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Tuberculosis
With the exception of 1939 when figures were no doubt artificially
low, this is the first year in the Borough's history in which the total
number of notifications of tuberculosis has been below 100. Of the 92
cases notified 78 were respiratory and 14 were non-respiratory. Again
with the exception of 1939, the number of cases of respiratory tuberculosis
notified is also the lowest on record.
Optimism must be tempered, however, by my impression that
there is a somewhat widespread reluctance amongst chest physicians
to notify a patient as a case unless active treatment is required. This
attitude seems to me most unfortunate since, irrespective of whether
treatment is or is not needed, the patient must have caught the germ
from someone else and notification should be made as the first step
in epidemiological investigation.
There were 580 cases on the Chest Clinic Register at the end of
the year after the removal of those who had been discharged as "case
arrested." Again I think this figure gives a somewhat optimistic
picture of the situation, since it does not include those patients who
refuse to accept treatment and more particularly since it excludes
those patients who are under observation for tuberculous infection
but whose disease does not call for active treatment and thus have not
been notified.
One of the more modern weapons against tuberculosis is mass
radiography, and in common with many of my colleagues I feel it
to have been unfortunate that this service was placed under the control
of the Regional Hospital Board rather than in the hands of those whose
primary interest is prevention.
The National Health Service Act has divided responsibility for
the tuberculosis services between the Regional Hospital Board (Chest
clinic buildings, chest physicians, clerical staff and mass X-ray units),
the Local Health Authority (T.B. Health Visitors, Occupational
Therapists, Prevention, Care and After-Care) and the Local Sanitary
Authorities (notifications and rehousing). In many areas this has led
to lack of co-ordination and has had the result that treatment of the
disease is now regarded as more important than prevention. In
Barking we must regard ourselves as fortunate in that close liaison
has been maintained with the Chest Clinic. This is, in no small measure,
due to the attitude of the Consultant Chest Physician and I should
like to record my appreciation of the courtesy and the very ready
help and co-operation which I have always received from Dr. Paterson.
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