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30
A comparison of the population, and the Phthisis death-rate, makes it at
once obvious that in many of these Boroughs, the number of cases notified, is
exceeded by the number of deaths from Phthisis; and, therefore, much more
so by the number of those afflicted with the malady. In other words, the number
of cases notified, is but a small fraction of the cases actually suffering.
Overlapping of Notifications.
Four boroughs report in the negative. Of the rest, some authorities pay
for a second notification of the same case after the lapse of a certain period.
By this means they retain a hold on the patient's address, and new place of
abode—if removal has ensued,—and are thereby enabled to offer disinfection
and other sanitary measures to the owner of the premises vacated.
Others do not accept a second notification, and one accepts and pays for
such second notification, when a change of address has occurred.
Secondary notification is chiefly found among the poorer classes, who
have no fixed " family physician." Finding no relief from their sufferings at
the hands of one practitioner, they consult another, the small fee charged for
advice encouraging the practice. When for any reason, such, as, for example—
removal to an infirmary—the patient is removed from his last address, a
second notification is valuable, as it enables the premises to be disinfected
before the entry of the incoming tenant.
Friction.
Nine boroughs answer negatively; one has no information on
this head, and two authorities state that very few better class cases are notified.
It is in these latter cases that friction is most likely to arise, for the poor, who
have learnt to regard the sanitary authorities and their officials with awe and
discrimination, are apt to regard notifications of this kind as something " to
do with the law," and accept such as inevitable. Its evasion is thought to be
fraught with the infliction of heavy penalties.
Generally speaking, therefore, there may be said to be no evidence of
friction apparent, for, on the one hand, those cases which would give rise to
it, are not notified; whereas, on the other, those cases which are notified are
those of patients which, by environment and circumstances are not disposed to
complain of it. The foregoing refers to friction between patients and sanitary
authorities.