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attention. To quote from my last annual report: "They fear discovery
of the disease on grounds of loss of employment, loss of friends or
disruption of family life, and for these reasons resist all effort to persuade
them to be examined".
The aim must be the complete eradication of tuberculosis and it
may be that x-ray should be made a condition of employment more
often than at present. One seldom wishes to advocate compulsion but
if it is accepted that infectious persons may intentionally refuse to
take steps to obtain treatment and thus remain a danger to the community
then compulsion may be the only answer. Initial x-ray should
be followed by further x-rays at regular intervals in employment
involving contact with susceptible groups. It would appear from an
examination of case histories that there is a fairly high incidence of
tuberculosis among immigrants. Immigrants to the United Kingdom,
it would seem, should not be accepted without a chest x-ray.
Compared with the 25,000 deaths from pulmonary tuberculosis
in 1939, the total of 5,837 for the whole country in 1955 appears very
heartening. However, tables issued by the Registrar General show
that the mean age at death in England and Wales from pulmonary
tuberculosis during 1954 was 55.2 for men and 46.3 for women, compared
with 65.1 and 69.4 respectively for deaths from all causes. Thus,
although the number of deaths continues to fall, those dying are comparatively
young persons.
The early examination of all contacts of tuberculous patients is
vitally important in order to discover the source of infection and to
enable susceptible contacts to be offered B.C.G. vaccination.
New notifications in Hornsey show no decrease this year, but deaths
from pulmonary tuberculosis have fallen to only 3 from 14 in 1954.
On page 11 it is shown that twelve cases of pulmonary tuberculous
were removed from the register after death. This apparent discrepancy
results from only three of these deaths being ascribed to tuberculosis,
the others being due to other causes.
A report on tuberculosis in schools is given in the Appendix (pages 94
to 97).
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