832 
PROCEEDINGS OF SECTION I. 
only be secured by State compulsion; thus, in 1883 only 113 out of 
300 practitioners in a large town in England voluntarily notified. 
The voluntary system answers very well in the case of cholera, because, 
the alarm is so great that it is practically compulsory, or, in other 
words, that result is effected by fear which is denied by reason. But 
in the case of a disease of which there is no fear — e.g., scarlet fever, 
though it is a thousand times more destructive to life — the voluntary 
system breaks down altogether. Instead of the medical man reporting 
every ease of preventable disease, he reports only such as be chooses. 
He will report, for instance, the case of a domestic servant whose 
presence in a large and respectable family is considered objectionable, 
and whose removal is therefore to be desired, and she is removed to 
the hospital accordingly ; but the next case lie may for special but 
insufficient reasons omit to notify, although the danger to the public 
may be as great in the one case as in the other. 
Hence notification to be of any real value must not be optional, 
but imperative. Again, it must be immediate. In Birmingham 
where the optional system is in vogue, the health officer reports that 
he frequently receives notification of zymotic diseases after the 
medical man has been in attendance for weeks, and sometimes after 
the death of the patient, although there is a fee of 5s. attached to 
each notification. To expect efficient — that is to say, complete — 
notification by voluntary means is to ignore all past experience. 
The one great objection to notification comes from those who hold 
that the adage “ an Englishman’s house is his castle” overrides even 
the advantages of notification. They object to have their infectious 
diseases brought under the focus of the State lamp. 
The objection bardly requires serious answer. No one lias a 
right to spread infectious disease through the State, however free and 
enlightened the community may be. A man is master of his own 
actions so long as those actions do not jeopardise the safety of his 
fellows; and, as 1 have shown, no system can be effective without being, 
complete, and none complete without State compulsion. 
2. Next comes the important phase of the question, How is the 
system of notification of infectious disease best carried out? Herein 
lies the crux of the whole question. There can be little doubt of the 
utility of the system. There is a good deal of doubt as to where 
responsibility shall lie. The voluntary system has been considered 
and condemned. The compulsory system remains. Is it to be com- 
pulsory on the householder, the medical attendant, or on both ? If 
the responsibility devolves on the householder aloue, complete regis- 
tration can hardly be looked for; want of opportunity, ignorance, and 
poverty will now and again almost compel omission or at least tardy 
notice. A disinclination on the part of the relatives of the sick to 
have a public medical officer thrust iu on the scene, or of having the 
patient sent off to some hospital, with perhaps destruction or damage 
to some of the surroundings of the patient, or the risk of themselves 
being isolated in quarantine, or of injury to business, would assuredly 
prevent complete returns. Still, the householder must not be 
exempted, as from the fear of such consequences as the above lie may 
be loth to send for a medical man at all when there is a suspicion of 
anything infectious. The Act of 1879 is very explicit as to the house- 
holder or person who is responsible (section 55), 
