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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 probable that the
actual number of sufferers in any year approximates to quite
three times the number of deaths.
The circumstances which still operate against the reduction in
the prevalence of this disease are: the difficulty of securing accommodation
for advanced cases; the lack of proper housing conditions,
and the consequent impossibility in many cases of getting a separate
bedroom for the sufferer; the difficulties of securing a satisfactory
measure of after-care.
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
this infection is generally recognised, and of the circumstances
responsible for reducing resistance under-nourishment is the
chief.
The early recognition of infection and the skilled treatment of
sufferers in sanatoria and outside of them is, of course, essential
from the preventive standpoint; but I am convinced that next to
improved social and industrial conditions, which will always continue
to play the major part, must come the adoption of measures
of dealing with those who are running special risks in early life;
and until this is done no scheme for the reduction of Tuberculosis
can satisfy.
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.