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64
the register of one area leads to those in other districts becoming more
correct.
For some years it had seemed that less attention was being paid by
the medical officer of health to his obligations about the tuberculosis
register. The practice appeared to have been growing of those at the chest
clinics passing on the clinical records of the patients to those at the clinics
of the districts to which the patients were going, and this practice seemed
to be replacing the intimation that the medical officer of health of the
district was obliged to send to the medical officer of health of the new
district of the change of residence of a patient. This was in spite of the
very clear wording of sub-paragraph 6 as to the procedure. That the
medical officer of health of the district to which the patient removed might
ultimately obtain the necessary information from the physician at the
chest clinic serving those in his area, did not excuse the non-compliance
by the medical officer of health of the district from which the patient was
going with the provisions of this section.
The 1930 regulations were revoked by those of 1952. These say
nothing about the medical officer of health keeping a register. In regard
to this though Circular 6/52 accompanying the regulations says—"The
new regulations no longer require a medical officer of health to keep a
register of tuberculosis notifications. In the Minister's view he may
naturally be expected to do so—and the Minister would urge that he should
—in the same way that he keeps a record, for his own purposes and without
any legal requirement, of notifications of other diseases. The provisions
on this point in the 1930 regulations were necessary at that time because
of the correlated requirement about supplying certain particulars to the
County Medical Officer. These particulars have in practice come to
be derived, for some years past, from the registers maintained at chest
clinics. These remain the essential " tuberculosis registers."
The register serves two purposes. Firstly it is a compilation of the
known cases of the disease, something which is of importance in
epidemiological enquiries. Secondly it gives a figure which can be used
for statistical purposes as indicating the prevalence of the disease in the
district.
It has been seen that there were shortcomings in the previous register.
Is the new register more satisfactory, or has it too its own shortcomings?
In regard to the register being a list of names of those in the district
who have been notified by interchange of information between the
health offices and the clinics, the registers should be the same for the areas
common to both. This proviso is added because not all of an area is
necessarily served by the one clinic, while many clinics serve those living
in more than one sanitary district; but even to this extent the registers
will be the same only if the same rules of admissions to and removals from
are complied with. Now before 1952 the registers that were kept at
the chest clinics would in most cases be the working registers of clinics.
Although most of those living in the areas served by the clinics would
be urged to attend the clinics, or to take advantage of the home visits of
the clinics staffs, there would be many who for one reason or another
did not do so. It was the practice then at many chest clinics to remove
from the registers the names of those persons. If nothing has been done