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32
others. This fact dominates the whole subject of the notification of
the disease, and therefore the matter is dealt with in the following lines
almost entirely in its application to the poorer section of the community.
The better class patients are almost negligible quantities. They
canbeisolated at home under the directions of their medical attendants,
and need not be a source of infection. The subject of the compulsory
notification of the disease is too often discussed by adverse critics
as if it mainly affected the middle and better classes, who, it is alleged,
would resent all our interference. It affects them to a relatively very
small extent, and almost all our action would be taken among the
poorer classes, who have already shown a high appreciation of the
importance of preventive measures.
It is essential not to lose sight of the fact that, although consumption
may be classified as an infectious disease, it differs from all
other dangerous infectious diseases in two respects, which demand
due recognition at the hands of public health administrators. I refer
to the long average duration of the disease and to the facility with
which infection can be limited. If in any scheme of compulsory
notification sufficient allowance is not made for these facts, then I
do not favour the measure, and I am confident that so much opposition
would be met with at the hands of medical practitioners and the
general public that if it were ever adopted, its value would be
much restricted.
In the majority of cases visited I have been able to make suggestions
for improving the existing arrangements and reducing the risk
to others, but it has often happened that a patient in the last stages
of the disease has had to occupy a room shared by several. In these
cases no suggestion which I was able to make could do away with the
enormous risks the other occupants were daily called upon to face.
What is therefore urgently required is that some provision should
exist in each sanitary district in London and elsewhere for the isolation
of those cases which are a source of great danger to others. It
is impossible to get them into the sanatoria for consumption which at