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consumption of tobacco in recent years has been accompanied by an
increase in cancer of the mouth and tongue, but this theory takes
no account of the fact that the consumption of alcohol has decreased
almost to a greater degree. The arguments as to the use
of alcohol and tobacco as a cause rather seem to be mutually
destructive.
The new regulations which provided for the notification of all
forms of tuberculosis, pulmonary and otherwise, came into force on
February 1st, 1913. The order imposes several important new
duties on the Medical Officer of Health, some clerical and some
inspectorial; for instance, he, or an officer approved by him, is
bound to make any enquiries he may think necessary as to the
source of infection, and the taking of such steps as may be desirable
for the prevention of infection. This seems to be a duty which can
most appropriately be carried out by the Medical Officer of Health
himself, for there are occasions in which difficulties may daily arise in
the course of the enquiry which could hardly be dealt with by any
one but a medical man. Not only this, the investigation occasionally
leads to the exposure of old family sores which the persons
concerned would fain hide, if not forget.
The seamy side of life is often revealed where one least expects
to find it. The investigations by any one but the Medical Officer
himself seems therefore especally inadvisable, for it must in that
case of necessity involve a less amount of secrecy. I have, therefore,
perhaps to the detriment of other duties, taken this matter in
hand myself.
There is also not infrequently an objection to the enquiry
apparently on the ground that the information may in some way
be used to the detriment of the informer, and it takes some tact to
allay the anxiety and obtain the information. Resentment is also
sometimes shown at so many enquiries in respect to the patient,
and I have myself at a first visit been asked, "How many more
people are coming to ask about this person?" The enquiry was,
however, made in rather more forcible terms.
The deaths from pulmonary tuberculosis for the year numbered
303, that is 30 less than last year, while there was one death less
than in 1912 from other forms of tuberculosis. One would have
hoped that in view of the especial measures that have been put
into practice, the provision of sanatoria, the establishment of
dispensaries with officers specially trained in tuberculosis work, &c.,
that a greater decrease in the mortality would have taken place.
In order to explain this disappointing result it has been argued that,
owing to the increased attention now given to suspected cases of
tuberculosis, deaths are certified as due to this disease that were
formerly assigned to other causes; the decrease therefore of phthisis
is more real than it appears. A theory like this must obviously cut
both ways, for increased attention need not always have a result of
certifying consumption, but might cause its elimination from the
diagnosis. Nevertheless, the theory, even from the statistical aspect,
is a disquieting one, for it necessarily throws a doubt on the value