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42
the frequent removals from one house to the other, which is common to this
class, and the absence of definite improvement in the disease, tend to induce
the patient to seek fresh medical aid.
Even in Liverpool, where £160 is paid yearly in notification fees, and
double notification is occasional, the number of notifications do not equal the
number of deaths that occur.
Sheffield affords an instructive example, inasmuch as notification was
voluntary from 1899 to 1903, and was made compulsory in October, 1903.
Sheffield has a population of 440,000, and the annual average death-rate from
Phthisis has been 1.33 per 1,000. When the notification was voluntary, the
average number of notifications received in a year was 216. Since it has been
compulsory, the number has been 760 during the year. Before October, 1903,
15 per cent. of the notifications were second ones of the same case. Since
October, 1903, second notifications are not accepted. The annual number of
deaths was 585. Before compulsory notification came into force, the number
of notifications per annum was less than the number of deaths, and less than
one-third of what they were afterwards. It must be remembered that here,
as in all the other places, notification is restricted to Pulmonary Phthisis, and
the number by no means represents a complete list of those afflicted with
Tubercle in all its forms.
It will, therefore, be seen that the number of notifications received is but a
fraction of the number of the deaths occurring from Pulmonary Phthisis, and
is still a smaller fraction of the cases known to occur and still living.
The benefit that is claimed as the result of voluntary notification is
educational. This has again been mainly the result of residence in a
Sanatorium. A patient when ne resides in a Sanatorium is compelled to do
certain things, and after his return home, he not only adheres to the rules himself,
but he becomes the means of teaching others that come into contact with
him. When we realise that for every death, there are about five others that
suffer from Phthisis in various stages, we have some idea of the number of
Sanatoria that would be necessary for the effectual dealing with even the most
suitable of the 40,000 persons, that suffer from the disease in London alone
Unfortunately, some people rush to the conclusion that the erection of a few
Sanatoria is going to immediately stamp out the disease throughout the
country.