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181
Elimination of tuberculosis from the community probably
ranks as one of the most important tasks ever falling to the lot of
the medical profession and public health staffs. For some time,
progress was seriously hampered by the fact that tuberculosis was
only voluntarily notifiable until the introduction of the Public
Health (Tuberculosis) Regulations in 1912. Once the disease had
become compulsorily notifiable, there was the initial flood of noti
fications with more accurate diagnosis and, by 1917, the Borough
had sustained its highest number of deaths, viz. 219, of which 182
were of the pulmonary type. Since that time, there has been a
gradual diminution of notifications and deaths until the present,
more satisfactory, situation was reached. Nevertheless, tuberculosis
is likely to smoulder on for a decade or two yet.
However, the current year shows an increase of 9 notified
cases over those of the previous year and a suspicion that the
disease is being imported by immigrants not subject to medical
examination gains ground. Vagrancy is perhaps too strong a word
for the people who wander the countryside and have no fixed
abode but the practice is growing especially among the younger
age groups. Control of infectious cases under these conditions is
virtually impossible and the infected immigrant and the grossly
infected mobile patient, in close contact with susceptible groups,
could lead to latent pools of infection throughout the community.
The situation presents grave difficulties to health departments in
general and to chest clinics in particular.
That elderly people may suffer from tubercu'osis which
remains undiagnosed until they are admitted to hospital for other
reasons or until a post mortem is undertaken is revealed in a recent
examination of 1,713 post mortems carried out in a South East
London hospital between 1950/64, on patients over 70 years.
Thirty-one cases of tuberculosis were discovered and in only 4
cases was there a previous tuberculosis history. Fifteen of these
were found durine the terminal illness and 12 at post mortem. In
these cases there is a potential risk to other patients in the hospital
and there must be a certain number of inaccuracies in clinical
diagnoses and death certificates if a post mortem is not performed.
Thirty-one cases over a period of 15 years may not be much
but if this situation is common throughout the country then there
is a need for routine necropsy and examination of all sputum
specimens for acid-fast bacilli.
The number of notified cases of Tuberculosis remaining on
the Register at 31st December, 1964, was as follows:—