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necessary to know where they are, and to meet this a system of
voluntary notification has been instituted in many provincial towns
and already in several Metropolitan Boroughs—viz., Kensington,
Finsbury, and Stoke Newington.
In Manchester the Medical Officer of Health, referring to the
work done in connection with phthisis, states in bis Annual Report
for 1901 that "There is no department of public health Avork in
which the value of administrative action is so apparent as in this.
It may fairly be said that a considerable degree of success lias
attended our efforts. It is true that only about one-third of all the
cases are known to us and dealt with; but they are cases occurring
in such houses as render them peculiarly dangerous, and our
operations are, therefore, doing a maximum of good. Moreover,
they must profoundly affect the precautions taken by those in better
circumstances."
I am strongly of opinion that the City Council should introduce
a system of voluntary notification in the City. Notification must be
voluntary, and can be given only with the consent of the patient or
those in charge. It should only be of such cases of consumption as
are attended with tuberculous expectoration. The same fee as is
paid for compulsory notification certificates (of fever, &c.) under the
Public Health (London) Act, 1891, would be payable, but only one
certificate in respect of each case would be paid for, except in case
of change of patien0ts' abode.
Following on the notification of the disease in any person, the
house in which he resides would be visited, and inspection of the
premises made. Notes will be taken of any insanitary conditions,
and these will be dealt with under the Public Health Acts.
A printed card would be left at the house with advice on the best
methods of cleansing the rooms and their contents, and instructions
as to precautions to be taken to prevent the spread of disease
through expectorated matter. The careful carrying out of these
rules would greatly benefit the persons suffering, and minimise the
risk of infection to the rest of the family. The disinfection and
cleansing of the rooms occupied by the patient should, at stated
intervals as may be necessary, be carried out by the Sanitary
Authority, or under their supervision, with the consent of the owner,
by methods which have been proved efficacious for the destruction
of the tubercle bacilli. After the death of a patient, or when the
family moves to another house, these measures should be repeated
with the greatest care and thoroughness. When it is thought
necessary the bedding and clothing should be disinfected by
steam.