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Section 172 of the Public Health Act, 1936, empowers 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 taken, and when serious risk of
infection is thereby caused to other persons. No application for such an
Order has as yet been made.
Incidence of Tuberculosis.
Various figures can be used as a guide to the prevalence of tuberculosis.
However accurate any of these might be, there is probably not
one which can be accepted as an index of the effect living in the locality
has on the likelihood of one's contracting the disease.
(1) Notification. Tuberculosis is a very insidious disease with
often a most indefinite onset. Frequently, then, it will have been developing
for long before the attack is recognised. The patient might not have
been living in the locality all that time. The interval between the time
the infecting organism gains the upper hand and the date the disease is
diagnosed is very variable. A case notified in any one year often enough
will not have been the result of any influence in that year but in some
preceding time, possibly one, two, three and more years before. Then
again, a medical practitioner is required to notify the case whether or not
the patient had been previously notified in some other district before
removing to his present address. On the other hand a transferred patient
might not be notified either because the practitioner does not appreciate
his obligations in such a case, or perhaps because the patient does not
attend a doctor in his new district.
Then the number of notifications might be related to the facilities
there are for aiding the making of a diagnosis. A striking instance is the
result of examination of a section of the population by mass radiography.
Previously unsuspected active tuberculosis of the lungs is found on an
average in about 4 per 1,000 persons. By the end of 1947 over two million
persons in this country had been examined in this way. This led to the
detection of 8,000 cases. These possibly would have become manifest
in later years but were at the time of examination unsuspected. The
detection of these cases, then, helped to swell the numbers of cases
notified since mass radiography was introduced though, of course,
probably leading to a fall in the numbers in those years in which it
might have been expected that the disease would have reached the stage
in which it would be recognised in those persons.
Another factor arises in a community which is growing by the influx
of new populations. The patient once notified remains notified for a long
time. In any population which moves into a new district then, there will
be not only those who have been notified the previous year, but those
notified in the preceding years. All these might, as they should be, have
been notified to the new authority very shortly after their transfer into
the new district. Amongst any 2,000 persons who transferred, then,
within a short time, the new authority might receive not the 3 notifications
of those in whom the disease became manifest in the previous twelve
months, but the 10 who had been notified over the earlier years, and