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541
the number of notifications of Tuberculosis often does not much
exceed that of the deaths registered from the disease, in Stoke
Newington they are generally about double. It is, however, probable
that the actual number of sufferers in any year approximates to
three times the number of deaths.
The principal reasons for delayed notification and for nonnotification
of Pulmonary Tuberculosis are probably the failure on
the part of patients to consult a doctor until late in the disease and
the doubt and difficulty which often surrounds the diagnosis. The
fear of the consequences of notification, embracing the setting in
motion of the machinery of official visitation and the possible
publicity, with consequent dislocation of business and domestic
life, are considerations which deter from notification, and members
of the medical profession, sympathising with the sufferers, sometimes
postpone the notification when appealed to.
The object of all anti-Tuberculosis measures must be to increase
the resistance of mankind to infection and to reduce the amount
and frequency of infection to which mankind is exposed. The
amount and frequency of infection are greatest in consumptive
families with whom, owing to poverty and its associated circumstances,
the resistance to infection is often at its lowest.
The supreme importance of protecting young children against
infection is generally recognised, and of the circumstances
responsible for reducing resistance under-nourishment is the chief.
As Professor Leon Bernard has recently said, the home infection
of this disease is specially dangerous, as it is often long-standing
and continuous and abundant; and he strongly advocates better
measures for early detection of Tuberculosis and prompt removal
from the source of infection. I have long felt that this is an urgent
need, and that our Tuberculosis schemes are very imperfect without
it. There is only one alternative measure to the removal of young
children who are at risk in their home, and that is a preventive
vaccination, but we are by no means certain yet as to whether we
have a useful and safe means of applying this means of protection.