COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES. 
833 
On the other hand, some contend that it is the medical attendant 
who should be compelled to notify. Then there are the two phases of the 
dual method — (r/) that the local authority should be informed by both 
the householder and the medical attendant ; and ( b ) that it should be 
compulsory on the medical man to inform the head of the household 
in writing as to the infectious character of the disease, which informa- 
tion the householder should be bound under a penalty to transmit to 
the local authority. The question is a nice one; there is no doubt 
that the medical man is the best qualified to give the information from 
his knowledge of the case and of the surroundings, but the house- 
holder must not be exempted, for the reasons already stated. In most 
case s where the dual system obtains the local authorities, recognising 
the additional responsibility thrown on the medical man, give a small 
bonus for each case notified: at one time 5s. in Birmingham, 2s. 6d. 
in Edinburgh and other places; now 2s. 6d. and Is. for cases reported 
from hospitals. There is also a penalty of 10s, in case of neglect. 
This helps to make the registration more complete, and is therefore 
desirable. At a meeting of the Society of Medical Officers of Health, 
held in December, 1875, it was unanimously resolved that — 
1. Infectious disease ought to be reported by the ho us holder to 
the sanitary authority without delay. 
2. Every medical man attending a case of infectious disease 
should give immediate information respecting its nature to 
the occupier or other person responsible for reporting to 
the sanitary authority. 
Since that date it has been found in practice that the notice must 
come from the medical man. In one town only has notification by 
the householder been tried — viz., Greenock ; and, as might be expected, 
the results are very unsatisfactory, as only something over 50 percent, 
of the cases came to the knowledge of the sanitary authorities ; but 
even under these circumstances the death-rate of the town diminished 
progressively and considerably. It is therefore clear that with a more 
complete system a proportionately greater advantage would be gained. 
Dr. Wallace, Medical Officer of Health for Greenock, concludes a 
valuable and interesting report by expressing a fear that “ no further 
material improvement will take place from notification by the house- 
holder.” 
Notification by the medical attendant has been opposed by some 
on the ground that it is a betrayal of that confidence which is necessary 
between doctor and patient. Such might be the case if there were no 
compulsory law requiring it; if the object were to injure instead of 
benefit the patient and the community, and if all medical men were 
not placed under the same obligation to notify. When, further, it is 
the rule of the householder as well as the doctor to notify, the former 
can have no possible ground of complaint in that direction. Salus 
populi suprema lex. 
Dp to 1886 thirty-eight of the largest towns in Great Britain 
adopted compulsory notification, and of these thirty-four had adopted 
direct notification by the medical man, while thirty of these required 
notification also from the occupier; in three of them only did it rest 
with the medical man to notify indirectly or to the occupier, so that 
the dual system was by far the most in favour. It is the one recom- 
mended by the Local Government Board in 1878, and by the Select 
