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Asylum, with milk from Rookery Farm, so that it would be well for
your Public Health Committee to again discuss the advisability of
fitting up a sterilizing plant in association with the farm supply, not
only as a means of perfecting that consumed in their own institutions,
but also as a means of developing a town distribution, with the object
of decreasing both the infantile and Diarrhoea death-rates. I suggest
that they at least visit one or more dairies in London where the
sterilization process may be seen in operation.
2.—Notification, compulsory or voluntary.—Strong
arguments can be advanced for and against compulsory notification.
The long course usually taken by the disease, the fact that patients
suffering are for the greater part of that period able to get about and
attend to their business; the fact that they thus have probably
been spreading the Tubercle Bacillus broadcast before the disease is
recognized, the fear that sufferers, able to get about, would be subject
to a system of espionage—these are some of the reasons advanced
against compulsory notification. Up to the present, too, I believe the
Local Government Board have opposed the application of notification
to this disease, and there docs not appear to be any immediate
likelihood of obtaining such powers. On the other hand, if systematic
action is to be taken against Phthisis, it surely is of the first
importance that every possible case should be known to the Local
Authority. With the exception of the lengthy course, all the other
arguments are equally applicable to and were advanced against the
adoption of notification of other infectious diseases, yet no one now
doubts the value of their compulsory notification to the public health
service.
While, however, I do not advise the Council to seek powers of
compulsion at present, I am certainly of opinion that advantage would
be gained by paying the usual fees for voluntary notification. In this
way the Medical Officer of Health would hear of many cases from the
Board of Guardians, Hospitals, and other Institutions, probably the
very cases most needing definite instructions as to the precautions to
be adopted to avoid spreading the disease, and most likely to benefit