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of notifications is received about those in the services and also amongst
those engaged in nursing. Actually this year there were only four cases.
There are some trades or places of work which have an unenviable
record as the employees are considered to be very liable to contract
tuberculosis. Only two of the sufferers could be put in any of these
categories.
Poor housing conditions are thought to be an important factor
the aetiology of this disease. How important it is is very difficult to
assess. It can be accepted that the overcrowding of a household in
which there is an infective case is a highly important factor. It was this
belief, of course, that has determined the Council's policy in the generous
provision it makes for the rehousing of those families which there is
a member suffering from pulmonary tuberculosis. Overcrowding
itself, even without there being a recognised infectious person present,
may be important, as also may insanitation and poor structural conditions.
What makes the importance of these factors so difficult to assess is that poor
health might lead to poverty, and this in its turn can lead to bad housing;
and where all these factors are present, the chief one in predisposing to
tuberculosis might be not so much the poor housing as the poor health
of the individual. In few of the cases notified in this district could the
housing conditions be felt to be the important factor.
Sometimes predisposing states seem to play an important partIn
children an attack of measles or of whooping cough might be followed
by the disease; in adults an attack of influenza or pneumonia. Sometimes
the stress of pregnancy seems to upset the balance and allows the
organism to gain the upper hand. Those suffering from diseases such as
diabetes seem to be more prone than others to attack. There were few
enough occasions in this year when these causes seemed to play any real
part.
The position would seem to be then that as a bolt from the blue in
some three persons every week the disease is recognised amongst those
who have not been especially exposed to infection in their homes, who
are not engaged on any employment in which the risk of contracting
tuberculosis is especially marked, who are not living in poor surroundings
and who are not themselves poor and in whom there has been no precipitating
cause just before the illness. It is known, of course, that
everyone is exposed to infection, that in most this very exposure builds
up a resistance to further average infection, that in many probably the
organisms are dormant and might re-awaken their activity if the condition
of the host is adversely affected. What is it that determines the onset in
all these apparently healthy people, many living apparently healthy lives?
There must, of course, be many sufferers from the disease in whom
it has not been detected, and of these some will be infective. It may
be that some of those in whom the disease has become manifest have
succumbed because of exposure to massive infection. The various
steps which are now being taken to pick out the sufferers in those who are
apparently healthy, such as by the examination by the mass radiography
units, should result in a decline in cases originating in that way; but
n many, perhaps in most of these cases, they would not appear to have
een especially heavily exposed to infection. In these it must be presumed