700 PROCEEDINGS OF SECTION I. 



by consumptive persons, and periodically of conveyances and public 

 buildings where a large number of people are accustomed to assemble, 

 improvement of the dwellings of the working classes ; the provision 

 of open-air schools, reserves, parks and playgrounds ; the frequent 

 and close inspection of dairies and slaughter-houses, and the com- 

 pulsory application of the tuberculin test to all dairy cattle, and 

 the destruction of those found to be tubercular with compensation 

 to the owner ; the establishment of tuberculosis dispensaries, of 

 sanatoria and hospitals for advanced and incurable cases, of farm 

 colonies for the reception of those in whom the disease has been 

 arrested in the sanatorium, and the consolidation of their cure ; the 

 establishment of a fund for the support of the families of bread- 

 winners who are under treatment in the sanatorium or hospital ; 

 and, finally, making provision for the education of the people by 

 leaflets, by popular lectures, and especially by travelling tuber- 

 culosis exhibitions. 



On two of these State measures of prevention I must say a few 

 words. The first is compulsory notification, wliich should be 

 made applicable to the whole State. There are still a few educated 

 people who oppose compulsory notification, mainly on the ground 

 that it is unnecessary and that its operation is harsh and cruel. 

 The answer to the first objection is that without compulsory notifi- 

 cation it is practically impossible to discover a large number of the 

 most advanced, and therefore most infectious, cases of pulmonary 

 tuberculosis. Further, that by notification many early " contact " 

 cases are found, and being treated may be prevented from passing 

 into the advanced stages, and so becoming new centres of infection. 

 Again, and this I think should be a convincing answer to the state- 

 ment that compulsory notification is unnecessary, the International 

 Tuberculosis Congress, which met in Washington in 1908, composed 

 of experts in the study of tuberculosis from all parts of the world, 

 unanimously resolved that compulsory notification is a necessary 

 factor in the crusade against that disease. 



In answer to the second objection raised to compulsory notifi- 

 cation, namely, that its operation is harsh and cruel, it should be 

 sufficient to point out that in 55 large cities in the United States, 

 including New York, where the law has been in operation for 13 

 years, in Denmark, in Sheffield and Bolton, in Edinburgh and 

 Glasgow, and in the city of Sydney, the report is that the 

 Compulsory Notification Acts have worked smoothly and without 

 complaint. Even where the law provides for the compulsory 

 removal of a consumptive who will not or can not take proper 

 precautions, the patients, although objecting at first, have after- 

 wards, finding themselves in clean and healthy surroundings 

 and provided with abundant nourishment, expressed their satis- . 

 faction. I freely admit, however, that wherever notification 

 is made compulsory it is the bounden duty of the State 

 to ]:)rovide sanatoria and hospitals for the reception and free 

 treatment of those who may be unable to carry out a proper system 

 of treatment in their own homes. In connection with this subject 



