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54
the list of conditions notifiable by one regulation or another is as long as
the original list of diseases set out in the Notification Act, most of which
now appear in the Public Health Act, 1936, as the notifiable diseases.
Each of the earlier of the notifiable diseases was a clinical entity, caused
by closely related if not the same organisms. But some of the conditions
which are now notifiable, although they may be communicable, are not so.
Ophthalmia neonatorum is the reaction of an infant's eye to one of a
variety of organisms; while the fever which occurs in a recently confined
woman and is notifiable as puerperal pyrexia, might be due to a very
wide range of causes, some having nothing to do with pregnancy, delivery
or the puerperium.
In the case of most of these conditions that are notifiable, there are
certain common factors. The condition is usually sufficiently serious for
it to be desirable that steps should be taken to control it; and in most
cases some steps can be taken that might enable some control to be
exercised. Most but not all of the notifiable diseases possess these
features, though some diseases which are notifiable to-day are notifiable
not because of the severity of the disease to-day as that it was a danger
in past years. Where the clinical type has changed and the general
condition is so very different to-day from what it was before, there is the
question of whether any good purpose is now served by such a disease
remaining in the list of those to be notified. At one time, a patient had
to be considered to be suffering from one of the notifiable diseases before
he could be admitted to an isolation hospital; but to-day that is not the
case to the same extent so that is not a point in favour of the retention
of a disease on the list.
What might be done to limit the spread of infection varies with the
disease and is not the same, even in different cases of the one disease.
Notification is the means by which the health department gets to know
of the case of infection and is the starting point of certain enquiries which
are made in all cases. These enquiries are directed to two ends. On the
one hand, they aim at obtaining information which will indicate the
source from which the patient contracted his infection; if this is established,
steps can be taken to prevent others contracting infection from
the same source. The other line of enquiry is to determine those with
whom the patient might have been in contact and who therefore might be
carriers of the infection. The activities of some of these might have to
be controlled for a period until they can be felt to be no longer a risk of
spread of infection.
As to the detection of the source of infection, difficulties arise in
either extreme. If there is, as is so often the case, only the single case of
enteric infection, it is virtually impossible to trace the origin, though
laboratory investigations may now result, at a later stage, in the case
being linked with others. On the other hand, when during a measles
outbreak one to two per thousand of the population might be falling ill
each week for a number of weeks, there is little need to spend time in
tracing the origin. In point of fact, measles which is now generally
notifiable, has been made so not because of any steps which can be taken
to control it, but primarily for statistical purposes.