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71
Fifteen deaths occurred amongst those who had not been notified,
though in only two cases was a posthumous diagnosis made. In two
instances the disease was of many years' standing, and in another case
the patient had transferred to the area suffering from the infection.
Three patients were inmates of a mental institution, while in two instances
the patient had only recently been admitted to hospital suffering from
meningitis. Two of the remaining four deaths took place in sanatoria
for the treatment of the tuberculous, one in a County hospital and one in
a London hospital.
Preventive Measures.
Although the local sanitary authority is responsible for the sanitation
of the premises in which a tuberculous patient is living, in this area the
home visiting is undertaken by the tuberculosis sister attached to the
staff of the local tuberculosis dispensary or chest clinic. Routine reports
are received about the home circumstances, and the sanitary inspector
visits homes where housing is unsatisfactory, either because of crowding
or because of the structural condition of the premises.
Amongst the chief of the preventive measures is early diagnosis. To
facilitate this, arrangements are available for the bacteriological examination
of sputum from suspected patients.
Section 172 of the Public Health Act, 1936, repeats the powers previously
granted under the 1925 Public Health Act, for the compulsory
removal to hospital on a Court Order of infectious persons suffering from
pulmonary tuberculosis where precautions to prevent the spread of
infection cannot be or are not being taken, and when serious risk of
infection is thereby caused to other persons. No application for such
an Order has as yet been made. The very existence of such powers,
though is helpful in difficult cases.
The insidiousness of the onset of tuberculosis, and the indefiniteness
or even complete absence of symptoms add to the difficulties in the control
and eradication of this disease. While the disease is unrecognised not
only are the sufferers possibly communicating the infection to others, but
in themselves the disease is progressing so that at best when recognised
the lesions are so advanced that long-term treatment is necessary, while
in many even that state has been passed. Although not invariably so,
diagnosis can usually be made earlier by X-ray than by physical examination.
To result in detection in the earliest stages, though, examination
must precede even the onset of symptoms. To be successful, then, facilities
must be available for the examination of normal healthy individuals.
While this cannot as yet be arranged for the general population, something
is being done for the examination of specially selected groups. It is
found that about 1 per cent. of those examined by mass miniature radiography
are found to be or are suspected to be suffering from tuberculosis
and so require observation or treatment. A further 0.5 per cent. were
found to need referring to their own doctors or to hospital because of some
non-tuberculous condition of the chest requiring further investigation,
treatment or observation. The immediate result of the testing of any