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83
there is a relationship between natural resistance to tuberculosis and the
state of the function of certain ductless glands such as the thyroid and
ovary. In the case of women suffering from active pulmonary tuberculosis
I have noted in several cases that at the period of middle age, when profound
changes are in progress in those glands, the condition of tuberculosis
tends to become either very acute or rapidly quiescent. I have known
cases described as almost hopeless steadily to put on flesh and the disease
in the lungs to become almost unrecognisable to the stethoscope. It is well
known that most women tend to put on adipose tissue about middle age,
but in those who show the wasting associated with tuberculosis those
changes are remarkable. It has also been noted that in young adults, both
male and female, those showing derangement of thyroid function often
prove when they develop tuberculosis to be cases of rapidly progressive
nature. The suggestion that there is a definite relationship between
resistance to tuberculosis and the functioning of the glands of internal
secretion seems worthy of investigation.
The total number of new cases certified to the Medical Officer of Health
during the year numbered 348, of which 223 were dealt with directly
through the tuberculosis dispensary. The gross total of 348 includes
a number of cases which could not have come within the purview of the
dispensary, for example, 30 patients were not certified before death,
6 were notified from asylums and had been resident there for a number of
years, and finally there were some 10 patients for whom private arrangements
for treatment were made. If this number, 46 in all, be deducted
from the total 348 it will be noted that the dispensary dealt with 73-8
per cent, of all the cases which might ordinarily come within its sphere.
The following table shows the classification of cases and the proportion
of the total which passed through the dispensary.

In 1923, 60.8 per cent, of total new cases of tuberculosis were examined
by the Tuberculosis Officer,