THE NEW HYGIENIC LAW.
ON and after October .30th, fathers of families through- out the Metropolis will find themselves, in regard. to the health of their households, under a new series of statutory obligations. Up till now, the man whose wife or children or servants caught scarlet fever, small-pox, diptheria, or any other infectious disease, had nothing to do but to call in such medical aid. as he might think necessary, and to take or not take the precautions recom- mended to him. If the head of the house was of a secre- tive nature, or had any reason for concealing the fact that a member of his family was - ill, he was under no sort of compulsion to communicate the circumstance—except, indeed, in such few places as had obtained local Acts similar to that which is now made compulsory for London and permissive for the rest of the Kingdom at the discre- tion of the Local Authorities. Such concealment will, therefore, in less than six weeks' time be no longer possible within the Metropolitan area, and. the officers of each sanitary district will have to be informed whenever an outbreak of an infectious nature takes place in a house over which they have jurisdiction. Under the new Act every head of a family, or, in default, e nearest relative of the patient, or in default of him or her,- every person in attendance on the patient, and. finally, in default of any one better qualified, the occupier. of the house must, as regards all infectious forms of sickness, as soon as he is aware of their presence, send. a notice or certificate to the Medical Officer of Health of the district. Nor are the obligations imposed. by the Statute ex- hausted by this provision. Every medical practitioner called in to visit the patient, is also required to forthwith send a notification of the case to the same quarter, stating therein the name of the person affected, the nature of the disease, and the situation of the building. The machinery by which the Act is to be enforced, though by no means drastic, will probably be found sufficient for the purpose. Persons who fail to send in the required. certificates will be liable, on summary conviction, to a fine not exceeding 40s., unless the accused was only obliged to send in a certificate in default of some other person. In that case, and if he can prove that he had reasonable cause to suppose that the notice had been duly given, the fine is not to be enforced. Such are the main requirements of the new Act. Except for clauses making a letter sent by the Post a sufficient notice, applying the Statute to all kinds of human habitations, such as boats, tents, vans, and sheds, and defining the meaning of the word "occupier," there is little else contained in it which need claim the attention of the British paterfamtilitte. All he is required to bear in mind is the fact that directly the family doctor pronounces any severe illness to be infectious, he must communicate the fact to the local medical officer. But though the carrying out of such a process sounds simple enough to write about, we expect that a great many householders will at first sight regard. the provisions of the Act as ex- ceedingly oppressive. How aru I to send to the Medical Officer of Health of the district the ordinary head. of the middle-class family will exclaim. I have no more idea where he lives or who he is. than the man in the moon. Indeed, I had never even heard of the existence of such a person till this moment. Surely it is most unfair to add to the complications and woeeies that beset a man when one of his children or servapts gets scarlet fever. It is difficult enough as it is to be regular at the office when there is illness in the house, but if in addition one has to go on a wild goose chase after some obscure official it is positive torture !' No doubt, painted thus, the outlook before the head of an infected household. looks gloomy enough, and, no doubt also, it is perfectly true that no one short of a Vestry Clerk could tell, off hand, the name of the medical officer of his district. This difficulty, however, will soon be got over. Since the doctors will be obliged to send in certificates, they will of necessity know the names and addresses of the medical officers. When, then, the family doctor announces to the perturbed parent that Tommy or Mary has picked up scarlatina at the seaside, he will hand him, as a matter of course, a certificate-form, and will furnish him at the same time with the necessary particulars as to how and where the notice is to be sent in. Armed with this, the head of the house will have no further trouble except to drop the paper into the post-box, for appearance in person is in no way required. by the Act.
But though An practice the new Statute is not likely to give any reap annoyance to the householders, it may be asked what Wood service is it likely to render to the com- munity? People may perhaps be inclined to argue that the mere notification of disease will do nothing to check its ravages, and to contend that the fact that the Medical Officer of Health in a certain district knows that A and. B have cases of typhoid in their houses, will not prevent the spread of the poison to other families, or in any way limit the range of its operations. Such arguments, however, though apparently reasonable, are, in reality, fallacious. For the work of stopping infection, nothing is more im- portant than a full knowledge of the facts. In the case of anything like an epidemic, the first question the doctors ask is, What is the cause of the outbreak ? If that can be ascertained, it may prove possible to stop the in- fection at the fountain-head. But the true source of an epidemic can only be inferred from an accurate know- ledge of all the circumstances. To put the matter .in a concrete form, let us suppose that there is an outbreak of typhoid in a particular London district. If the ex- perts can feel certain that they know all the houses in which the fever is present, and so can accurately localise the outbreak, they may proceed to investigate the cause with the assurance that they are at least not arguing on an insufficient basis. For instance, let us assume that they find that all the houses affected communicate with one and the same sewer, but that above and below two distinct places on its course there is no typhoid. Under such circumstances there is a very strong inference that something has gone wreng between the points indicated. The value of such an inference depends however entirely upon whether or not all the cases that- have occurred have been reported, for unless this has been done, there is no possibility of accurately determining the area of the epidemic. In the same way, in cases where milk or water is suspected of being the cause of disease, accurate information may turn mere conjecture into cer- tainty. As an example of how misleading the most taking theories may be when they are based on imperfect knowledge, let us put the following case. A certain dairy is suspected, and it is found that 70 per cent. of its customers are suffering from fever, sore throat, &e. The immediate inference is that the dairy is the source of the sickness. Sup- pose, however, that it can be ascertained from the certificates sent into the medical officer that plenty of other families are suffering from the disease who do not use the suspected dairy. Obviously, then, some other explanation must be adopted to account for the infection, and some other
source of contamination common to all the cases must
be discovered. The notification of infectious diseases will also do a great deal to prevent the spread of sickness in other ways. At present, people often conceal the fact that inmates of their homes are suffering from such com- plaints as scarlet fever, in order to prevent the worry of being shunned in their business pursuits or their social pleasures. To avoid having to give up a dinner-party or to put off a ball, people will often let crowds of guests enter a house which should in reality have been placed in strict quarantine. Under a proper system of notification, such acts of selfish cynicism will be carried out with great risk of detection. Again, if the register of the certificates sent in under the Act is open to public inspection, as it certainly ought to be, a very useful function may be per- formed by the new Statute. When a man takes his amily to the seaside, he is always haunted by the feeling that he may be unconsciously - engaging rooms lately occupied by a person with typhoid or scarlet fever. If the register could be consulted, and the question of a clean or unclean bill of health settled authoritatively, pater and materfamilias would contemplate the prospect of getting holiday quarters with considerably more equa- nimity than they do at present. From whatever point of view it is contemplated, the Act is, in fact, likely to work beneficial results. It will certainly help the doctors and students of zyrnotic diseases, while the injuries that the timid imagine will be inflicted on the householder are, in reality, non-existent. It will be no more difficult to notify an outbreak of infection than to forward the certificate of a baby's vaccination to the proper quarter.
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