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From this it will be seen that the actual number of people in the
district who have been notified as suffering from tuberculosis, and who
have not reached that stage of cure which enables their names to be removed
from the register, has grown quite markedly.
This total number of cases on the register is relatively higher than
that for the country as a whole, in keeping with the notification rate
being higher than the national rate, and is a reversal of the satisfactory
state which obtained in the earlier years of the life of this Council.
By contrast the death rate is lower. For the years 1934-38 the
average number of deaths from tuberculosis of those living in Harrow
was 81 ; for the years 1940-44 it was 105 ; and for 1945-49 it was 83.
For the year 1947, the death rate from tuberculosis per 1,000 population in
Harrow was 0-353 ; the corresponding figure for the country as a whole
was 0-547.
That the position of Harrow in this respect is so much more favourable
than that for the country as a whole, is only in keeping with the
general vital statistics, and in keeping, too, with the general feeling that
the circumstances of the district are probably more favourable than the
average of the country. On the other hand there is no gainsaying the
marked increase in the number of notifications and the increase in the
numbers of names on the register. To some extent these are attributable
to the new cases amongst the population moving into the district. This
factor, however, accounts for only part of the increase. Is there any
explanation which could account for an increase in notifications but,
because the death rates are so low, is not dependent on an actual increase
in the incidence of disease. A marked improvement in the diagnosis
of the disease and in the notifications of those diagnosed would provide
such an explanation. It might be well that this is the case. The tuberculosis
service for the district was extended markedly since the middle
1930's. This is reflected in many ways. The facilities at the chest
clinic have been improved and diagnosis has been made easier. In
addition much more is now being done in the way of examining contacts
of diagnosed cases. Mass radiography leads to the detection of cases
amongst members of the population who did not consider themselves to
be suffering from any complaint. Mass radiography, too, has considerably
lightened the work of the examination of contacts other than home contacts,
such as school children. The chest clinic now means more to
the general public. A third way in which the effects are manifest is
that the general medical practitioners more freely refer their patients
for consultation, a step which results in earlier diagnosis and notification.
If this is the explanation then it means not that there are more cases