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52
tuberculous person in that efficient ventilation can be maintained
and use rtiade of a garden—but no advantage may be taken of these
benefits because of the mode of life of the occupants. These
houses might be of no more benefit than crowded slums if the
consumptive is careless in disposal of his sputum, if windows are
shut, or if the premises are overcrowded.
W hat are the advantages to the tuberculous person and his
family of living in satisfactory housing conditions compared with
living in unhygienic premises ? To the case infected but not
clinically recognised, the difference might not result in his overcoming
the infection ; similarly, satisfactory housing conditions
might result in the contacts of a patient successfully resisting
infection to which in other surroundings they might succumb. In
very rare cases the patient might overcome his infection ; in any
event he should be less likely to suffer a relapse should his infection
be arrested as the result of treatment or otherwise ; in progressive
cases, death may be postponed. For the home contacts of an
infectious patient there should be less exposure to massive doses of
infection, and, living in healthy surroundings, they should be better
able to resist infection.
These beneficial effects should be demonstrated in the
postponement of the age of death of the tuberculous, and in the
occurrence of a smaller number of cases of tuberculosis, especially
in those of younger ages.
To obtain full benefit of the improved housing full co-operation
of the patient is necessary ; this applies especially to the benefits
to be obtained by contacts. Apart from the personal conduct of
the patient, the factor of most importance probably is nourishment.
The advantages of satisfactory housing are chiefly to be found in
aiding in building up the resistance of those exposed ; shortage of
suitable food would outweigh any such advantages.
It is very difficult to compare local statistics with others to
determine the extent of tuberculosis. Notification figures are of
little use—apart from the fact that in different districts the extent
to which notification is carried out varies so widely. In this
district, with its population growing by importation, notifications
are received each year of those cases already occurring in the
transferred population. Although they might individually have
been notified in the other districts over a number of years they are
all added to the local register in one year. Further, there is
sometimes an interval of two or more years between a tuberculous
patient transferring here and a notification being received.
To remedy these defects the use of the register for comparative
purposes was considered. The deficiencies of notification are.