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Proceedings of the Midland Branch of the incorporated society of medical officers of health
PROCEEDINGS
OF
THE
practice in respect of this matter, a n d t h a t t h e y b e e m p o w e r e d to e x p e n d a m o d e r a t e s u m out of our f u n d s in prosecuting such inquiry. I t h i n k it would be of a d v a n t a g e if we c o u l d in s o m e way or o t h e r b r i n g to t h e n o t i c e of t h e whole b o d y of t h e orofession t h e i m p o r t a n c e of clearly defining d e a t h s d u e to diarrhoea in t h e i r certificates of t h e cause o f d e a t h s o c c u r r i n g in their practices, a n d o f a d h e r i n g to t h e t e r m s o f t h e a b o v e - q u o t e d i n s t r u c t i o n s of t h e R e g i s t r a r General, or, b e t t e r still, to t h e n o m e n c l a t u r e o f t h e :Royal College of Physicians. Dr. KEIqWOOD complimented Dr. Ashby on his valuable and useful papers. So far as bringing measles within the scope of the Infectious Diseases Notification Act was concerned he noted that the experience of Reading presented little~ if any~ evidence of the value of the measure. He was satisfied that much more full and prompt information of the existence of measles cases could be obtained through the medium of school attendance if, as was Iris practice, weekly information was obtained as to the absentees from naeasles from all the schools in the sanitary area. In the larger part of his parish he found that it was rarely possible to ensure efficient isolation of t/ze patient at home on account of the inadequate accommodation possessed by the parents and the tender ages of the sufferers, but valuable measures can be taken in the direction of isolating the i~fected house/zold. Almost the whole of the mortality from measles is among the poor, and although he had grown somewhat pessimistic with reference to the adequacy of the existing powers of checking the spread of infection, when a measles epidemic threatened, he thought that the mortality rate could be attacked with success. That was a matter of the education of the public, and he believed that the measure of promptty distributing handbills of advice and caution along infected streets did good in this respect. During a recent severe epidemic in Stoke Newington he had secured the services of an army pensioner, who distributed such handbills at almost every house ill the southern division of the parish (population, 2I,OOo) in three days. He agreed with. Dr. Ashby's remarks as to the value of school closure, and he believed that frequently some good would result therefrom even in large communities, if it were enforced early, for a period of at least one month, and if the measure was extended to the infant departments of all the schools (day and Sunday) in the district. Dr. SKINNER thought that the ordinary notification of measles was not of much practical use, but that early information of cases might be obtained by rendering it compulsory on the district medical officer to notify measles, whooping cough, and chicken-pox to the medical officer of health occurring among the poor in his district, l i e might be expected to have as early information of the occurrence of either as anyone, and by notifying it the medical officer of health would be informed, of it earlier than if he waited for the return from the Board of Guardians. Dr. TEw said that he was very glad to hear the remarks made by Dr. Ashby respecting the classification of diarrheeal diseases, which at the present time was most unsatisfactory. When such an important item in vital statistics as the zymotic death-rate was involved, it was specially necessary to eliminate error, and this could only be done by endeavouring to insist on the use of definite terms in the nomenclature of diarrhceal diseases in death certificates, and by following out these ten:as in classification. He was strongly in favour of any measures which the Branch might adopt with the object of obtaing more uniformity in the use of the term "diarrhoea." In some cases the term was used merely as a symptom while in others it signified a zymotic disease. It was important for obtaining accurate statistics to distinguish between these meanings. During the same loealised epidemic one medical man signed certificates as "diarrhc0a,"
MIDLAND
BRANCH.
295
and another as "enteritis " and '~ gastro-enteritis " with the occasional addition of " marasmus," " debility," etc., until it became in some cases little more than a matter of chance under which heading the deaths were placed. I t was p r o p o s e d by Dr. A s h b y , a n d s e c o n d e d by Dr. Skinner, " T h a t a c o m m i t t e e b e formed, consisting of t h r e e m e m b e r s of t h e B r a n c h , for t h e p u r p o s e of t a k i n g steps t o p r o m o t e u n i f o r m i t y in classification of diarrhoea deaths, a n d t h a t they b e e m p o w e r e d to e x p e n d a s u m n o t e x c e e d i n g five p o u n d s o u t of t h e f u n d s of the B r a n c h . " T h i s was carried u n a n i m o u s l y . I t was t h e n p r o p o s e d by Dr. T h r e s h , a n d s e c o n d e d by Dr. K e n w o o d , t h a t the P r e s i d e n t , T r e a s u r e r , a n d Secretary d o form t h e said committee. T h i s was carried u n a n i m o u s l y . A vote o f t h a n k s to Dr. A s h b y for his interesting papers was p r o p o s e d by Dr. Seaton, s e c o n d e d by Dr. T h r e s h , a n d c a r r i e d unanimously.
PROCEEDINGS OF THE MIDLAND BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. THE quarterly m e e t i n g o f the B r a n c h was h e l d at the Birmingham Council House on Thursday, April 2xst, Dr. R i d l e y Bailey ( P r e s i d e n t ) in t h e Chair. T h e r e were p r e s e n t Drs. A. Hill, B o s t o c k Hill, R e i d , F o s b r o k e , Clarke, Malet, Millard, R i c h a r d s , R o b i n s o n , R i c h m o n d , Snell, T n b b T h o m a s , U n d e r h i l l , R e a d , Barwise, a n d Biggam. T h e P r e s i d e n t apologised for t h e a b s e n c e of t h e H o n . Secretary (Dr. H . M a n l e y ) . A letter was r e a d from the H o n . Secretary of t h e Society, calling a t t e n t i o n to the fact t h a t the A n n u a l P r o v i n c i a l M e e t i n g of t h e Society would b e h e l d at E d i n b u r g h o n July 27th, d u r i n g t h e M e e t i n g o f t h e British M e d i c a l A s s o c i a t i o n , a n d t h e P r e s i d e n t expressed t h e h o p e t h a t as m a n y as possible would a t t e n d . A letter was r e a d from t h e Secretary o f t h e Sanitary Institute, stating t h a t t h e I n s t i t u t e h a d a c c e p t e d t h e i n v i t a t i o n of t h e L o r d M a y o r a n d t h e City C o u n c i l of B i r m i n g h a m , to h o l d t h e C o n g r e s s in B i r m i n g h a m this year, a n d a s k i n g t h e B r a n c h to a p p o i n t Delegates to attend. T h e P r e s i d e n t a n d t h e P r e s i d e n t - e l e c t (Dr. M a l e t ) were a p p o i n t e d . A f u r t h e r letter was read expressing t h a n k s of t h e I n s t i t u t e for t h e cordial w e l c o m e t h e M e m b e r s of the Branch had accorded them on their approaching visit to B i r m i n g h a m . T h e M e e t i n g t h e n p r o c e e d e d to c o n s i d e r t h e circular issued by the Society w i t h r e g a r d to t h e Notification of I n f e c t i o u s Diseases, t a k i n g t h e clauses seriatim. T h e first, " S h o u l d t h e A c t b e m a d e u n i v e r s a l ? " was u n a n i m o u s l y a n s w e r e d i n t h e affirmative w i t h o u t any discussion. D e a l i n g with t h e first p o r t i o n of t h e s e c o n d
296
PROCEEDINGS
OF THE
clause, " Is it desirable to amend the list of notifiable diseases," (a) " b y omission ? " Dr. Malet thought erysipelas might with advantage be omitted, and proposed a resolution to this effect. Dr. trosbrooke seconded, and it was unanimously agreed to. T h e second part of the clause dealt with the question of amending the list " b y addition," and it was unanimously decided that no additions were necessary. Consideration was then directed to sub-clause (c) of clause 2, which was as follows : - (c) I n connection with the proposed notification ot Measles, is it desirable to restrict compulsory certification by the Medical Practitioner to the first case occurring in a house during each epidemic, the obligation on the part of the householder to notify each successive case being enforced ? Dr. BOSTOeK HILL remarked that it had been proposed to notify measles, but he suggested that it was most objectionable and not o f the slightest use in urban, quasi-urban, or rural districts. At first when only a few cases occurred, it seemed to have a good effect and the inspectorshad time to get ready, but directly it became epidemic, no staff in theworldcould doanything. They obtained practical information of an outbreak by the failing off in the school attendance, and thus obviated an enormous and useless expenditure. H e had that day signed a bill for one practitioner f o r ~ i 5 tbr the notification of measles alone during the last few months. Dr. FOSBROOr:Eagreedwith theseremarks, adding that at first he was an advocate of measles being included, but he had now changed his opinion. Dr. RoBnqso~I thought the first case should be notified by the practitioner, and every first case after 28 days, the other cases being notified by the householder. I t was of great advantage to have cases notified when people went from one district to another free from measles. H e expressed the opinion that Sunday-schools were a great medium for carrying infection. Dr. THOMAS thought they wanted to get information of cases early. The first he obtained was that children were absent from school, but they ought to know before this. H e thought the information might be given by the teachers. Dr. ALFRED HILL said in Birmingham they had the co-operation of the school masters and mistresses. Dr. BOSTOCK HILL moved " t h a t the notification of measles in any form is undesirable." Dr. MALET seconded. Dr. ROBINSON moved an amendment " t h a t the first case be notified, and every fresh case occurring after 28 days, the parents or householders being compelled to notify all others." Dr. BARWISlgthought the notification was not of much use unless they could isolate the cases. Dr. HILL remarked that expenses of isolation would be too great.
MIDLAND
BRANCH.
Dr. THOMAS seconded the amendment, which, however, was lost, and the resolution was carried by I2 to 2. Sub-clause (d) of the second clause which was as follows, was then dealt with. (d) Is it desirable to arrange for a weekly notification by Practitioners, as in European countries, of such diseases as Erysipelas, Phthisis, and Pneum o n i a ; notification to be restricted to new cases occurring during the week ? This question was answered in the negative, the first words being made to read " i t is undesirable at the present time," etc., the opinion being expressed that any unnecessary extension of the act must influence its compulsory enforcement. I n dealing with the third clause, " I s any alteration of fee desirable ? " Dr. TrtOMAS expressed the opinion that Poor Law Medical Officers should be paid the same as other practitioners. Dr. BOSTOCK HILL thought it useless to seek to increase the fee. Dr. THOMAS suggested that the fee should be uniform and proposed a resolution that it should be uniformly 2s. 6d. Dr. BARWlS~. seconded, and the motion was carried by I~ to 5. Consideration was then directed to Clause 4 : Are further certificates n e e d e d - e.g. (a) O f freedom from infection ? (b) In connection with Elementary Schools ? (c) To County Councils at regular intervals ? Dr. BOSTOCK HILL moved, " That it is desirable that a certificate of freedom be obtained from a medical p r a c t i t i o n e r ? ' Dr. ALFRED HILL seconded. Dr. BAI~WlSEthought they would get certificates long before the case was free from infection. Dr. MALET suggested that the resolution should read, " T h a t it be compulsory upon the householdeL when a case of infectious disease is treated at home, to supply a certificate before the patient goes from home." Unless they did this he thought it would be a very difficult thing to prevent people getting about. Dr. ALFRED HILL did not think the time limit would make the case safer, I n Birmingham a certificate was not allowed to be acted upon unless the hous~ was disinfected. Dr. READ said in all cases kept at home he had a certificate sent him stating that the patient was free from infection. Dr. MALET moved, " T h a t it is desirable to have a certificate from the householder stating that the patient is free from infection." This Was seconded and carried, J I voting for it and 5 for the original resolution. With regard to sub-clause (b) Dr. REID said the
P R O C E E D I N G S OF T H E Education Department had flamed certain certificates to be used in this case, but there was nothing to compel a medical officer of health to sign it, and he knew some cases where t h e y refused because they were not paid for it. It was eventually decided that this clause was not definite enough to pass an opinion upon, and it was unanimously decided that sub-clause (e) was quite unnecessary. Clause 5, "Should dual notification be enforced?" was unanimously answered in the affirmative, and Clause 6, " I n prosecutions for non-notification should ignorance be accepted as a sufficient plea ? " was then discussed. Dr. BAl~WlS~ contended that this was not a question for medical men to decide, it was a question of evidence and law and only the magistrates could decide it. Dr. THOMAS said the law laid it down that ignorance was not an excuse. Dr. MALET remarked that in many cases of scarlet fever no medical man was called in, in order that the parent might escape the Act. When summoned the parents said they did not know it was scarlet fever and the Wolverhampton magistrates refused to convict. H e had seen children ,~n the streets of Wolverhampton in the peeling ~tage and had summoned the parents, but the magistrates had refused to convict. Dr. BARWlSE moved that it was a question for the legal authorities to decide. O n Dr. Barwise's proposition being seconded, Dr. MALET moved as an amendment that "culpable ignorance or negligence should not be accepted as a sufficient plea." This was seconded, and Dr. BAP,WlSE then withdrew his proposal. Dr. Malet's proposal was unanimously carried. With regard to Clause 7, "Should Notifications Forms be postally prepaid ?" i i voted in favour of the postage being' paid by the practitioner certifying, and 5 in favour of it being paid by the sanitary authority. " T h i s is a question for the legal authorities," was the answer decided upon in reply to Clause 8, ~' Is the penalty on conviction adequate ?" Clause 9 read " I n many cases multiple reports o f the same case had been received on the same day ; Is it desirable to a m e n d t h e clause requiring notification of the case by every medical man called in to see it ? If so, how ?" Dr. THOMASsaid he knew of instances of two or three practitioners regularly notifying the same case. In one instance three partners and one assistant notified the same case. Dr. BOSTOCK HILL, speaking from the public health point of view, thought it was undesirable to alter the present form. Dr. MALET mentioned a case attended by two doctors. The second did not notify the case
NORTHERN
BRANCH.
297
because he thought the first had done so, while the latter thought the second would. Unless they could get a clause to prevent such an occurrence, they had better not interfere with it at all. Dr. BARWISE moved, "that one fee shall be paid in reference to one case, and that to the first practitioner sending in the first certificate." It was a very serious matter to have two or three practitioners notifying the same case. It was one of the reasons why one of his councils did not adopt the Act. Eventually the PRESIDENTmoved that the query be answered as follows : "Yes, if it be possible so to amend the Act as to ensure a thorough and adequate notification of each case." Dr. BARWISE seconded, and the motion was unanimously agreed to. Only the first part of the ioth clause--" Is membranous croup a ' dangerous infectious disorder' or necessarily of a diphtheritic nature ? " - - w a s answered, the reply being, "Yes, and should be notified." The Vaccination Bill was briefly discussed, and the opinion expressed that the whole administration of the Act should be entrusted to sanitary authorities rather than to the guardians, and that there should be some clause in the Bill for the enforcement of re-vaccination after 14 years. It was pointed out that the British Medical Association, the Incorporated Society of Medical Officers of Health, and the Sanitary Institute, were arranging for a joint deputation to await upon Mr. Chaplin, and that the whole question had been considered by these various organizations. PROCEEDINGS OF T H E NORTHERN B R A N C H OF T H E INCORPORATED SOCIETY OF MEDICAL O F F I C E R S OF HEALTH. A MEETING of this Branch was held on April 29th at Newcastle-upon-Tyne. There were present Drs. Armstrong, Hembrough, Home, Fisher, Clayton, Jackson, Green, Turnbull, Taylor, Boustead, and Scurfield. The Memorandum ~: sentout by the Council as to proposed amendments in the Infectious Diseases (Notification) Act was discussed. The Branch determined to r e c o m m e n d (l) That the Act be made universal. (2) That erysipelas be omitted from the schedule of diseases. (3) That no diseases be added to the schedule. (4) That it would be advantageous to have stated on the certificate the address of the notifier and the age of the person notified. ( ~ That the maximum penalty be increased to 5 * See PuzLIC HEALTH x. I97 (March, 1898).
OF
THE
practice in respect of this matter, a n d t h a t t h e y b e e m p o w e r e d to e x p e n d a m o d e r a t e s u m out of our f u n d s in prosecuting such inquiry. I t h i n k it would be of a d v a n t a g e if we c o u l d in s o m e way or o t h e r b r i n g to t h e n o t i c e of t h e whole b o d y of t h e orofession t h e i m p o r t a n c e of clearly defining d e a t h s d u e to diarrhoea in t h e i r certificates of t h e cause o f d e a t h s o c c u r r i n g in their practices, a n d o f a d h e r i n g to t h e t e r m s o f t h e a b o v e - q u o t e d i n s t r u c t i o n s of t h e R e g i s t r a r General, or, b e t t e r still, to t h e n o m e n c l a t u r e o f t h e :Royal College of Physicians. Dr. KEIqWOOD complimented Dr. Ashby on his valuable and useful papers. So far as bringing measles within the scope of the Infectious Diseases Notification Act was concerned he noted that the experience of Reading presented little~ if any~ evidence of the value of the measure. He was satisfied that much more full and prompt information of the existence of measles cases could be obtained through the medium of school attendance if, as was Iris practice, weekly information was obtained as to the absentees from naeasles from all the schools in the sanitary area. In the larger part of his parish he found that it was rarely possible to ensure efficient isolation of t/ze patient at home on account of the inadequate accommodation possessed by the parents and the tender ages of the sufferers, but valuable measures can be taken in the direction of isolating the i~fected house/zold. Almost the whole of the mortality from measles is among the poor, and although he had grown somewhat pessimistic with reference to the adequacy of the existing powers of checking the spread of infection, when a measles epidemic threatened, he thought that the mortality rate could be attacked with success. That was a matter of the education of the public, and he believed that the measure of promptty distributing handbills of advice and caution along infected streets did good in this respect. During a recent severe epidemic in Stoke Newington he had secured the services of an army pensioner, who distributed such handbills at almost every house ill the southern division of the parish (population, 2I,OOo) in three days. He agreed with. Dr. Ashby's remarks as to the value of school closure, and he believed that frequently some good would result therefrom even in large communities, if it were enforced early, for a period of at least one month, and if the measure was extended to the infant departments of all the schools (day and Sunday) in the district. Dr. SKINNER thought that the ordinary notification of measles was not of much practical use, but that early information of cases might be obtained by rendering it compulsory on the district medical officer to notify measles, whooping cough, and chicken-pox to the medical officer of health occurring among the poor in his district, l i e might be expected to have as early information of the occurrence of either as anyone, and by notifying it the medical officer of health would be informed, of it earlier than if he waited for the return from the Board of Guardians. Dr. TEw said that he was very glad to hear the remarks made by Dr. Ashby respecting the classification of diarrheeal diseases, which at the present time was most unsatisfactory. When such an important item in vital statistics as the zymotic death-rate was involved, it was specially necessary to eliminate error, and this could only be done by endeavouring to insist on the use of definite terms in the nomenclature of diarrhceal diseases in death certificates, and by following out these ten:as in classification. He was strongly in favour of any measures which the Branch might adopt with the object of obtaing more uniformity in the use of the term "diarrhoea." In some cases the term was used merely as a symptom while in others it signified a zymotic disease. It was important for obtaining accurate statistics to distinguish between these meanings. During the same loealised epidemic one medical man signed certificates as "diarrhc0a,"
MIDLAND
BRANCH.
295
and another as "enteritis " and '~ gastro-enteritis " with the occasional addition of " marasmus," " debility," etc., until it became in some cases little more than a matter of chance under which heading the deaths were placed. I t was p r o p o s e d by Dr. A s h b y , a n d s e c o n d e d by Dr. Skinner, " T h a t a c o m m i t t e e b e formed, consisting of t h r e e m e m b e r s of t h e B r a n c h , for t h e p u r p o s e of t a k i n g steps t o p r o m o t e u n i f o r m i t y in classification of diarrhoea deaths, a n d t h a t they b e e m p o w e r e d to e x p e n d a s u m n o t e x c e e d i n g five p o u n d s o u t of t h e f u n d s of the B r a n c h . " T h i s was carried u n a n i m o u s l y . I t was t h e n p r o p o s e d by Dr. T h r e s h , a n d s e c o n d e d by Dr. K e n w o o d , t h a t the P r e s i d e n t , T r e a s u r e r , a n d Secretary d o form t h e said committee. T h i s was carried u n a n i m o u s l y . A vote o f t h a n k s to Dr. A s h b y for his interesting papers was p r o p o s e d by Dr. Seaton, s e c o n d e d by Dr. T h r e s h , a n d c a r r i e d unanimously.
PROCEEDINGS OF THE MIDLAND BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. THE quarterly m e e t i n g o f the B r a n c h was h e l d at the Birmingham Council House on Thursday, April 2xst, Dr. R i d l e y Bailey ( P r e s i d e n t ) in t h e Chair. T h e r e were p r e s e n t Drs. A. Hill, B o s t o c k Hill, R e i d , F o s b r o k e , Clarke, Malet, Millard, R i c h a r d s , R o b i n s o n , R i c h m o n d , Snell, T n b b T h o m a s , U n d e r h i l l , R e a d , Barwise, a n d Biggam. T h e P r e s i d e n t apologised for t h e a b s e n c e of t h e H o n . Secretary (Dr. H . M a n l e y ) . A letter was r e a d from the H o n . Secretary of t h e Society, calling a t t e n t i o n to the fact t h a t the A n n u a l P r o v i n c i a l M e e t i n g of t h e Society would b e h e l d at E d i n b u r g h o n July 27th, d u r i n g t h e M e e t i n g o f t h e British M e d i c a l A s s o c i a t i o n , a n d t h e P r e s i d e n t expressed t h e h o p e t h a t as m a n y as possible would a t t e n d . A letter was r e a d from t h e Secretary o f t h e Sanitary Institute, stating t h a t t h e I n s t i t u t e h a d a c c e p t e d t h e i n v i t a t i o n of t h e L o r d M a y o r a n d t h e City C o u n c i l of B i r m i n g h a m , to h o l d t h e C o n g r e s s in B i r m i n g h a m this year, a n d a s k i n g t h e B r a n c h to a p p o i n t Delegates to attend. T h e P r e s i d e n t a n d t h e P r e s i d e n t - e l e c t (Dr. M a l e t ) were a p p o i n t e d . A f u r t h e r letter was read expressing t h a n k s of t h e I n s t i t u t e for t h e cordial w e l c o m e t h e M e m b e r s of the Branch had accorded them on their approaching visit to B i r m i n g h a m . T h e M e e t i n g t h e n p r o c e e d e d to c o n s i d e r t h e circular issued by the Society w i t h r e g a r d to t h e Notification of I n f e c t i o u s Diseases, t a k i n g t h e clauses seriatim. T h e first, " S h o u l d t h e A c t b e m a d e u n i v e r s a l ? " was u n a n i m o u s l y a n s w e r e d i n t h e affirmative w i t h o u t any discussion. D e a l i n g with t h e first p o r t i o n of t h e s e c o n d
296
PROCEEDINGS
OF THE
clause, " Is it desirable to amend the list of notifiable diseases," (a) " b y omission ? " Dr. Malet thought erysipelas might with advantage be omitted, and proposed a resolution to this effect. Dr. trosbrooke seconded, and it was unanimously agreed to. T h e second part of the clause dealt with the question of amending the list " b y addition," and it was unanimously decided that no additions were necessary. Consideration was then directed to sub-clause (c) of clause 2, which was as follows : - (c) I n connection with the proposed notification ot Measles, is it desirable to restrict compulsory certification by the Medical Practitioner to the first case occurring in a house during each epidemic, the obligation on the part of the householder to notify each successive case being enforced ? Dr. BOSTOeK HILL remarked that it had been proposed to notify measles, but he suggested that it was most objectionable and not o f the slightest use in urban, quasi-urban, or rural districts. At first when only a few cases occurred, it seemed to have a good effect and the inspectorshad time to get ready, but directly it became epidemic, no staff in theworldcould doanything. They obtained practical information of an outbreak by the failing off in the school attendance, and thus obviated an enormous and useless expenditure. H e had that day signed a bill for one practitioner f o r ~ i 5 tbr the notification of measles alone during the last few months. Dr. FOSBROOr:Eagreedwith theseremarks, adding that at first he was an advocate of measles being included, but he had now changed his opinion. Dr. RoBnqso~I thought the first case should be notified by the practitioner, and every first case after 28 days, the other cases being notified by the householder. I t was of great advantage to have cases notified when people went from one district to another free from measles. H e expressed the opinion that Sunday-schools were a great medium for carrying infection. Dr. THOMAS thought they wanted to get information of cases early. The first he obtained was that children were absent from school, but they ought to know before this. H e thought the information might be given by the teachers. Dr. ALFRED HILL said in Birmingham they had the co-operation of the school masters and mistresses. Dr. BOSTOCK HILL moved " t h a t the notification of measles in any form is undesirable." Dr. MALET seconded. Dr. ROBINSON moved an amendment " t h a t the first case be notified, and every fresh case occurring after 28 days, the parents or householders being compelled to notify all others." Dr. BARWISlgthought the notification was not of much use unless they could isolate the cases. Dr. HILL remarked that expenses of isolation would be too great.
MIDLAND
BRANCH.
Dr. THOMAS seconded the amendment, which, however, was lost, and the resolution was carried by I2 to 2. Sub-clause (d) of the second clause which was as follows, was then dealt with. (d) Is it desirable to arrange for a weekly notification by Practitioners, as in European countries, of such diseases as Erysipelas, Phthisis, and Pneum o n i a ; notification to be restricted to new cases occurring during the week ? This question was answered in the negative, the first words being made to read " i t is undesirable at the present time," etc., the opinion being expressed that any unnecessary extension of the act must influence its compulsory enforcement. I n dealing with the third clause, " I s any alteration of fee desirable ? " Dr. TrtOMAS expressed the opinion that Poor Law Medical Officers should be paid the same as other practitioners. Dr. BOSTOCK HILL thought it useless to seek to increase the fee. Dr. THOMAS suggested that the fee should be uniform and proposed a resolution that it should be uniformly 2s. 6d. Dr. BARWlS~. seconded, and the motion was carried by I~ to 5. Consideration was then directed to Clause 4 : Are further certificates n e e d e d - e.g. (a) O f freedom from infection ? (b) In connection with Elementary Schools ? (c) To County Councils at regular intervals ? Dr. BOSTOCK HILL moved, " That it is desirable that a certificate of freedom be obtained from a medical p r a c t i t i o n e r ? ' Dr. ALFRED HILL seconded. Dr. BAI~WlSEthought they would get certificates long before the case was free from infection. Dr. MALET suggested that the resolution should read, " T h a t it be compulsory upon the householdeL when a case of infectious disease is treated at home, to supply a certificate before the patient goes from home." Unless they did this he thought it would be a very difficult thing to prevent people getting about. Dr. ALFRED HILL did not think the time limit would make the case safer, I n Birmingham a certificate was not allowed to be acted upon unless the hous~ was disinfected. Dr. READ said in all cases kept at home he had a certificate sent him stating that the patient was free from infection. Dr. MALET moved, " T h a t it is desirable to have a certificate from the householder stating that the patient is free from infection." This Was seconded and carried, J I voting for it and 5 for the original resolution. With regard to sub-clause (b) Dr. REID said the
P R O C E E D I N G S OF T H E Education Department had flamed certain certificates to be used in this case, but there was nothing to compel a medical officer of health to sign it, and he knew some cases where t h e y refused because they were not paid for it. It was eventually decided that this clause was not definite enough to pass an opinion upon, and it was unanimously decided that sub-clause (e) was quite unnecessary. Clause 5, "Should dual notification be enforced?" was unanimously answered in the affirmative, and Clause 6, " I n prosecutions for non-notification should ignorance be accepted as a sufficient plea ? " was then discussed. Dr. BAl~WlS~ contended that this was not a question for medical men to decide, it was a question of evidence and law and only the magistrates could decide it. Dr. THOMAS said the law laid it down that ignorance was not an excuse. Dr. MALET remarked that in many cases of scarlet fever no medical man was called in, in order that the parent might escape the Act. When summoned the parents said they did not know it was scarlet fever and the Wolverhampton magistrates refused to convict. H e had seen children ,~n the streets of Wolverhampton in the peeling ~tage and had summoned the parents, but the magistrates had refused to convict. Dr. BARWlSE moved that it was a question for the legal authorities to decide. O n Dr. Barwise's proposition being seconded, Dr. MALET moved as an amendment that "culpable ignorance or negligence should not be accepted as a sufficient plea." This was seconded, and Dr. BAP,WlSE then withdrew his proposal. Dr. Malet's proposal was unanimously carried. With regard to Clause 7, "Should Notifications Forms be postally prepaid ?" i i voted in favour of the postage being' paid by the practitioner certifying, and 5 in favour of it being paid by the sanitary authority. " T h i s is a question for the legal authorities," was the answer decided upon in reply to Clause 8, ~' Is the penalty on conviction adequate ?" Clause 9 read " I n many cases multiple reports o f the same case had been received on the same day ; Is it desirable to a m e n d t h e clause requiring notification of the case by every medical man called in to see it ? If so, how ?" Dr. THOMASsaid he knew of instances of two or three practitioners regularly notifying the same case. In one instance three partners and one assistant notified the same case. Dr. BOSTOCK HILL, speaking from the public health point of view, thought it was undesirable to alter the present form. Dr. MALET mentioned a case attended by two doctors. The second did not notify the case
NORTHERN
BRANCH.
297
because he thought the first had done so, while the latter thought the second would. Unless they could get a clause to prevent such an occurrence, they had better not interfere with it at all. Dr. BARWISE moved, "that one fee shall be paid in reference to one case, and that to the first practitioner sending in the first certificate." It was a very serious matter to have two or three practitioners notifying the same case. It was one of the reasons why one of his councils did not adopt the Act. Eventually the PRESIDENTmoved that the query be answered as follows : "Yes, if it be possible so to amend the Act as to ensure a thorough and adequate notification of each case." Dr. BARWISE seconded, and the motion was unanimously agreed to. Only the first part of the ioth clause--" Is membranous croup a ' dangerous infectious disorder' or necessarily of a diphtheritic nature ? " - - w a s answered, the reply being, "Yes, and should be notified." The Vaccination Bill was briefly discussed, and the opinion expressed that the whole administration of the Act should be entrusted to sanitary authorities rather than to the guardians, and that there should be some clause in the Bill for the enforcement of re-vaccination after 14 years. It was pointed out that the British Medical Association, the Incorporated Society of Medical Officers of Health, and the Sanitary Institute, were arranging for a joint deputation to await upon Mr. Chaplin, and that the whole question had been considered by these various organizations. PROCEEDINGS OF T H E NORTHERN B R A N C H OF T H E INCORPORATED SOCIETY OF MEDICAL O F F I C E R S OF HEALTH. A MEETING of this Branch was held on April 29th at Newcastle-upon-Tyne. There were present Drs. Armstrong, Hembrough, Home, Fisher, Clayton, Jackson, Green, Turnbull, Taylor, Boustead, and Scurfield. The Memorandum ~: sentout by the Council as to proposed amendments in the Infectious Diseases (Notification) Act was discussed. The Branch determined to r e c o m m e n d (l) That the Act be made universal. (2) That erysipelas be omitted from the schedule of diseases. (3) That no diseases be added to the schedule. (4) That it would be advantageous to have stated on the certificate the address of the notifier and the age of the person notified. ( ~ That the maximum penalty be increased to 5 * See PuzLIC HEALTH x. I97 (March, 1898).