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7
In some districts its failure seems to be partly due to the requirements of the sanitary authority.
There seems to have been a fear, when voluntary notification was instituted, that non-tuberculous cases
such as bronchitis, or other cases which simulated pulmonary tuberculosis, might be notified as actual
cases of pulmonary tuberculosis. It was apparently to meet this contingency that in certain Boroughs
the rule was made, and still holds good, to accept notification of those cases only in which tbercle bacilli
are demonstrable. While this may make for economy, it is apt to repel knowledge of early cases, and is
contrary to the policy usually pursued in the prevention of infectious disease, viz., to encourage news
being brought of suspicious or threatened cases.
Turning now to a recent step which has been taken by the Local Government Board to improve
the notification of pulmonary tuberculosis, we come to the Order known as the Public Health (Tuberculosis)
Regulations, 1908. These came into force on 1st January, 1909. They provide for the compulsory
notification to the local medical officer of health of all cases of the disease known to the Poor Law.
Notification to that officer is required to be made by medical officers of Poor Law institutions,
and also by superintending officers of institutions in the event of intended change of address of the
patient; in the latter case the notification goes to the medical officer of health of the district to
which the patient is proceeding. Similar notification is required for outdoor cases from the
outdoor officers, namely the district medical officers and relieving officers. One of the first effects of
this Order is to demonstrate the migratory life which is led by some of the Poor Law patients who
suffer from chronic pulmonary tuberculosis. It is common to have numerous notifications relating to
the same case. Thus in respect of one case, in the Borough of Finsbury, there had been received
between the 25th January and the 28th August, 1909, no less than 21 notifications about the same
individual. The details, furnished by courtesy of Dr. A. E. Thomas, the medical officer of health,
are as follow; the last column has been added to show the nature of the patient's movements.
P. W., labourer, suffering from pulmonary tuberculosis.
Reg.
No.
Address.
Notified by.
Date of notification or
discharge.
138
Common lodging house
Medical Officer, Infirmary
Entered infirmary, Jan. 25th, 1909.
196
„ „
Superintending Officer, Infirmary
Left ,, Feb. 6th, ,,
201
„ „
Medical Officer, Workhouse
Entered workhouse, Feb. 9th, ,,
203
„ „
Medical Officer, Infirmary
„ infirmary, Feb. 11th, ,,
268
Private
Superintending Officer, Infirmary
Left „ Mar. 8th, ,,
305
Common lodging house
Medical Officer, Workhouse
Entered workhouse, Mar. 22nd, ,,
307
„ „
Medical Officer, Infirmary
,, infirmary, Mar. 23rd ,,
337
„ „
Superintending Officer, Infirmary
Left ,, Apr. 6th, ,,
347
„ „
Medical Officer, Workhouse
Entered workhouse, Apr. 10th, ,,
355
„ „
Medical Officer, Infirmary
,, infirmary, Apr. 13th, ,,
369
„ „
Superintending Officer, Infirmary
Left ,, Apr. 17th, „
381
„ „
Medical Officer, Workhouse
Entered workhouse, Apr. 19th ,,
553
„ „
„ „
„ ,, June 23rd ,,
571
„ „
Medical Officer, Infirmary
„ infirmary, June 27th, ,,
613
Private
Superintending Officer, Infirmary
Left „ July 15th, ,,
626
Common lodging house
Medical Officer, Workhouse
Entered workhouse, July 20th, ,,
628
„ „
Medical Officer, Infirmary
„ infirmary, July 21st, ,,
649
Private
Superintending Officer, Infirmary
Left „ July 31st, „
655
Common lodging house
Medical Officer, Workhouse
Entered workhouse, Aug. 7th, ,,
653
„ „
Medical Officer, Infirmary
,, infirmary, Aug. 9th, „
713
Private
Superintending Officer, Infirmary
Left „ Aug. 28th, ,,
Of the general effect of the Order it is too early to speak definitely at the time of writing, viz.,
September, 1909. Incidentally it demonstrates, what is alluded to on page 5, that the majority of
voluntary notifications came from Poor Law officers. In the Royal Borough of Kensington, for instance,
in which there were voluntarily notified 229 cases during the year 1908, there were so notified during
the first six months of 1909 no more than six cases; in the same period the Poor Law notifications
numbered 153. This points to the probability that many cases formerly notified in one way, viz., voluntarily,
are now notified in another, viz., under the Tuberculosis Regulations. Regarding the stage
of disease at which Poor Law cases are notified, there is little reason to anticipate that it will be earlier
than under voluntary notification.
In closing these remarks about notification, it may be said that, under the present system, much
information about cases does not come to the knowledge of sanitary authorities or it comes too late; the
system fails to secure that vitally important part of phthisis preventive measures, viz., information of
cases in their earliest stages.
General administrative action comes next to be mentioned. In considering this, it is well
to have in mind an example of the class of case which notification may have brought to light.
Such a one is the following. An itinerant newspaper seller is found to have tuberculous cavities in
his lungs, and well marked cyanosis; his general health is fair, all things considered, and he prefers
to keep on selling newspapers and partially to earn a living. His wife also works; between them they
are able, and prefer to support themselves and two children, who go to school. All live in one room in
very poor circumstances. If such a case is to be effectively dealt with, certain general principles require
attention. First of all there is the infection; as to the actual striking power of such a case there may
be difference of opinion; but there is unanimity about it being diminished by personal cleanliness,