favouring a system of voluntary notification;
but they recommended "that the extention of notification should be encouraged in all districts
in which efficient sanitary administration renders it possible to adopt the consequential
measures." On the same occasion Professor Robert Koch, the discoverer of the tubercle bacillus,
emphasized the need for obligatory notification in cases that, " owing to the domestic conditions
are sources of danger to the people about them," so that measures to prevent the spread
of the disease, including disinfection of rooms, might be " effected when consumptives die,
or change their residence, in order that those who next occupy the infected dwelling may be protected
against infection." Five years later this illustrious man in his " Nobel" lecture (" How the
fight against Tuberculosis now stands "), delivered at Stockholm, after stating that "the starting
point for the combating of all pestilences is notification, because without it most cases of disease
would remain unknown," said," We must demand it for tuberculosis too " (The Lancet, May 26,
1906). Again, in the "Milroy" Lectures (1903) on The Causes, Prevalence, and Control of Pulmonary
Phthisis,t similar views were expressed, the suggestion, however, being thrown out, that it
might be well, in the first instance, to " limit notification to cases in which the condition and
environment of the patient are such that danger to the public is likely to accrue;" for example,
in " the cases of patients occupying tenement houses, or other places where the first principles of
cleanliness are not observed, and where the people live much in common, with tendency to overcrowding."
The views of the lecturer have a special interest, by reason of his official position.
He was, moreover, one of the delegates of the British Government at the International
Congress on Tuberculosis, held in Paris, in 1905, at which, he reports, that the view expressed
was, that " it is desirable that the notification of open tuberculosis (e.g. consumption with spitting)
should become general." On the other hand, the Council of the National Association for the Prevention
of Consumption, in their latest Manifesto (February, 1906) had not arrived at such a
*In this important document the Board explicitly characterise consumption as "an infectious disease within the
meaning of the Public Health (Scotland) Act, 1897" (the provisions of which are practically identical with corresponding
provisions in the Public Health Acts applicable to England and the Metropolis). "The cardinal fact is. that the infection of
pulmonary phthisis passes from one person, directly or indirectly, to some other person. Accordingly, the sections of the
Public Health Act applicable to other infectious diseases, are equally applicable to pulmonary phthisis, and the obligation
resting on the Local Authority to deal with and control infectious disease, extends to consumption."
By Dr. H. Timbrell Bulstrode, Inspector, Medical Department, H.M. Local Government Board. The lectures,
delivered before the Royal College of Physicians, were published in The Lancet.