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589
the number of notifications of Tuberculosis often does not much
exceed that of the deaths registered from the disease, in Stoke
Newington they are much more numerous. It is, however, probable
that the actual number of sufferers in any year approximates to
quite three times the number of deaths. Every endeavour is made
to secure the co-operation of medical practitioners, and the working
arrangements set out on Memo. 283 of the Ministry of Health have
been carried out.
The germ of the disease is known to be very widely diffused
among our people, yet the actual disease is manifest in only an
increasingly small proportion of those who have harboured the
germ. Although, then, our special measures directed against the
disease appear to be of less avail in protecting the community from
the risks of exposure to the germ, they, with other factors concerned,
are proving serviceable in reducing that dosage of infection
which is necessary in many cases to produce the disease.
There can be no doubt that if the proximity to a sufferer is
sufficiently prolonged, or often enough repeated, the dosage of
infection will generally result in the transference of the disease.
The dilution of infection is therefore very important, especially
during childhood and adolescence. A considerable dosage of the
germ can only be received indoors from an infective person.
I have long felt that a greater protection of children 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 method of applying this means
of protection. The removal of the source of infection, so very
desirable when practicable, is likely to prove more difficult than the
removal of a child at risk, for the sufferer is often contributing something,
by light work, to the support of his family. Nevertheless,
compulsory powers of removal of a sufferer who is putting others
at serious risk are very desirable, and these powers are given in the
Public Health Act of 1925.