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motion", with one peak of infection superimposed upon another, but
otherwise there is no fundamental difference.
Let us consider the measures needed to control an outbreak of
smallpox. These are:—
(1) The doctor making the diagnosis must immediately inform
the local Medical Officer of Health (notification).
(2) The patient must be removed to hospital (isolation).
(3) The immediate contacts must be protected by vaccination
and then carefully watched for early symptoms of the disease
(surveillance).
(4) A careful search must be made for unsuspected but nevertheless
highly infectious cases which may give rise to further
spread of infection (tracing possible sources of infection).
(5) One measure should have been taken before the outbreak
commenced—the routine vaccination of a large proportion of
the population in early life, thus making a large epidemic
unlikely (prior vaccination).
Now can we apply these five principles to tuberculosis?
NOTIFICATION
The Ministry memorandum stated "completeness of notification
of all detected cases is, of course, one essential contribution clinicians
in or out of hospital should make". I could not agree more wholeheartedly.
I did mention last year that I felt certain that by no means all
rases of tuberculosis infection were being notified. A particularly
good (or bad) example of this can be quoted this year in that a member
of the Health Area staff, picked up as a case by mass X-ray examination,
has been off duty for many months but has never been notified
to me. On taking up this point with the Chest Physician he pointed
out,quite correctly, that the regulations only require notification where
a person is suffering from tuberculosis. In this particular case the
disease was not active and therefore she was not, in his opinion,
suffering from the disease. This is solely a matter of opinion, although
personally feel that where a patient has to stay away from work
for such a prolonged period that person is indeed suffering from
tuberculosis. There is urgent need for a revision of the tuberculosis
regulations so that all cases of tuberculous infection are notifiable.
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