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48
with regard to keeping the windows open as much as possible, and furnishes the poorer of the patients
with pocket spittoons, free of charge. On his first visit he gets all the particulars and history of the case,
and pays subsequent visits as often as possible. In all cases when the house is dirty, or the patient is
much confined to the house by his illness, the room is disinfected forthwith by the inspector with a
formalin sprayer."
This is precisely the " method " adopted in working the system of voluntary notification of
phthisis, which has been in operation in the Royal Borough since January 1st, 1902. But as regards
disinfection, we have no compulsory powers, such as the Section confers upon the Sheffield sanitary
authority; and whereas in that City a very large proportion of cases of the disease come to
the knowledge of the Medical Officer of Health, I estimate that in Kensington about one fourth
only of the total number of cases are notified to me; and these, with a few exceptions, by the
Poor-Law Medical Officers, the sufferers being persons in receipt of relief.
With regard to the success of the system as compared with our system of voluntary notification
(dealt with at page 49) it appears that at Sheffield, in a period of 3£ years ended 30th April,
1907, there were 1,773 deaths from " tuberculosis of the lung," the " number of persons who died
from this cause without being notified" being 121, or a little over seven per cent.; whereas in
Kensington, in the same period of time, the deaths having been 734, the number of persons who died
from tuberculosis of the lung, without being notified was 387—in round figures, 53 per cent.; i.e.,
nearly eight times as large a proportion as in Sheffield. The Medical Officer has " no doubt there
has been some little failure to notify on the part of the medical practitioners; " but this is " only
what one would expect with a new Act." There is, moreover, a " small percentage of cases—about
one or two per cent.—where the medical man does not wish the inspector to call [at the house of
the patient], in which case the medical attendant is asked to fill in [an] enclosed form and to use a
copy of [an] enclosed leaflet entitled ' Advice with regard to Consumption.' "
We are told that " there has been no opposition on the part of the public, or the medical
practitioners: the provisions of the Act are being carried out without friction," and the Medical
Officer is of " opinion that the work is doing a considerable amount of good." As to isolation, it
appears that " each of the Boards of Guardians provide accommodation for a certain amount of
open-air treatment at the workhouse-hospitals," and there is no doubt that a considerable number
of the advanced cases are thus isolated," whilst it has been " decided to use a pavilion in one of the
City hospitals for infectious diseases for a similar purpose." Amongst the documents forwarded,
was a letter addressed by the Medical Officer to medical practitioners which may be cited, as
indicative, inter alia, of the considerate method adopted in execution of the exceptional powers
conferred upon the Corporation.
"The voluntary notification of tuberculosis [it is stated] had been extremely satisfactory," [so far as
it went ] and " one of the most important reasons for seeking compulsory powers .... was to do
away with any risk to the profession who, in voluntarily notifying such cases might be considered to be
betraying a professional secret." It is noted that " great care has been taken in keeping all the requirements
relating to [consumption] quite separate from those contained in the general Acts relating to other
infectious diseases; " the object of the Corporation being to " prevent at any time injustice being done
to a large number of persons suffering from tuberculosis who daily follow their employment, or of
necessity must take open air exercise." Under the heading ' Special Cases,' the Medical Officer says
" there will probably be a few cases where the medical practitioner desires to look after the preventive
measures to be adopted by his patient. In such cases a statement to this effect should be made at the
time of notifying, and an undertaking given that the practitioner will see that the required preventive
measures are carried out, and will report on their fulfilment at least twice in every year ....
If these conditions be fulfilled no visits will be made to the patient's house by any member of the staff
of the Health Department"; and, finally, "in order that citizens may know of the obligations cast on
medical practitioners, public notice [was] given of this by advertisement in the newspapers, and by handbills
and otherwise in the City."
Worked in so considerate a manner, it is no wonder that " the provisions of the Act are being
carried out smoothly and without friction."
The subjoined tabular statement will be perused with interest.