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46
The notifications received numbered 218, out of a probable total of 800 actually existing
cases, and 207 of them were of chargeable persons. The registered deaths were 199 (136 of them
of chargeable persons), including 78 at the Borough infirmary: 62 of persons whose illness was
notified in the year, and 29 of persons whose illness had been notified in previous years; total, 91*.
With respect to the remaining 108 fatal cases = 54 per cent, of the entire numoer, no mlormation
had been received prior to registration of death, and therefore no measures could be taken for preventing
the spread of the disease, by visitation of the sufferers to give advice as to precautionary
measures with respect to the sputum, &c.; by supervision of the homes, or by means of disinfection.
For the rest, it remains to be seen whether the authorities of hospitals, etc., will be willing
to furnish information of out-patients suffering from phthisis. The County Medical Officer of
Health is hopeful, and should his expectations be realised, and all boroughs co-operate, voluntary
notification would be made to approach somewhat more nearly than at present to completeness.
But, personally, as the Council are aware, I am of opinion that the better plan would be to
make this dangerous communicable disease compulsorily notifiable. It is the cause of about 7,000
deaths yearly in London alone—the exact number in 1905 was 6,809—and there are probably thirty
thousand sufferers from it at the present time; the great bulk of whom are unknown to the Public
Health Authorities; a vast majority of them, moreover, belonging to the poorest classes who
stand greatly in need of the assistance, which, practically, those Authorities alone can render.
Such being the state of the case, I had no hesitation in recommending the Council, (1) to
express the opinion that phthisis should be declared under the Public Health (London) Act, 1891,
a notifiable infectious disease ; (2) to request the County Council to issue an Order under the said Act
for making the disease compulsorily notifiable; and (3) to request the Metropolitan Borough
Councils, generally, to address a similar representation to the County Council. The Council did not
adopt my views on the subject. Nevertheless, I adhere to the opinion expressed in these reports,
on several occasions during the last six years, that compulsory notification is indispensable to success in
the " administrative control of phthisis "; which, year by year, is the cause of more deaths than all
the scheduled notifiable diseases combined. It is hardly necessary, perhaps, to mention that the
Public Health (London) Act, 1891 (Section 56) enables the County Council, and any Metropolitan
Borough Council, by resolution, to add phthisis to the list of notifiable diseases mentioned in
section 55; but an order so made, has not any validity until it has received the approval of the
Local Government Board—which, presumably, would not be given, even if the County Council were
to ask for it, and a fortiori, not at the request of a local sanitary authority. As regards London, however,
it has regretfully to be admitted that the Local Authorities are not in a " position," and are not
"ready" to deal "effectively" even with the cases voluntarily notified to them; practically no
provision, outside the Poor Law Infirmaries, having been made for the isloation and treatment of
sufferers. But this cannot be imputed to indifference ; as, with almost complete unanimity, they
have, on more than one occasion, requested the Local Government Board to give sanction to the
AsylumsBoard to utilise their superfluous hospital accommodation for sanatorium purposes. That
sanction has, so far, been withheld; and it must be confessed that the Managers do not appear
anxious to undertake the duty.
The Sanatorium Question.—This question was fully dealt with in the annual report for
1905, especially in connexion with the Memorial of the London Medical Officers of Health, presented,
by a highly representative deputation, to the Metropolitan Asylums Board on 15th April, 1905. The
Memorial was referred to the General Purposes Committee, who, on 17th February, 1906, reported
thereon as follows:—
" On the 15th April, 1905, we were instructed to consider and report to the Board upon the
memorial which the Managers then received from the Metropolitan Branch of the Incorporated
Society of Medical Officers of Health, and in which they were urged to provide hospital
accommodation for the treatment and isolation of patients suffering from pulmonary phthisis.
" In this memorial it was proposed—
" ' (a) That an order of the Local Government Board be obtained to make Section 5 of
" the Metropolitan Poor Act, 1867, applicable to the case of ' poor persons' suffering from
" pulmonary phthisis (consumption); and, if necessary,
" ' (b) That an Act be obtained to make the provisions of Section 80 of the Public
" Health (London) Act, 1891, applicable to pulmonary phthisis (consumption), as if such
" disease were therein mentioned, as well as ' fever, or smallpox, or diphtheria.'
* The comparative results of voluntary notification in 1906 are given at page 54.