Annual report of the General Board of Control for Scotland : 1923.

Date:
1923
Catalogue details

Licence: In copyright

Credit: Annual report of the General Board of Control for Scotland : 1923. Source: Wellcome Collection.

    30/408 (page 24)
    It must be realized also that complete mortality returns do not reach our office until the end of each year. In our opinio p, the periodical notification of infectious diseases, and of other morbid conditions where, from time to time, knowledge concerning incidence appears to be desirable, has proved of sufficient value to justify continuance, and we would accordingly welcome any suggestions that would tend to render them still more reliable. Errors in diagnosis, sometimes unavoidable, especially in places where laboratory facilities are imperfect, can be corrected subsequently should post-mortem or other evidence reveal conditions not recognized at the time of notification. It is better that notifications should be amended when necessity arises rather than that our figures should remain even to this small extent unreliable; adequate office provision has been made for any corrections that may be necessary. Tuberculosis.—The new cases of this disease, notified to us as occurring in county and borough mental hospitals between 1st January and 31st December, 1923, totalled 1,288, being 12- 6 per 1,000 of the daily average number of patients resident. This is a very marked diminution as compared with the corresponding returns published in our last Report, which showed 1,683 cases occurring during 1921 in a smaller population, with an incidence rate of 17*1 per 1,000. The total incidence among the stall was very small—only 14 men and 17 women, being about 1*5 per 1,000. Although perhaps not so extreme as noted last year, com¬ parison between individual mental hospitals still shows a marked variation in the incidence of the disease, probably too great to be explained by locality or character of population. In some cases the proportionate incidence for 1923 is as high as 35*5, 29 °6, 26-7, 24*6 and 24*5 per 1,000 persons resident, and, on the other hand, in institutions of similar size and character of popu¬ lation, as low as 8- 8, 8- 7, 6- 7, 5- 7, and 5- 3 per 1,000. Variations m incidence must, of course, be anticipated year by year in different institutions; but this fact appears insufficient to explain the high and low incidences above mentioned, seeing that the institutions to which they refer in all cases occupied a similar position amongst the high and low last year. There are other instances of disparity also, less marked, but still definite, that* justify the suggestions that some undetermined factors materially affect incidence adversely in some institutions and not in others, and that close enquiry with a view to their recognition is desirable. is necessary to determine whether the incidence of tuberculosis m mental hospitals (at least 7 or 8 times greater than in the general population, notwithstanding recent reduction) is unavoid¬ able if not, what are the causes that predispose to such undue mcir ence, and how can they be removed. Are the mental and physical peculiarities of patients entirely responsible; does intramural ward infection constitute an important factor, or are average mental hospital dietaries so deficient in essential food