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it is second only to rheumatic disease in the average duration of
stay, namely, 28.8 days.
The tragedy of this distressing situation is that the bulk of
these deaths and the permanent disability so often preceding
them are the direct or indirect results of cigarette smoking, the
elimination of which could reduce the enormous physical and
financial burden being carried by the country's medical and welfare services. Assimilation into the circulatory system of oxygen,
that indispensable commodity without which life is impossible, can
be effected only by means of the lungs and yet the defiling of
these organs on such a large scale merely demonstrates a human
capacity for self-immolation. Indeed, it is arguable whether such
self-inflicted respiratory disability has a moral right to preferential
treatment despite its serious nature.
Over the years man has learned to release nature's stored
energy to modify his surroundings but in such a way that he has
polluted his environment—a mistake which, at very great expense, he hastens to rectify. Certainly Britain has the reputation
of being a country with the ever-burning hearth which, together
with its damp climate, constitutes a constant and serious respiratory hazard to the very young and the very old. Lung cancer and
bronchitis rates are higher in towns and cities than in rural areas,
suggesting that air pollution adds to the problem of chest infections. This postulation was substantiated by the "smogs" of 1952
and 1958/9, when a combination of atmospheric conditions produced heavy death tolls from respiratory causes and which the
Clean Air Acts now seek to remedy.
Nevertheless, despite improved environmental conditions, an
ageing population is much more susceptible to chest infections
particularly in those instances where there is financial hardship
leading to enforced dietary deficiencies and restricted home heating. Moreover, diabetes, stroke or cancer, often the concomitants of old age, also pave the way for pneumonia and, in other
conditions where cytotoxic drugs or cortisone are the selected
forms of treatment, pneumonia can advance insidiously because
of absence of prodromal symptoms.
Between the two World Wars it was recognised that some pneumonias differed clinically from the ordinary bacterial kinds such
as the pneumococcal and streptococcal types and were, as such,
referred to as primary atypical pneumonia. Subsequently, as a
direct result of progress in microbiology and virology, various
rickettsiae and viruses were revealed as causal organisms.
Certain viruses which appear to have a predilection for the
young include the respiratory syncytial virus and the pera-influ-