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Mortality from Tuberculosis in the Borough of Ealing has fallen
by 60% in the last ten years and by 27.5% since 1952. This last
figure is exceptional but otherwise these figures are comparable
with those for England and Wales as a whole.
There can be little doubt that these significant falls can be
attributed to the pasteurization of milk and partly to the fall in the
number of deaths from respiratory tuberculosis may be due
principally to the remarkable effect of the antibiotic and in a lesser
measure to the great advances made in the technique of chest
surgery and the management of tuberculosis patients. With regard
to notifications of respiratory tuberculosis, whereas it is almost
impossible to compare the years before the end of the war with the
post war years—because of improved case finding due to Mass
Miniature Radiography, Patch testing of children and the attitude
of the public towards the disease—there can be no doubt that the
fall in notification in the past two to three years is a real one.
Because of the important part played by patch testing in this
reduction I feel that it would not be out of place here to explain
the rationale of this procedure. In the case of Tuberculosis it is
extremely important to distinguish between infection and disease.
Infection occurs when the body had been invaded by the causitive
organism of the disease but where the organism does not settle in the
body and consequent upon its initial invasion leaves behind a resistance
and immunity. Disease occurs when the causitive organism
settles in the body and multiplies producing clinical or X-ray evidence
of this successful settlement. In a population in which the tubercle
bacillus has been circulating freely a large proportion of the adult
population will have been infected before or during adolescence but
here will be a relatively small proportion with active disease. It has
been estimated that by the age of about 20 years, 60—70% of children
have been exposed to infection as shown by a positive patch test.