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53
The primary object in requiring notification is to enable the local authority
to assist in the eradication of the disease.
It is worthy of note that the death-rate from pulmonary tuberculosis,
though still far higher than that resulting from any other disease to which
the principle of notification has hitherto been applied, has, nevertheless,
shown a marked decline in the last thirty years. In 1881 the death-rate per
10,000 of the population was 18.25, in 1891 it was 15.99, in 1901 it was
12.64, and in 1909 it was 10.93. This decrease has coincided with a marked
increase in the activities of local authorities, including greatly improved
sanitary administration and the treatment of the sick under more satisfactory
conditions. It is impossible to estimate precisely the influence of these causes
on the diminution of the death-rate, but there can be no doubt that they have
been powerful factors in bringing about the reduction.
With regard to the statutory powers of the Council, the Board point out
that in certain cases it is no doubt desirable that the local authority should be
able to offer sanatorium treatment, and for this the powers of the Public
Health (London) Act, 1891, are available. Under these powers local authorities
may either themselves provide sanatoria or may contract for the use of such
institutions.
The Board have been advised that these powers also enable a local authority
to provide or contract for the use of dispensaries or out-patient hospitals.
Treatment in an institution is not, however, always necessary or desirable,
and there are many cases which, under suitable instruction and supervision, may
properly be treated in the patients' own homes.
Accordingly the Board have, by the Order, given a general power to the local
authority, on the advice of their Medical Officer of Health, to supply such medical
assistance, facilities and articles as may be necessary for detecting pulmonary
tuberculosis, for preventing the spread of' infection and for removing conditionsfavourable
to infection. The local authority are also empowered to appoint any
necessary additional officers.
Tn considering in what ways they can best aid in the control, treatment, and
prevention of pulmonary tuberculosis, the Board suggest that local authorities
should carefully take account of existing agencies.
Apart from the actual treatment of cases, the Board urge on local authorities
the great importance of their making full use of their powers of preventing
overcrowding, and of securing the removal of any conditions tending to injure
the health of persons residing in their districts.
As to the position of persons notified, the term "notification" has been
associated in many minds with certain disabilities and discomforts which would
involve no hardship to an adult suffering from an attack of an acute infectious
disease, such as typhoid fever, but which would be intolerable, in many instances,
to phthisical patients. Tuberculosis of the lung is usually a chronic disease
which may permit the patient during many months, or even years, to pursue
his ordinary work. The ability to convey infection is limited and intermittent,
and infection can be prevented by the patient himself, when he has learnt, and