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47
benefit be conceived greater, not merely to the man affected, but to those dependent on him, and to
the society of which he was a part, than if in the early stages, before he was driven by the disease
from useful work, he could place himself in a sanatorium? There would then be not merely a chance,
but a high degree of probability, that he would be restored to his family and to those dependent on
him, as efficient a member of society, as he was when he was driven from his own roof tree.'
[I may perhaps be pardoned for mentioning that in November, 1905,1 addressed a letter to Mr.
Balfour, when Prime Minister, drawing attention to the great mortality from consumption, and to
the fact that "the disease is preventible, often curable at the early stage, and communicable." I
stated that the London Medical Officers of Health were unanimous in desiring that the Metropolitan
Asylums Board should become the Sanatorium Authority for the Metropolis ; and "having regard
to the national importance of the question," I transmitted a report of "the proceedings at the
representative deputation to the Board in (April (1905), at which they were invited to acquire that
position."]
COMPULSORY NOTIFICATION OF CONSUMPTION.
The views of the several Local Government Boards on the subject of compulsory notificatiou
differ somewhat widely. The Local Government Board for Scotland are favourable to the practice,
and in a communication I had the honour of receiving from them in November it was stated:—
(1) That the Local Authorities of the Burghs of Edinburgh, Brechin, and Pennicuick have, with
the Board's approval, extended the Infectious Disease (Notification Act) 1889 permanently to
include pulmonary phthisis, (2) Th it the Local Authority of the Lower Ward District of Lanarkshire
have extended the Act for five years, and (3) That the Cupar Burgh and the Linlithgow
and Bathgate Districts of the County of Linlithgow have also extended the Act for the period of
five years." Nothing to the contrary being said, it is to be presumed that the provisions of the
notification sections are applicable in their entirety; but no doubt the Local Authorities are
exercising their powers with discretion.
The view of the Local Government Board for Ireland on the subject, as explained in a communication
I had the honour of receiving from them, also in November last, is that notification "should
be carried out by special legislation, and that safeguards should be provided to ensure that no unnecessary
restraint is placed on the liberty of consumptive patients. If notification is used merely for
the purpose of gaining information as to the locality of the disease, and helping the sufferer by
giving assistance and advice which would be useful in protecting other members of his family from
contracting the disease, [they consider that it would, under efficient and sympathetic administration,
be a most useful public health measure."
To this it may be added' that at the meeting of the " Consultation Committee," at Dublin,
above referred to (page 46), at which her Excellency the Countess of Aberdeen presided, delegates
from all parts of Ireland being present, the following resolution was adopted:—
" That it is desirable that the Government should, without delay, introduce special legislation with
the object of making it compulsory to notify all cases of pulmonary tuberculosis, taking care, at the
same time, to protect consumptive patients from any undue interference with their liberty."
And as we have seen (page 46) not only did the Chief Sectetary, when receiving a deputation,
assent to this view, but he has prepared a Bill to provide for the compulsory notification of consumption,
which he hopes to carry during the present Session.
In England the opinion that in order to be effective, notification of consumption must be compulsory,
seems to be gathering force. The Conference of delegates of the Metropolitan Sanitary
Authorities, held at the County Hall, in July, 1904, passed a resolution in favour of compulsory
notification, as did the representatives of the Borough Councils at the conference convened by the
Paddington Council, and held in June last. This view, however, is not yet accepted by the Local
Government Board, who some time since, in response to an application from the Barnstable 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.
It will be interesting to see in what manner the Chief Secretary deals with the question in his
promised Bill; it will probably be by special legislation, as the Local Government Board for Ireland
suggest, and on the lines adopted by Parliament in giving compulsory notification power in The
Sheffield Corporation Act 1903, Section 45 (s.s. 5) of which reads as follows :—
" No provisions contained in any general or local Act of Parliament relating to infectious disease
shall apply to Tuberculosis of the lung or proceedings relating thereto under this Section."
With regard to this Act, which appears to be giving satisfaction, it may be interesting to state,
briefly, the " method adopted in working the Section," as described in a communication with which
I was favoured some time since by the Medical O fficer of Health of the City of Sheffield, as
follows—
" Two special inspectors are employed to visit houses where cases of consumption are notified. The
inspector leaves a copy of instructions with the relatives, or with the patient. He also advises patients