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definite view on the subject; for they did not go farther than to say that " voluntary notification is
of the greatest importance; " a view with which my five years' experience of it does not enable me to
coincide. In any case, however, they are of opinion that " notification need be obligatory only on
Poor Law Medical Officers, and, perhaps, on hospitals and dispensaries."
The Society of Medical Officers of Health (Metropolitan Branch) last year, after careful consideration
of the subject, unanimously declared in favour of compulsory notification for
the Metropolis, on the lines of the Sheffield Corporation Act, 1903, which have been followed in the
Branch it is desirable, in the interests of public health, and for the prevention of the spread of tuberBolton,
and the Rathmines, Acts of 1905*. The resolution adopted was—" That in the opinion of the
culous diseases of the lungs, that such diseases should be compulsorily notifiable by medical practitioners
to the Metropolitan Medical Officers of Health." It was ordered that a copy of the resolution
be forwarded to the Local Government Board, the London County Council, and the National
Association for the Prevention of Consumption and other forms of Tuberculosis. The movement
for securing such notification, subject to proper limitations necessitated by the special circumstances
of the disease, would appear to be commending itself to many sanitary authorities.
The matter was brought to the attention of the Metropolitan Sanitary Authorities last year,
in a communication from the London County Council, enclosing a report by the Council's Medical
Officer of Health raising the question, Whether notification of consumption should be made compulsory,
or efforts be made to extend the system of voluntary notification which is in operation in
18 out of the 29 Metropolitan Boroughs, etc.?
Reporting on this communication, I observed that "the Medical Officer doubts whether, at
the present time, it is desirable to endeavour to apply to London a system of compulsory notification,
but thinks there would be advantage if the system of voluntary notification were adopted in all
the boroughs.t" He suggests, moreover, that hospital and dispensary authorities in London, should
be asked to furnish the County Council, from time to time, with the names and addresses of outpatients
attending for treatment for phthisis, so that the Medical Officer of each borough could be
informed of local cases. The Public Health Committee of the County Council desired to be informed
of the views of the several borough councils on this subject, and specially inquired,
Whether the council of the Royal Borough were of opinion (a) that phthisis should be declared
under the Public Health (London) Act, 1891, to be a notifiable infectious disease, or (b) that the
system of voluntary notification of the disease should be adopted throughout London; and that
particulars as to out-patients attending hospitals and dispensaries, should be obtained and circulated
to the Medical Officers of Health of the several boroughs? Before the Council could arrive at a
satisfactory conclusion in regard to the above named communication, I stated that if would be
necessary to consider (1) the objects sought to be obtained by notification, and (2) the prospect of
success, in regard to the suggested extension of voluntary notification. As regards the " objects
I observed that the County Council's Medical Officer, in his report, deals with " the uses to
which compulsory notification can be put. These uses," as he pointed out, " depend in a
large degree upon recognition of the view (a) that phthisis is capable of being communicated
. . . . to susceptible individuals by the sputum of persons suffering from the disease; (b)
that by the adoption of suitable measures, especially the open-air treatment of persons suffering
from the disease in its early stages, some of such persons can be cured." With respect to (a), I
pointed out that if knowledge of the existence of cases could be obtained, precautionary measures
for the prevention of the spread of the disease in the home, and removal of sufferers, especially from
advanced phthisis, where poverty and overcrowding exist in the home, would safeguard the other
members of the family, and allow of disinfection, cleansing, &c.; whilst as regards (6), the advantages
of the open-air treatment, in early cases of phthisis, were explained. I stated that—
" The first step necessary to secure knowledge of the existence of the sick, with a view to
the selection of cases for removal to such institutions (i.e. Sanatoria) as may be provided, and
the medical supervision of those who remain at home, is, undoubtedly, notification of cases of this
dippftse."
Whilst not questioning the advantage that would accrue from extended voluntary notification
in the boroughs, and approving the suggestion to seek the assistance of hospital and dispensary
authorities, I emphasized the inadequacy of the system (which the Council were
among the first to adopt, in January, 1902), as shown by our local experience in 1905.
• These Acts may be regarded as experimental: if not continued, they will expire in 1910.
f In this connexion it may be mentioned that the Conference of Representatives of Metropolitan Boroughs, convened
by the County Council, in July, 1904, unanimously adopted a resolution—"That the system of voluntary notification of
phthisis is desirable, and should be made general throughout London."