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Notification: To voluntary notification the objection raised is the infringement
of professional confidence between patient and medical attendant; but in the
interests of the patient and the family and Mends that cannot be advanced
against a second proposition, (2) that the expectoration of a person su ffering from
a pulmonary disorder suspected to be tuberculous should be examined bacteriologically
at public or private expense. To obligatory notification the objection made is
that the intervention of the sanitary authority is likely to be of a kind to raise
the opposition of both patient and medical attendant. On the other hand, the
obligation exonerates the medical attendant from exceeding his duty, and may
be so framed as to avoid interfering between doctor and patient in the words
of a third proposition, (3) that it is desirable that cases in which tubercle bacilli is
found in the sputum upon bacteriological examination should be notified under
statutory obligation, and the precautions required should be prescribed by the
registered medical practitioner in attendance.
Disinfection: Upon the foregoing follows a fourth proposition, (4) that, after
removal, on account of change of residence, or of entry into a sanatorium, hospital,
or home, or of death, the medical attendant should require the sanitary authority to
disinfect the room previously occupied by the pjtient.
Sanatoria: In regard to the treatment of expectorating pulmonary tuberculosis
away from home, there are three classes of cases to be provided for—
incipient, pronounced, and advanced cases. This means— for the incipient cases,
sanatoria proper, for the pronounced cases consumption hospitals, and for the
advanced cases homes for incurable consumptives or homes for the dying. The
provision may be made either in separate institutions or within the precincts of
the same institution in separate structures, as is now being done in connection
with some workhouse infirmaries. In the homes of the poorest the advanced
cases are by far the most dangerous, the pronounced are intermediate, and for
the incipient cases sanatoria afford the most promising and permanent results.
In addition, it would also be desirable, in connection with sanatoria to enlist
the co-operation of local dispensaries and medical institutions in discovering
cases of threatening or suspected consumption in order that the benefits of
existing charities and convalescent homes may be extended to them so as
to render the sickly more resistant to the disease, and to re-establish their
health. Whilst this is relieving the pressure upon sanatoria at one end
at the other end it would be necessary to organise a system of directing
those discharged from sanatoria and convalescent homes to such forms of
occupation in the open air as would prevent recurrence of the disease and
conduce to the maintenance of bodily health. The last-mentioned - namely,
the organisation of the provision of suitable occupations for patients on
leaving—is yet to be realised, but may best be undertaken in conjunction
with sanatoria as well as the co-operation of dispensaries and other medical
institutions in selecting patients most fit for admission. At present the only
resort for advanced cases of incurable consumption amongst the poorest is the
workhouse infirmary, and no doubt special separate provision would, sooner or
later, be provided for them in all these institutions, as they would not willingly
be admitted to sanatoria, where the period of residence will doubtless be
restricted. The sanatorium is being regarded more and more as a place where
for a limited period the consumptive may be cared for with a view to isolation,
regimen, and education. The isolation will be temporary until the education
is complete as to the necessary methods of personal hygiene requisite to prevent
communicating the disease to others, and the regimen will be devised to endow