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55
The number of certificates received in connection with each class
was:—
159 patients living at home notified voluntarily 164 certificates.
145 patients living at home notified under the
Order 193 „
136 patients living in common lodging-houses, &c.,
notified under the Order 244 „
Eighty-one of the last-named group had one certificate each, 24 were
twice notified, 10 three times, 8 four, 1 five, 2 six, 3 seven and 1 sixteen
times. That means that the patients had been in and out of the
infirmary on a good many occasions. In connection with these only 31
notices were received that they were leaving to come to Westminster,
whereas at least 51 ought to have been received. Probably, an address
in some other borough was given as the intended destination. Information
was received of 13 persons who said they were coming to addresses
in Westminster, but who went to common lodging-houses in other
boroughs. The danger in consumptive persons frequenting common
lodging-houses is considerable, but as they can seldom be traced when
not in the infirmary, it is almost impossible to ensure that any
precautions are taken by them against infection of others.
The Poor Law Commissioners discussed the practicability of
detention of consumptive patients, and in their report express the
opinion that the suggestion is beset with administrative difficulties,
on the grounds that it may be a moot point at what period
of its development phthisis becomes infectious; further, that the
detention would often have to be for a considerable time, and that the
knowledge that detention might be enforced would probably lead to concealment
of the disease, or at least make it less possible to attract
patients for treatment at the earlier and curable stages, and that public
opinion is not likely to sanction such drastic powers of detention as
would be involved in detaining all infectious cases. The majority of
the Commissioners, therefore, think that:—
"Meantime the spread of phthisis must be checked mainly by a
wider diffusion of the knowledge of its dangers and of the means of its
prevention, and by a stimulation of the efforts of the authorities concerned
with its prevention and cure. If, however, anything is to be done
in the direction of detention of phthisis, a beginning might be made,
perhaps, with advanced cases, in which, first, the medical officer pronounced
the patient in such a condition as to be likely to communicate
the disease, and, secondly, the home conditions of the patient are such
as to lead with practical certainty to the spread of the disease."
About a dozen men of those notified might have been detained in
the infirmary with considerable advantage to the community. The