London's Pulse: Medical Officer of Health reports 1848-1972

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Greenwich 1937

[Report of the Medical Officer of Health for Greenwich Borough]

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In females, the early rise and sharp fall in the fourth decade
clearly indicate the risks which the changes of puberty and
adolescence and the stress of childbearing engender, whereas it
appears to be the hazards of employment which play an important
part in the male sex.
Symptoms.—Early cases are those in whom the disease is
usually unilateral and limited to part of one lobe and in whom
physical signs and constitutional symptoms are absent or minimal.
Late cases are those where both lungs are extensively involved
and in whom the physical signs and constitutional symptoms are
It is gratifying to note the greater number in the early category.
Note that cough is not a universal symptom. As symptoms,
lassitude, breathlessness, night sweats, wasting and digestive
symptoms, are all evidence of toxaemia only, and are not specific
for tuberculosis.
Hoarse voice is a late sign as one would expect.
Haemoptysis (spitting of blood) is a very valuable early sign
of tuberculosis when it occurs, as it quickly brings the patient to
his doctor.
Family History.—Note that of all cases a family history of
tuberculosis was elicited in under 40%. It thus appears that most
cases contract their disease outside the home, i.e., in public vehicles
or at work, etc.
Sputum Tests.—Less than half the cases had sputum tests
positive for tubercle bacilli, the majority having negative tests
or no sputum when first seen.
Physical signs.—It is noteworthy that in more than half the
early cases, physical signs were absent.
History of pleurisy.—Note the high incidence amongst the early
cases, indicating when present the necessity for early investigation.
Pulse rate.—In view of the commonly supposed acceleration
of pulse rate in incipient tuberculosis it was thought worthwhile
to investigate this possibility in the cases under review. It will
be seen that even in the early cases there is a noticeable acceleration,
and it is even very marked in the advanced cases. For comparison,
70 non-tuberculous cases were taken and an average pulse rate
obtained. It will be seen that the average rate in the early tuberculosis
cases is not markedly greater. It will appear therefore
that an increased pulse rate is present in early tuberculosis, but
the increase does not appear to be of a degree sufficiently great to
merit special comment.