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appreciate the fact that communication on their cases
must be direct between doctors, and that it would not
be to their own advantage if they themselves were to
act as intermediaries. The observance of these and
other similar rules in the past and their continuance
at present has resulted in a cordial co-operation between
the local practitioners and the Tuberculosis Officers,
and I think that one can justifiably claim that the
spirit that obtains in Fulham is one of collaboration
rather than of competition. Practically all the local
doctors realise that we do our best within the limits
and restrictions imposed on us, to assist them in procuring
the earliest diagnosis and the best treatment at
present available in public institutions for their patients.
The number of new cases referred by doctors—
244—is, I think, a testimony to the fact that the dispensary
preserves its position as a unit for consultation.
In this connection one may remark that many who
write on the subject of tuberculosis find themselves at
a loss to account for the fact that the proportion of
early cases submitted for institutional treatment is
comparatively small. This is undoubtedly an unfortunate
fact, but I am convinced that it cannot be used,
as it often is, as an argument for the suggestion that
it implies a general lack of sympathetic working between
Tuberculosis Officers and general practitioners. There
are many reasons which are responsible for late diagnosis,
but it must be admitted that in the great majority
of cases it is not because of failure on the part of the
medical man to detect early signs, but owing to failure
on the part of the patient to present himself till too
late. It is, moreover, a curious psychological phenomenom
that a large number of these persons actually
in their own minds have a strong suspicion that they
are suffering from tuberculosis, but partly from a dread
of having their fears confirmed, and partly owing to
the unhappy social consequences that an unwise propaganda
has led them to expect, they have refrained from
seeking advice earlier.
There remain, of course, a considerable number who,
owing to the insidious onset and course of the disease,