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59
As to the Compulsory Notification.
The experience of St. Paneras during the time that voluntary notification
has been in force appears to coincide with that of nearly all other Authorities
which have adopted the same course. This experience is that voluntary
notification of Consumption is ideal in theory, hut of little value in practice,
because the number of cases notified is very small, and the notifications often
take place when the patients are moribund. The reasons for the unsatisfactory
working of voluntary notification are that the duty of medical practitioners
is first to their patient, and that therefore the desire of the Public Authority
to obtain notification can scarcely weigh with them; furthermore the
experience is that patients suffering from Consumption are so apprehensive and
timid of interference that persuasion will not induce them-to allow their cases
to be notified.
If notification were compulsory, the law would give the Authority no more
power than it has at present under the voluntary system beyond the actual
notification; 110 power to interfere with the doctor or patient as to isolation,
disinfection, or sanitary inspection, without the desire of the patient and the
advice of the medical attendant. The value of compulsory notification would be
this, that practically all the cases of Consumption would come to the knowledge
of the Medical Officer of Health and he would be able to send out to each of
these cases the printed matter which is now sent out under the voluntary
system, and that therefore a very much larger number of afflicted persons would
be made acquainted with the desire of the Authority to help them if they
needed help, and of the methods that could be adopted by them without the
help of the Authority if they desired no official interference; furthermore, a
record of the distribution and localisation of Consumption would be obtained
as a guide to the condition of parts of the Borough.
In Scotland, Pulmonary Phthisis is defined as an infectious disease and all
the powers, in addition to notification, are applicable to it. This, in my
opinion, is undesirable.
I11 Sheffield, by a Local Act, the notification is compulsory, and so also is
disinfection. In London, if the notification clause only were made applicable
to Consumption, as it can be without conferring any other power, in my opinion
it would be even preferable to the method in force ill Sheffield, because it
would leave to the medical attendant, who must know better than anyone else,
the circumstances as to isolation or removal, disinfection or cleansing, and
sanitary inspection or amendment.
All medical practitioners would be placed on the same footing with regard to
each other and with regard to their patients, and all patients would be 011 an
equal basis, and not exposed to interference.
The communication mentioned in the first paragraph of this report as received
from Woolwich, states that the Woolwich Borough Council have asked the
London County Council to take steps to cause Phthisis to be declared a notifiable
disease, and they ask the St. Pancras Borougli Council to take similar
action. The communication from the Finsbury Borough Council does not deal
with the question of notification at all but with the provision of sanatoria and
the isolation of advanced cases of phthisis. The communication from the