As time went on it became clear that registration of deaths gave a very imperfect view of the prevalence of disease, and that so far as infectious diseases were concerned, valuable time was lost when preventive action could only be taken after the patient’s death. Death registration told of the total wrecks which had occurred during the storm; it gave no information as to early mishaps, enabling others to trim their vessels and thus weather through. It gave a list of killed in battle, not of the wounded also.
And so began gradually, in characteristic British fashion, the notification of infectious cases, the list of notifiable diseases being extended from time to time.
From 1911 onwards the Local Government Board prepared a weekly statement of infectious cases notified in each sanitary area which was distributed to every medical officer of health. Similar returns of exotic diseases of interest to port medical officers were distributed; and the successive annual summaries prepared in the Medical Department of the Local Government Board showing the incidence of the chief epidemic diseases in every area now constitute one of the most valuable epidemiological records extant.
Collaterally with the notification of infectious diseases, including tuberculosis, to the medical officer of health, occurred the enforcement of notification of various industrial diseases occurring in factories, such as anthrax, lead and arsenic poisoning, to the Chief Inspector of Factories, Home Office.
Conditions of Medical Practice Bearing on Public Health
It cannot be claimed that notification of acute infectious diseases, still less of tuberculosis, has been complete. It is impossible to discuss the reasons for this in the present address (see Lecture IX); but the present conditions of medical practice are largely responsible for the partial lack of success. Hasty conditions of work, failure to employ laboratory means of diagnosis, or to utilise available consultation facilities (especially in tuberculosis), and lack of training of medical practitioners in preventive medicine, are among the obstacles to further control of disease.
There will not be complete success until means are discovered for training and enlisting every medical practitioner as a medical officer of health in the circle of his private or public practice, and of securing his services not only in the early and prompt detection of disease, but also in the systematic supervision during health of the families under his care, and in advising them as to habits or methods of life which are inimical to health.
Poor Law v. Public Health
An approximation to this ideal was in the minds of the early sanitary reformers; and it was one of the misfortunes associated with the deterrent policy of poor-law administration in medical relief, that separation between Poor Law and Public Health appeared to offer the best prospect of sanitary progress.
Had Simon’s advice been followed, when the Local Government Board was about to take over the public health duties of the Privy Council, the poor-law organization might, and probably would gradually, have been permeated by public health activities, and thus the sanitary welfare of the poorest class of the community would have been more completely safeguarded on its personal as well as on its environmental side.