View report page

67
In 8 male and 13 female original pnlmonary cases a close
family history of tuberculosis was obtained, being given by 3 males
in the age-groups 35-44 and by 9 females in the age-groups 25-44.
Of the 55 non-pulmonary cases first heard of during the year,
70 per cent. were original cases and 30 per cent. transfers. Of the
original cases. 80 per cent. lived in estate houses, 15 in the older
property and 5 per cent. in the newer houses. Of the transfers,
80 per cent. lived in estate houses, the other cases occurring amongst
residents of the newer property.
Of the non-pulmonary cases, 2 had lived here less than 1 year;
1 were notified in each of the years of residence from the 2nd to
the 7th; and 2 persons had been resident here 8 years. Of these
28 eases, 20 were infections of cervical lymph glands; the meninges
were affected in 4, mesenteric glands and skin in one each, and
bones and joints in 2 cases. A family history of infection was
elicited in 7 cases of infected neck glands, and in one case of
meningitis. The cases giving the family history were mostly children
of school age, only 2 being under the age of 5. There were few
households in which the milk supply was not pasteurized.
Great difficulties confront one in attempting to assess the
extent of tuberculosis occurring in the estate ; and yet, apart possibly
from the standardized death-rate, this is the most important
index of the general standard of health of a district as, concerned
in the aetiology of this disease are, on the positive side, the
presumed advantages of satisfactory housing, and on the negative
side, the disadvantages of high rents, resulting possibly in
deficient nutrition.
To demonstrate the difficulties, the possible comparisons which
might be made will be dealt with:—
The notification rate—the local to be compared with the
national or some other rate. The defects are:—(1) no notification
rates are perfect and even including posthumous information are
still unreliable. (2) Owing to the transfer of large volumes of
population, a large number of cases may be on the register for
some years before a primary notification is received. (3) W ith
regard to notifications received in respect of transferred persons,
8 pulmonary cases represent the incidence of infection in a
transferred population of some 1,000 persons, the disease being
notified over a period of years and is added to the ordinary
notifications which had an incidence of say, of one per thousand
Population, in which the illness was contracted generally within a
short Period prior to notification. (4) A case may be notified at
short a time after his coming to reside locally that it is highly
imProbable that infection was caught here and the patient was
probably already suffering before transfer. (5) A number of cases