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half per cent, of all male deaths over 45 were due to carcinoma
of the bronchus compared with 2.6 per cent, for tuberculosis.
The public health aspects of tuberculosis control continue
to exercise the minds of the Medical Officer of Health and the
Chest Physician. The Public Health (Prevention of Tuberculosis)
Regulations, 1925, make it an offence for any person who
is aware that he is suffering from tuberculosis of the respiratory
tract to enter upon any employment or occupation in connection
with a dairy which would involve the milking of cows, the
treatment of milk, or the handling of vessels used for containing
milk. What is equally important, however, is the routine X-ray
examination of all shopkeepers and others who are in frequent
contact with the public, especially where children and young
persons are concerned.
It is now the policy of the Clinic to give long term ambulatory
chemotherapy to patients whose lesions may be considered to
be in the least bit unstable. In other patients who are known
to have chronic disease and may become intermittently infectious
we have endeavoured to give them ambulatory chemotherapy
for as long as two years. The admission rate to sanatoria
continues to be high and fortunately there is now no waiting
period. Because of the policy of long term chemotherapy many
patients return home and subsequently to work much more
quickly than they would have done in the past and the rate of
turnover of beds in chest hospitals and sanatoria has correspondingly
increased. The benefits of surgical treatment are
now becoming obvious to most patients and rather than have to
persuade patients to go into hospital for surgical treatment,
many on their admission now ask if they cannot be treated by
surgical means rather than undertake a prolonged stay in bed
and gradual up-grading. The results of the long term chemotherapy
combined with the patient's realisation of the benefits
of surgical treatment must all help to accelerate the decline of
the disease but only by complete co-ordination of the preventive
and clinical side of chest medicine can the disease finally be
eradicated.
I should like to thank the Medical Officer of Health for the
whole-hearted co-operation of his departments both in the
Town Hall and in the London County Council Divisional Office
and also the various voluntary and nursing organisations who
have helped with domiciliary treatment. A special word of
thanks is due to the London County Council Ambulance Service
for the way in which they bring patients to the Clinic and also
take them to hospital for admission and for chest X-rays.
KENNETH MARSH,
Consultant Physician.