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manifestations. The great obstacle in the past to the early
discovery of these cases has been the fact that patients have
rarely visited their doctor until confronted with symptoms, by
which time some 70% of oases are moderately advanced. It follows,
therefore, that improvement in early diagnosis with a corresponding
improvement in the recovery rate, must depend upon the recognition
of the disease before it has produced symptoms of impaired health.
The Ministry are now well aware of the importance of Mass
Radiographer and the National Association for the Prevention of
Tuberculosis issued their policy in this connection in January,
1942, but in point of fact we have practised in this Borough the
main features of this policy for some time, as reference to the
Annual Reports of 1939 and 1940 will testify. In this Clinic
every contact case, especially adolescents, has an X-ray examination
of the chest as a routine, and in 2,681 of those contact cases
6.75% have shown evidence of pulmonary tuberculosis in symptomless
subjects, as mentioned in the Annual Report for 1940. This work
is being continued in full measure.
We are continuing the X-ray examination of symptomless subjects
as above outlined, but it is to be hoped that when satisfactory
mobile mass radiography apparatus becomes more generally available,
it will be transported widely and bo available in this Borough as
part of a general health examination for the whole population.
This wider use of chest radiology will greatly assist in the
prevention and treatment, not only of pulmonary tuberculosis, but
of other forms of chest disease, such as cancer of the lung, cardiac
disease, etc.
THE ASSOCIATION OF WAR, INDUSTRY, LONG HOURS OP WORK AND
TUBERCULOSIS.
The close correlation between war, industry, long hours of work
and tuberculosis, has been strikingly apparent among the histories
of some of our cases and we are again learning that tuberculosis
provides a barometer of social conditions. The pre-war steady
decline In mortality has already been converted Into a rise, as the
figures throughout the country clearly show. The reasons are, of
course, not far to seek: fatigue, due to long hours of work, the
black-out interfering with ventilation, the problem of transport,
etc. are among the contributory factors.
Hours in the factory in excess of 60 a week lead to
absentee-ism from sickness and to a fall in production, as the
Industrial Health Research Board has frequently demonstrated.
That, at any rate, has been our experience, both in the cases
being discovered and the relapse cases.
THE NUTRITIONAL PROBLEM IN WAR-TIME.
In our view a healthy protective diet for the tuberculous
subject in time of war should include, broadly speaking, the
following factors:-
1. Milk - 2 pints Household milk may be used for puddings.
2. Vegetables - cooked in a little boiling, salted water:
potatoes in skin; raw vegetables - something raw every
day, e.g. finely shredded raw cabbage, sprigs of parsley, etc,
3. Meat, Cheese, Eggs Dried Eggs: Pull rations of these.
Fish especially herrings as often as possible.
4. National, Hovis, scofa Bread.
5. Bemax: 3 tablespoons daily.
These are the general outlines we have endeavoured to give to our
patients during the war period and ensures a well balanced diet
with a full supply of vitamins A B C D.
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