View report page

106
signs of disease. In consequence of the advance in radiological
technique and our experience in the interpretation of X-ray films,
it is now possible in nearly all cases to detect tuberculosis in its
early stage. In spite of this, out of 232 new cases notified as
tuberculous during the year, only 92 had early disease, the
remainder being in an advanced or moderately advanced stage.
These figures are rather disquieting and in my opinion are due
to two main causes: (1) The insidious nature of the onset of
tuberculosis in the majority of cases, and (2) the reluctance of
the average man to seek medical advice until his condition is
such that he can no longer carry on with his work. Frequently
we meet cases presenting none of the symptoms usually associated
with tuberculosis, such as cough, sputum, loss of appetite and
weight, etc., yet which, on examination reveal extensive disease.
How to secure earlier diagnosis is still one of our main outstanding
problems. I think it would be reasonable to state that
the Tuberculosis Dispensaries can guarantee early diagnosis, if
the cases present themselves for examination in time. The
problem, therefore, is really one of securing earlier attendance
of patients. There is an all too frequent tendency to lay the
onus for the delay on the general practitioner, but in my opinion
this is quite unjustified, and I am convinced that he is playing
his part satisfactorily. Our relations with the general practitioner
are so cordial that he does not hestitate to send a doubtful case
to the Dispensary for a further opinion, and it is no fault of his
if the patient does not seek his advice until the disease is well
advanced. We can seek out the contacts, but our difficulty lies
in getting into touch with cases other than contacts, who delay
seeking advice for the simple reason that they do not feel ill.
As I have previously pointed out, the only solution appears to
be the periodic X-ray examination of the whole population.
Colossal as this task would be, it has, I believe, been attempted
in some countries. Since, however, tuberculosis is largely a
disease of adolescence and young adult life, an attempt in the
first place might be made to supervise the age period 15-25, as
is already being done in the case of children up to the age of 14
by the Infant Welfare Service and the School Medical Service.
This, I feel certain, would bring to light many cases of tuberculosis
at a stage which would offer a better hope of cure, and help
materially to reduce the already falling death rate.
Some figures, provided through the courtesy of the Medical
Officers of Health, showing the decline in the incidence and death
rate of tuberculosis during recent years, may be of interest, and
I have accordingly drawn up tables giving the actual number of
notifications and deaths in each Borough during the last 20 years.
The graphs, showing the notification and death rate per 1,000 of
the population, present the information in another form, and are
of course corrected for any change in the population.