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To the Mayor, Aldermen and Councillors of the Metropolitan
Borough of Stoke Newington.
Ladies and Gentlemen,
I beg to present the annual report for the year 1937. On
pages 76 and 77, will be found the statistics dealing with the
year's work. This has shown an all-round increase over that of
1936, but in general the difference has not been sufficiently marked
to call for any detailed analysis. There are, however, several
points on which I feel that some comment is appropriate.
(1) New Cases.—In spite of the fact that the number of
persons referred for investigation has increased, and that the
co-operation of local practitioners has continued to be cordial,
it is rather disturbing that a considerable proportion of the cases
found to be tuberculous are already past the early stage. This
is doubly regrettable, firstly because a patient with an active
but undiscovered lesion constitutes an infectious focus, which is
particularly dangerous since he naturally observes none of those
rules of hygiene which have been proved efficacious in preventing
the spread of the disease; and secondly because his own prospects of
receiving benefit from such forms of treatment as artificial
pneumothorax are greatly lessened. The main problem in dealing
with tuberculosis is the discovery of the early case, and it is one
whose consideration offers the most fertile ground for progress
in any anti-tuberculosis scheme. At the present time, I believe
it to be true that there are a considerable number of persons,
who for the very reason that they suspect themselves to be
suffering from tuberculosis, refrain from seeking medical advice
till the urgency of their symptoms compels them to do so, and
even then many deliberately withhold vital information from their
doctors in the hope that some general treatment may be given
them that will be of benefit to them, without an official diagnosis
being made. Apart from their dread of having their suspicions
confirmed, the ever present fear of losing their employment, and
the fact that the general public still regard tuberculous persons
as being under a stigma, probably lies at the root of this attitude
of mind. It seems very likely that over-enthusiastic antituberculosis
propaganda does more harm than good, by exaggerating
dangers, and thus increasing the mental strain on the sufferer
from the disease, and by frightening unduly many others in the
community. The ignorance of the man in the street of the
principles of elementary anatomy and physiology renders it an
extremely delicate task to educate him rationally in matters of
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