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amount of information concerning some of the persons suffering from
Tuberculosis in the area concerned. By no means all of the Tuberculous
persons in that area are notified, while at the same time a
number of non-tuberculous persons find their way into the register,
and no adequate system of denotification is practised. The number
of non-tuberculous persons notified can never be accurately determined
because the diagnosis is always a matter of opinion, but in
one year, taking into account the history of the patient, and the
result of examination by the Tuberculosis Officer, 71 cases have been
marked for denotification as probably not Tuberculous. Again,
the notification register is inaccurate because of duplicated entries.
In the report of the Medical Officer to the Ministry of Health, 1921,
it is stated that the Ministry receives from County and County
Borough Medical Officers of Health annual summaries showing
duplicate notifications, and hence it is possible to show the actual
number of "new cases"of the disease during the year. But on
investigating the local register, duplicated entries have been found
which were unknown to the Medical Officer of Health. As the
register was not being searched with the object of discovering these
unknown duplicates the actual error has not been determined, but
in the course of looking up 788 entries, 38 duplicates not known to
the Medical Officer of Health were discovered, an error of about 5 per
cent.
This error is in part to be ascribed to the disturbance of routine
work in the office due to the war. Two cases are known in which
deliberate concealment of information was practised by the patient.
Change of name on marriage is also responsible for a portion of the
error. Six of these cases were notified first as Non-Pulmonary, and
later as Pulmonary Tuberculosis. Inaccurate filling up of the
notification form, together with change of address not reported,
accounts for the remaining part of the error. It appears to be
impossible to obtain under the present system an accurate estimate
of the total number of persons actually suffering from Tuberculosis
at any given time in a particular locality. The dispensary service
has been revised and remodelled very largely, and a similar revision
of notification, to bring it into harmony with the dispensary service,