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77
rise in mortality will continue and, if so, whether it is evidence of
increasing bacterial resistance to modern drugs or the results of
recently introduced foci of infection has yet to be determined.
Fundamentally, tuberculosis has retained its nature but patterns
of treatment have changed. Chemotherapy, although more complex
than hitherto involving as it does various combinations of P.A.S.,
izoniazid and streptomycin, is the modern procedure whereby
infectivity is quickly eliminated irrespective of adverse environmental
conditions and relapse risks are minimised. Obviously the effectiveness
of such techniques depends ultimately upon the maintenance of
regular treatment.
Preventive measures, however, lie mainly in the sphere of the
family where an active case is, or has been revealed. B.C.G. vaccination
has become standard preventive practice during school life or in
instances where there are special risks and other steps include the
tracing and supervision of contacts and investigations into social
and environmental circumstances. However, there is more than a
suspicion that this disease is being imported by present immigrants
not subject to a medical examination or to one that is a little too
perfunctory. It may be that 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 tuberculosis 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 during the terminal
illness and 12 at post mortem. In these instances 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. If this situation is common
throughout the country then there would appear to be a need for
routine necropsy and examination of all sputum specimens for
acid-fast bacilli.
It seems that although a great deal has been achieved, there still
remains much to be accomplished.
There were 76 notifications received during the year and of these
67 were of the pulmonary type and 9 non-pulmonary, i.e. tuberculosis