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It is difficult to know exactly how many unreported cases of tuberculosis
chere are; but we can guess at the probable number. The mass radiography
unit has twice visited the Borough. The surveys have revealed one case of
clinical tuberculosis per 1,000 people examined, which is much below the
national average. The national average is about three or four persons per
1,000. We should therefore expect about 300 cases of clinical tuberculosis in
this Borough who are unknown, of whom about 150 will be infectious to others.
To these we can add the number of known cases which is about 1,100 of whom
about 100 are infectious to others. This gives a total of about 1,400 cases in
the Borough of whom about 250 are infectious to others. Thus, probably
anything up to 250 people are about, spraying the germs of tuberculosis
wherever they go, and infecting susceptible people especially young adults.
Every year these infectious persons pass on the disease to an average of 100
other people, so that we get our 100 new cases per year.
In addition to all of these clinical cases nearly all of us have had tuberculosis
in a non-clinical form some time in our lives. We can tell whether a person has
reacted to tuberculosis infection by using a test in which a tiny amount of
tuberculous material is injected into the arm. If in a few days a red area
appears we know the person has been infected. The procedure is quite safe
and in one form is known as the Mantoux reaction or test. A very few children
under five react; about 20 per cent at age 15 and about 70 or 80 per cent of
young adults from about age 20 onwards.
Most persons get tuberculosis by breathing in the germs carried in the
breath of an infected person during talking, coughing and sneezing; or by
breathing infected dust as from the room an infected person has occupied. A
few cases originate by drinking or eating material which is infected with
tuberculosis, especially milk. Now the more often anybody comes in contact
with large numbers of the general public then the greater the chance he or
she stands of being infected by an infected individual. The same thing applies
to the length of time the person is in contact with the patient. The child in a
household which contains an infected person, perhaps father or grandfather,
will stand a far greater chance of being infected than another child in an
infection-free house. The risk will be even greater where the persons are on
top of each other as in overcrowded houses. The risk is greater in those
occupations where individuals come in contact with large numbers of people as
in some factories, shop assistants, cloakroom and cinema attendants, and
especially doctors and nurses in contact with large numbers of sick people.
The other factor which influences the probability of contracting tuberculosis
is the soundness of the diet. When people are well fed on high protein and
vitamin diets their resistance to infection is greater, and they do not succumb
nearly so readily as people whose diets consist mainly of starchy foods. We
noticed this especially during the first world war and during the first two years
of the second world war when the rates of incidence went up enormously. It
is thus not surprising that we iind the largest number of tuberculous people in
overcrowded houses, with poverty, with bad nutrition, with industrial risks,
or in smoky atmospheres and towns.
In order to find the infectious people who are spreading the disease we
ought to have a mass X-ray unit permanently stationed somewhere in the
Borough with reasonable ready access for everybody. The West Middlesex
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