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with the view of a local practitioner who investigated this problem some time
ago. He came to the conclusion that nearly all these children lived in families
where there was an adult with an infected nose, or an infected nasal cavity,
or chronic nasal catarrh of some sort. The children thus live in an atmosphere
of heavy infection and unless they are well fed and able to establish good
resistance they succumb to the chronic reinfection time and time again. The
situation is parallel to the household in which the elderly man with open tuberculosis
spreads his infection to the children; similarly in the case of the
staphylococcus, the nasal carrier also spreads his infection to other people in
the house. We are reminded once again that the family is a unit and in
considering what happens to one member we should have regard to the state of
affairs of the whole.
1 Williamson, P. (1956) G.P. 13. 85.
TUBERCULOSIS
Elderly Men.
There are more deaths from tuberculosis in men than in women after the
age of 50. Notifications in the older age groups have been gradually rising
during the last few years. The explanation why men suffer more than women
is not easy to find. It may have something to do with their constitutional
make-up. Frequently in older men tuberculosis is combined with chronic
bronchitis and with restriction of movement of the chest. A great many of
these men are infectious and spread tuberculosis germs in coughing, talking,
and sneezing. In such households there is an obvious risk to children, especially
where they are left in the care of grandfather. In elderly people, cough,
shortness of breath, indigestion and lassitude are often regarded as being natural
to old age. Miniature X-ray radiographic units should be readily available in
all parts of the area to give diagnostic opinions to practitioners who need them.
We need an effective campaign to search for these infectious cases which are
the reservoir of tuberculosis in our towns.
The End of an Epidemic.
Some people are now saying that they see the end of the tuberculosis
epidemic which began in the fourteenth or fifteenth century, rose to a peak in
the nineteenth century, and is now said to be dying out. It is said that tuberculosis
has been conquered because whereas in 1938 there were 25,000 deaths
in 1955 there were only 6,500 deaths ! Suppose the whole disease were concentrated
in Twickenham, then in 16 years the whole town would be wiped out
and completely devoid of population. There is no cause for complacency here.
There is no diminution at all in the number of notifications year by year. In
Twickenham it is always about 100; in the whole country there were 40,000
new cases in 1936 and there were 40,000 cases in 1954 just the same. One reason
for the reduced mortality is the success of the new antibiotic drugs. Formerly
we used to have tuberculosis officers who were concerned with the epidemiology,
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