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of the total deaths in the district. The corresponding figures lor last
year were 77 deaths from pulmonary and 16 deaths from non-pulmonary
tuberculosis, the disease accounting for 5.4 per cent, of total deaths.
42 per cent, of the total deaths of those who succumbed to pulmonary
tuberculosis took place outside the district, mostly in institutions, the
corresponding figure of those suffering from non-pulmonary tuberculosis
being 72 per cent.
Viewed from the angle of those concerned particularly with the
health of the community, the deleterious effects of the war may be most
pronounced through its influence on the incidence of tuberculosis. There
has been an increase in the notifications. As previously pointed out,
much of this may represent only a statistical increase arising from the
obligation of a medical practitioner to notify to the medical officer of
health of the area in which the patient is resident any case of tuberculosis
which he knows has not been notified in that area. With the large
movements of population which have occurred, many such persons will
have been notified in the area of their new temporary place of residence
though they will already have been notified in their home areas. Another
suggested explanation of the increase is that it is not so much an actual
rise in the incidence of the disease as the result of an advance in a
disease already present but up to then dormant. As most cases, at least
of the pulmonary disease, in humans have their origin in an organism
which at one time resided in another human who acted as a spreadei
any increase in the number of open cases results in a much larger rise
in the number of those infected. It is for this reason that the repercussions
of the war are to be so tragic. Without it, although the rate of
decline was slowing up there was a continuing reduction in the incidence
of the infection with the consequent lessening in the number of spreaders.
It would therefore have been possible to imagine that the time would not
have been far distant in which the existing tuberculosis service, including
bed accommodation, even without any marked extensions, would have
been amply adequate to deal with any demands made on it. Whatever
may be the real position of the incidence of infection there is no escaping
the fact of the increase in the number of deaths from tuberculosis. The
national figures showed an increase of about 10 per cent, in the mortality
figures for pulmonary tuberculosis in 1940 as compared with 1939, the
percentage increase being greatest amongst women between the ages of
15 and 25. The slight fall which occurred in the early part of 1941 was
unfortunately not maintained in all areas. One possible explanation
of an increase in the number of deaths from those suffering from tuberculosis
may be that it is due not to any factors arising from or associated
with war conditions but to circumstances which adversely affect those
suffering from this disease more than the general population. Inclement
weather might be such a factor. This, it might be anticipated, would
also affect the death rates of other groups such as the elderly, though not
necessarily leading to an increased fatality in such other sections of the
population at exactly the same time. Against this as an explanation
though is the fact that the rise took place in each quarter of the year and
not merely in that when the weather was most severe though this again
might well have been the late result of such adverse influences in the