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68
The statistical tables on pages 73 and 74 are presented in the
same form as hitherto adopted, and the detailed figures differ very
little from those recorded in 1931. The number of new cases,
including contacts, has shown a slight decrease from 312 in 1931,
to 273 in 1932, but in this connection it must be recalled that in 1931
the total was exceptionally high. There can be no doubt that in
a disease such as tuberculosis, which is so intimately dependent on
social factors, the prolonged industrial depression and the great
amount of unemployment prevailing, must ultimately tend to result
in a rise in the incidence of new cases notified and of the death rate,
or at any rate in a slowing up of the decline which has been recorded
during the past years. At the present time the effect of such
industrial conditions as regards clinical work shows itself mainly
in two ways:
(1). Persons who are in work and who develop symptoms,
tend to postpone seeking medical advice because they fear that resultant
absence from duty for any length of time may mean loss
of work, leading to permanent unemployment. Ultimately, the
increasing gravity of their complaint brings home to them the impossibility
of carrying on, but by this time they may have drifted
into the category of advanced cases. For this reason it is to be
feared that the number of persons coming to the notice of the
Public Health Authorities in a reasonably early stage of the disease
may be still further decreased.
(2). Patients who have attended the Dispensary and are diagnosed
as tubercular, but who can be regarded as genuinely early
cases, are often afraid to accept sanatorium treatment entailing
a prolonged absence from work, again owing to the possibility of
subsequent permanent unemployment.
While these two factors are always to a certain extent in operation,
there can be no doubt that the}7 have been intensified recently.
The co-operation of the local practitioners with the Dispensary
remains very satisfactory, and the number of new cases referred
by them has again been high. In October, I received an invitation