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11.
The first is the need of compulsory notification. That need was endorsed by the
Conference by a majority of nearly two to one, but unfortunately the Local Government Board
has yet to be convinced. The Scotch Board on the other hand, has urged the adoption of
compulsory notification, and the Irish Board has at the present time a Bill before Parliament
to make notification compulsory throughout that country. Notification alone, however, is
useless, and it is the difficulty of deciding what action should follow thereon which appears
to make the Local Government Board hesitate to take any steps to promote compulsory
notification.
Having regard to the differences between phthisis and those other infectious diseases
(commonly known as "specific fevers" or "zymotic diseases" which are already notifiable,
it is evident that the preventive measures prescribed against the latter cannot be applied
indiscriminately against the former. I think that the spread of tubercular phthisis can be
checked most successfully by (a) education of the patient and his relatives, on the infective
nature of the disease; (b) provision of sanatoria and hospitals, the former for hopeful, the latter
for hopeless cases; and (c) legislation to require disinfection from time to time and (to a very
limited extent) removal to hospital of patients whose home surroundings render the spread of
the disease almost inevitable. Notification should also be used as a means for searching out
early cases of the disease. Many relatives of patients whose cases have been notified have
been found (e.g. by the Edinburgh Tuberculosis Dispensary Staff) to be affected with the
disease, the existence of which they were quite ignorant. Early diagnosis affords such
persons their best chance of recovery. (It cannot be too strongly stated that the disease is
readily curable if taken in hand in its early stages).
The "campaign" indicated above is one in which municipal action requires the
co-operation of philanthropic agencies and of the public itself. The Health Society through
its Phthisis Committee is rendering valuable assistance by supplementing the work of the
Department. The establishment of a "tuberculosis dispensary" in the Borough, working on
lines closely following those of the Edinburgh Dispensary which has been so successful during
the past twenty years, should prove a notable addition to the existing agencies for coping
with the disease. The provision of hospitals (or infirmaries) for hopeless cases may be said
to fall naturally within the province of the municipality, but sanatoria should be largely the
charge of philanthropic agencies. It is a matter for great regret that the Trade Unions have
not initiated insurance of their members against sickness and incapacity, following with
suitable modifications the German system which, while securing the insurees against
pauperism, has provided a large amount of accommodation in sanatoria, &c., together with
maintenance of the patient's dependents during his stay therein.
In this country reliance has mainly been placed, up to the present time, on general
sanitary (municipal) work and independent uncorrellated philanthropic (hospital) efforts.
There is good reason to believe that the maximum results of such procedure have been
attained and that to further reduce "consumption" fresh measures duly co-ordinated are
necessary. This view is, to a certain extent, confirmed by the experience based on the results
of work directed to reduce the rate of infantile mortality.
Until the close of the last century no special efforts were made to limit the mortality
of infants which remained equal to, and at times exceeded, that of the earliest days of
"sanitary control," although the general death rate had fallen greatly. With the beginning
of this century a change was made. For several years past writers and speakers who have
studied the question, have invited attention to the continuous decline in the birth-rate, and
the consequent decrease in the rate of growth of the Nation. The general public can now