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47
average proportion of pulmonary cases of tuberculosis on the
register of local authorities) whereas, in point of fact, the actual
incidence of tuberculosis in that population will have been only
at the rate of, say, one per thousand of its members (this being
the average rate at which persons are formally notified as suffering
from pulmonary tuberculosis). The admission of a few thousand
persons, then, to any area might in this way in a short time be
followed by quite a sharp rise in the notification rate, an increase
which might give rise to illfounded apprehension.
The 53 notifications (31 male and 22 female) of non-pulmonary
cases is also an increase in the number of cases notified last year,
an increase due largely to the greater number of persons, 22 as
compared with 12, who came here already suffering from the
disease. Of the 21 (10 male and 11 female) who contracted infection
while resident here, the affected site in the case of 7 was
either bone or joint, cervical glands of 8, abdominal tuberculosis
4, and genito-urinary 2. Those who transferred here with the
disease showed a much higher rate of cases where the affected site
was bone or joint, namely, 14 out of 22.
In their circular 2362 issued on the 19th May, 1941, the
Ministry of Health deal with the question of the transfer of notificafications
of evacuated persons. The Public Health (Tuberculosis)
Regulations, 1930, require the transfer from the old to the new
area of residence of notifications in respect of tuberculous persons
who have changed their place of residence permanently. In the
Minister's view, evacuation or any other temporary change of
residence as a consequence of the war does not constitute a permanent
change of residence within the meaning of the Regulations,
and notifications in respect of evacuated persons should therefore
not be transferred to the new area of residence. While this line
may be taken with regard to transfers of notifications, an analogous
line as regards to notifications received in the area would not
seem to be practicable. If a patient evacuated to this area is
first diagnosed while living more or less temporarily here, there
could, it seems, be no question as to the obligation on the attendant
practitioner to notify the case to the medical officer of health of
the area, and as long as that patient resided in that area the
notification would not be transferred to the area of the patient's
original home. The attendant physician will not be expected
differentiate between patients who had or who had not been
notified in other areas as suffering from the disease. He will
always be encouraged to notify to the medical officer of health
of the area in which the patient was then resident whether or
not the transfer of the kind referred to in the circular had taken
place. Merely to exclude all notifications relating to evacuees
will not get over the difficulties as in many cases, no doubt, it
will turn out that the evacuees will become permanent residents,
and can it be suggested that a person is still a resident for statistical