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war against Tuberculosis. The main cause of this probably is, that the
Medical attendant fears that his patient will be annoyed, and will dispense
with his services, if he brings him (the patient) into contact with the Sanitary
Authority. He fears that the patient will leave him for another medical man,
who possibly has the reputation of never notifying such cases. The result is,
that the cases notified are those of persons in very poor circumstances, and
those who are nearly moribund.
Many Metropolitan Boroughs have adopted voluntary notification for
several years, but at the present time, one only supports beds (two in number)
in a country sanatorium for the benefit of the inhabitants within its confines.
Despite the enthusiasm with which the subject has been kindled in the lay
press, and despite the whole-hearted and persistent endeavours of the various
Sanitary authorities, there is no room for doubt that voluntary notification has
been an utter failure. Indeed, many of the authorities frankly acknowledge
this.
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Take two of the Metropolitan Boroughs as examples: The first has a
population of 74.000, with a death-rate of 168 per 1,000. The number of
deaths from Phthisis was 124, but the number of notifications received was 16.
In this particular Borough no double notifications are acknowledged. Allowing
that there are five persons suffering from the disease for every one death, we
have a percentage of 2.2 actually notified. Of the number of persons that die
from Phthisis 13 per cent. only had been previously notified.
Take another Borough, with a population of 100,000, with a death-rate
from Phthisis of 1.17 per 1,000. In this Borough double notifications are
received. The number of deaths was 121, but the number of notifications,
including secondary notifications, was 93. Including the secondary notifications
as equivalent to fresh cases, and making no allowance for this, 75 per
cent. of the deaths had been previously notified. This is assuming, of course,
that none but the fatal cases were notified. This particular Borough is a very
poor one, and the inhabitants are very unlikely to show their resentment.
Moreover, it is probable, that owing to the cheapness of the fees charged
for medical advice, some of the notifications were sent in twice, tnree, or
even four times. In these poor localities, when a man is notified as suffering
from any infection, which is said to be infectious, and attended by notification,
nothing is commoner, than, that he should resort to other practitioners, in order
that he may have what he considers to be a stigma—removed. Furthermore,