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113
I have visited the New End Hospital frequently during the year,
and have to thank Dr. Reade for his courtesy and help in respect of the
tuberculous patients in that Institution.
The outstanding feature in the report this year is the sudden fall
in the number of deaths; this can be scarcely other than accidental, and
one would expect it to be balanced by the figures for next year; at the
same time it serves as a very definite pointer to the gradual decrease in
the virulence of the disease.
The incidence of the disease is difficult to estimate; the virulence
may be judged safely by the Registrar General's report; in the same
way the notifications are figures of comparatively small value, except as
an indication of the susceptibility and lack of resistance of the individual;
just as a mild case of any infectious disease may escape notification. A
recent paper by Dr. Ward, T.M.O., Devon, in the " Lancet" of January
21st, is extremely illuminating, and expresses views which I have held
myself for some years; it is a point of view that would, I think, never
be formed by one who had not had experience in a Tuberculosis Clinic
with its close association with the patient; Dr. Ward states his conception
of the disease as "a widespread disease terminating usually in
uneventful recovery among the highly resistant majority of the
population, but dangerous to a minority with a low resistance."
I think in this lies half the difficulties arising concerning notification;
if the 40 to 50 per cent. of the population who have had at some
time a tuberculous infection were notified, then there would be few
unnotified cases dying. But the procedure soon would defeat its own ends,
however, one of these patients whose resistance is lowered by some concurrent
disease may easily die within 3 months or less of notification.
The dangerous cases from the communal point of view are those resistant
cases with advanced disease who possibly never attend a doctor or go
about labelled as chronic bronchitis. The lack of recognition of those
cases, grouped by Ward "Minor Tuberculosis," i.e., tuberculosis infection
in a resistant person, accounts, I think, for the variety of opinions as to
the prevalence of marital tuberculosis.
In my experience it is exceedingly common to find the partner of
an infected patient exhibiting no malaise or other outward signs of
disease, and yet having a few signs in the lungs which in a person not
exposed to infection one would regard as of no importance.
In my experience from watching these cases, they ultimately clear