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There has been a notable rise in the number of new cases of tuberculosis diagnosed during this year - 67 as opposed to 49 in 1966 and 54 in
1967. This should reduce the unfortunate air of complacency which has dedeveloped towards this disease during the last two decades: the pool of
infection has by no means been eradicated and has been greatly added to
in our larger cities by the influx of Asian immigrants. Half of the new
cases seen in the clinic during 1968 were in immigrants to this country;
the figure was only 2% 15 years ago. In fact the British Tuberculosis
Association Survey in 1965 showed that the tuberculosis rate in Indians
in this country was 12 times higher than in the indigenous population and
that for Pakistanis 26 times higher.
In spite of this rise in tuberculosis the rate for lung cancer has
maintained its lead established in 1966 when for the first time there were
more cases of cancer than of, tuberculosis. There were 69 new cases of lung
cancer diagnosed at the clinic in 1968. There is no doubt that the country
is in the grip of an epidemic of lung cancer which will get worse before
it gets better. This is all the more tragic when it is realised that recovery is very rare and that the epidemic is largely man made, being
consequent upon compulsive cigarette smoking. If one further adds the
deaths due to chronic bronchitis, which is rarely seen in non-smokers, it
is a simple matter to compute that there is one death from cigarette smoking every 9 minutes, throughout the year, in the population of England
and Wales.
Increasingly the social services are involved with cancer and bronchitis rather than tuberculosis;treatment for the smoker's diseases is
only temporising, usually followed by chronic invalidism and death, while
that for tuberculosis, provided rigidly controlled in co-operative patients,
is routinely curative.
A particularly important diagnostic service provided at the clinic
for many years is the chest tadiography facility extended to General Practitioners. Miniature 100 mm.films of high quality are used and these are
dual read by the clinic physicians to reduce observer error. This is a
service of great value to both general practitioners and clinic staff: a
high proportion of abnormalities is discovered in this way.
Teaching duties and research activities of the unit remain unaltered:
although lung cancer must loom large in the programme, emphasis is still
placed on tuberculosis, not only because of its persistence in this country, but because many of the students come from areas of the world where
it is still the "Number one" killer disease.
Again, I must sincerely thank the clinic staff for another year of
cheerful and loyal co-operation.
Peter Stradling,
M.D., F.R.C.P.
C. 15