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74
entry to the body. It is estimated that of the total number of
children affected by measles each year some 20,000 will suffer from
residual respiratory complications.
Statistics concerning infant morbidity and mortality reveal that
bronchitis and pneumonia come a close second to congenital malformations
in the causes of death and, in connection with childhood
consultations in general practice, respiratory illness heads the
morbidity list.
Another environmental factor important in the pathogenesis of
respiratory disease is air pollution. It is known that airborne
particles can be the precursors of industrial diseases such as
pneumoconiosis but it is becoming increasingly recognised that
some can initiate immunological responses in tissues to produce
pulmonary lesions and obstructions.
Efficiency of lung function depends upon the intimate contact of
its huge surface area with the environmental atmosphere but its
protection from the finer particulate and soluble contaminants is
relatively poor. The necessity, therefore, for an effective smoke
control policy by local authorities is self-evident.
Problems confronting respiratory medicine are legion and they
can now be seen to concern a wide range of scientific disciplines.
Because many respiratory infections defy identification, treatment
is almost solely confined to the discriminatory use of antibiotics.
Our hopes for speedier and more accurate diagnosis in the future
depend to a large extent on greater use of the electron microscope
and immunofluorescence. As yet no remedies exist for the treatment
of the viral diseases. So far, in this field, success has been
limited to immunising procedures in respect of selected types.
However, the greatest single preventive measure with regard to
respiratory diseases is already in the hands of the public. It is for
health education authorities to convince people that abstinence
in terms of cigarette smoking, is not only to their advantage financially
but will also lead to a fuller, healthier life.
Rheumatic Diseases
The seriousness with which the department views rheumatic
diseases is not new. Even as far back as 1938 a scheme had been
drawn up for the establishment in this Borough of a "rheumatism
clinic" and it had also been decided to recommend to the Ministry
of Health that manifestations of acute rheumatism in children up
to 16 years should be made compulsorily notifiable. Unfortunately
the 1939/45 war intervened and the subsequent introduction of the
National Health Services Act of 1946 rendered void the necessity
for local authority schemes.