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18
COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES.
To the Sanitary Committee.
29th December, 1887.
Gentlemen:
The extreme desirability of registration of all cases of the more serious infectious
diseases is now generally acknowledged, and has on various occasions been advocated
by us, At present we are dependent for information chiefly on the death-returns
and poor-law returns, which represent only a minority of the cases, and only reach
us after sufficient time has elapsed to allow of free spread of the infection.
The Voluntary notification of cases by medical practitioners on payment of a fee,
which has been tried in a few places, is at best imperfect, and nothing short of compulsory
notification seems fully to meet the requirements of the case.
The chief advantages of compulsory notification are—
(1.) The early isolation and separation of infectious cases. Perhaps no better
instances of the great value of compulsory notification in this respect can be found than
by a comparison of Metropolitan with Provincial mortality from Small Pox. According
to Dr. Seaton the average mortality in London from Small Pox during the last
6 years, is 26 per 100,000 of the population, while in Leicester it is only about 1 in
100,000. Leicester forms a very striking example of the advantages of notification
combined with an admirable sanitary organization.
(2.) Early notification limits the centres of infection by enabling the sanitary
officials to prevent the mixing of 'suspects' who have been exposed to infection
with others; and in case of Small Pox by enabling vaccination (at Leicester) to be
performed on all who have been exposed.
(3.) Certain collateral advantages are secured. When cases of Diphtheria or
Enteric Fever are notified, the sanitary condition of the house is examined, and the
milk and water supplies are investigated. The influence of the inspector in impressing
on Householders the importance and necessity of long continued isolation
requires also to be mentioned.
It should be clearly understood that notification is but a means to an end.
Unless information of cases is followed by efficient isolation, it can do but little good.
Hence the necessity for further powers enabling the Sanitary Authority to compulsorily
remove the infectious patients to hospital, where there are no means of isolation
at home. It would appear that bee. 26 of the Sanitary Act, 1866, does not give
this power.
The appended table (see end of report) represents the experience of 44 towns in
which compulsory notification is in force, representing altogether more than one-eighth
of the whole extra-metropolitan population. It will be seen (a) that in but one instance
(Greenock) is it made compulsory on the householder only to notify the existence
of infectious disease, when a practitioner is in attendance : (£) that in 9 towns (Aberdeen,
Ashton-under-Lyne, Dewsbury, Edinburgh, Hartlepool, Manchester, Norwich,
Preston, Rotherham) it is compulsory on the practitioner in attendance only ;
though in some of these, if no practitioner is in attendance, the compulsory duty falls
on the householder; (c) while in 34 towns what is known as the Dual system is adopted,
the duty of notification being compulsory on both householder and practitioner.
The remarks made by Medical Officers of Health for these 44 towns on the relative
merits of the various systems of notification, (in answer to a special circular
sent round by us, which contained the queries at the head of the appended table), are
suggestive and useful; but we do not think it necessary in this stage of the
discussion to recommend any one system of notification, only emphasising our unanimous
opinion that the entire onus of notification shall not fall on the practitioner,
but rather on the head of the household. We may add that the Local Government