View report page

124
large proportion of cases, and in a lesser degree to the reluctance
of the average man to seek medical advice until he is so ill that
he can no longer carry on with his work.
Frequently we meet cases with no cough, no loss of weight, no
loss of appetite or any of the other symptoms that we usually
associate with tuberculosis, yet on examination reveal wellmarked
disease. Lucky is the man whose onset of disease is
accompanied by a haemorrhage. He may be alarmed at the time,
but he is almost certain to seek medical advice, when there is a
very good chance of his obtaining a cure.
How to secure earlier diagnosis is one of our greatest outstanding
problems. I am satisfied that the general practitioner is
playing his part, as he does not hesitate to send doubtful cases to
the Dispensary for a further opinion, and it is no fault of his that
a patient does not seek his advice until the disease is well advanced.
In the case of contacts a fair percentage present themselves for
examination at the Dispensary, while others are sought out at
their homes. In cases other than contacts, patients delay seeking
advice for the simple reason that they often do not feel ill. We
cannot search for these ourselves, unless we undertake the
stupendous task of periodic examination of the whole population.
Tuberculosis is, however, largely a disease of adolescence, and
probably an effective medical supervision of this age period, which
has not showed a decline in the mortality rate to the same extent
as other age groups, would bring to light cases of tuberculosis in
an earlier stage than would otherwise be possible. As I have
previously pointed out, this age period is neglected by the State,
and I was pleased to note that attention was drawn to this fact
at the last annual meeting of the National Association for the
Prevention of Tuberculosis. The Infant Welfare Centres and
School Medical Service between them undertake the care of
children up to the age of 14. At this most critical period of their
lives, growing boys and girls go out into the world, often into
unsuitable and unhealthy occupations with no supervision of any
kind. The rush and competition of modern life demand their toll
and should this lead to the onset of tuberculosis, the natural
independence of youth deters them from seeking advice until the
disease is well established.
We must not be discouraged, however, by the gloomy outlook
I have presented, of what is, after all, only one of the many aspects
of the question, but rather take heart when we review the results
of the anti-tuberculosis scheme as a whole. A few figures showing
the decline in the mortality from tuberculosis in recent years
should prove a pleasant antidote. Perhaps I cannot do better
than quote from the speech of the Minister of Health in July last
to the National Association for the Prevention of Tuberculosis :—
" In 1898, the year the Association was founded, 41,335
persons died from pulmonary, and 12,447 from other forms of