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health, since he has no foundation on which one can build.
Moreover, at the present time he is more likely to become diseaseconscious
than health-conscious, owing to the sensational and
startling manner in which medical topics are presented to him
in the daily Press, and I believe that instruction should be as
unobtrusive as possible, lest the end achieved defeat its object
by over-emphasising the dangers of any one particular disease,
rather than by leading the community into a more healthy way
of living. It is to be hoped that the National Fitness Campaign
will counterbalance this trend, and that the whole question of
infectious illness, and in particular of tuberculosis, will be put
into its proper perspective, so that the patient may not have to
face the distrust and suspicion of his fellows, as well as the
physical misery inseparable from his malady. When he is able
to realise that early diagnosis means greatly increased chance
of cure without the attendant dread of social ostracism, we shall
probably find him much more willing to come forward for advice
about symptoms which he has hitherto been afraid to admit.
(2) Contact Examination.—It will be noted that only a very
small number of the contacts examined are found to have
tuberculosis. The figure is misleading to a certain extent, for
the following reasons:—
(а) The term "contact" officially denotes only those
persons who have been sent up for examination solely owing
to the fact that they have been in contact with the disease.
It does not include those referred by doctors, who, knowing
the family history and recognising some suspicious symptoms,
consider full investigation necessary.
(b) The contacts that are seen at the Dispensary are to no
small extent comprised of persons whose exposure to infection
has been practically nil, since the primary case may be a surgical
one, such as a patient with spinal disease, glands in the neck,
etc., which are rarely contagious.
(c) It is much more easy to secure the attendance of those
in age and sex groups who are the least vulnerable to the
disease, e.g., middle aged women, and children. The reason
for this is that the health visitors in the great majority of
cases are only able to interview the mothers of families, and
explain to them the desirability of examination, as it is rare
to find the others at home. It thus happens that middle aged
men and young adults of both sexes are not seen during the
visits of the nurses or the Tuberculosis Officer, and it is not
possible to apply persuasion to those who need it most.
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