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(3). " We think that every person suffering from an infectious disease, or
those in charge of him, or, if these neglect their duty, the occupier of the house
in which the sick person is residing, or if he is a pauper, his medical attendant,
should be required by law to notify the nature of the disease to the medical officer,
of health so soon as they or any of them are aware of it; and that, in the case
of non-paupers, the medical attendant should, if it is inexpedient to impose any
further obligation on him, be similarly required by law to furnish the sick person,
or those in charge of him, with a certificate of the nature of the disease, in the
form which we have already suggested, to be by them communicated to the
medical officer of health. On every certificate so communicated a small fee
should be paid to the medical man who signed it.
(4). " If the medical officer after receiving such a certificate is satisfied that
the patient can and will be properly isolated, and requisite means of disinfection
adopted, the matter will proceed no further.
(5). " If he is not so satisfied, and if the sick person is not too ill to be
removed, he will notify the case to the Metropolitan Asylums Board ; who will
thereupon be at once and entirely charged with the patient till his complete
recovery, and, in particular, will be empowered to remove him at once to one of
their hospitals. So far no distinction should be made between paupers and nonpaupers
who cannot be isolated. But within the hospital those who are desirous
of being placed in separate wards should be allowed such accommodation on
paying for it. In case of ordinary accommodation, it appears to us a question
whether payment should be claimed even from those who can make payment
without difficulty.
(6). " If the sick person cannot be removed or isolated by those about him,
the medical officer will be bound to take all necessary steps for his isolation, and
generally for the protection of the neighbourhood, with power to clear the house
of its inmates. In all cases he will be bound to disinfect the house, and in the
case of houses invaded by small-pox, should be empowered to require the revaccination
of all occupants who are not otherwise protected.
(7). " We are led by the concurrent evidence of several experienced witnesses
to hope that the immediate and complete isolation which ought to be secured by
these means will greatly diminish the amount of small-pox, scarlet fever, and
typhus in London. With regard to these, and also to typhoid, still further
diminution may be anticipated if the attention of the proper authorities is
directed to the removal of all local causes of disease, and to the constant employment
of means of disinfection. And we feel bound to repeat our conviction that
small-pox would be still further reduced if vaccination could be made more
effectual and re-vaccination more frequent. But in what follows we take little or
no account of these reductions. How far our recommendations will, from this
cause, be in excess of what is eventually found necessary is a mere matter of
conjecture. We hope they may prove considerably so. Meantime this uncertainty
is a reason for proceeding somewhat tentatively.