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being over 26 consultations per 1,000 patients per year. Progress
of this disease is insidious with a gradual loss of respiratory
efficiency and by the time a patient is compelled to seek medical
assistance, the lung damage is often severe and irreversible.
Lung cancer and bronchitis are more frequent in towns and cities
than in rural areas and this suggests that some additional factor is
present in the conurbations. Atmospheric pollution is an undeniable
environmental hazard in the production of respiratory disease and
this was amply demonstrated in the "smogs" of 1952 and 1958/9
and which the Clean Air Act seeks to remedy. Prevention lies in
the acceleration of nation-wide smoke control including a sustained
effort to reduce harmful products of combustion emitted from motor
vehicles.
Asthma, hitherto not considered a respiratory disease, is one of
the disorders about which we know very little and which has not
had the attention it warrants, although the introduction of the new
steroid drugs into its treatment has saved many lives.
Previously, we had considered that relief of spasm, sufficient to
re-establish normal lung ventilation, was all that was needed but we
are now learning that the removal of airway obstruction does not
automatically enable more oxygen to be taken up by the blood.
It has been found that it takes a matter of days for blood oxygenation
to become normal. Without reducing "allergy" research it
seems that we must get to know more about "lung functions" and
its complex blood supply before we can control this disabling
malady which creates so much misery and disablement.
Many other respiratory infections defy identification but, today,
some of these are known to be caused by a pleuropneumonia-like
organism now officially designated as a mycoplasma. Such
organisms, which stand somewhere between the bacteria and the
viruses, possess some characteristics of each and it is perhaps within
this sphere that our hopes for real improvement in the control of
chest infections lie. But when, despite thorough investigation, many
chest infections remain unidentified, preventive measures inevitably
become circumscribed.
Venereal Diseases
The term "venereal" is given to a group of diseases acquired
during sexual intercourse of which, in England, syphilis and gonorrhoea
are the most common. Other complaints, usually acquired
sexually, such as non-gonococcal urethritis and trichomonal
infection have recently been taking progressively more of the
venereologist's time but, fortunately, although in some instances
these can produce serious complications, in the main they do not
present the difficulties associated with syphilis and gonorrhoea.