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23
TUBERCULOSIS
The figures relating to the control of tuberculosis in St. Pancras in 1945 do not show
many marked changes when compared with those of the previous year and though a
comparison with the year immediately preceding the war reveals certain very marked alterations
the adverse effect of war conditions—some of which still persist—has certainly been less
than might have been expected.
The total deaths from tuberculosis in 1945 (127) are slightly less than they were in 1938
(133) and though there was a marked rise to 160 in 1940 and 147 in 1942, these peak years
were followed by a fall which in 1943 produced the lowest number of deaths (117) ever recorded
in St. Pancras. Although these figures are not strictly comparable owing to changes in the
population, they are likely to be more reliable guides than the crude death rates because the
tuberculous population did not diminish by evacuation and calling up in the same way as the
general population.
The notifications of tuberculosis in 1945 (337) also show a slight decrease compared with
1938 (365). During the war the annual figures were all lower than they were in 1938 or 1945
except in 1944 when it rose to 356. This recent rise may be partly the effect of war conditions
but may also be due to the increase in the use of X-rays for the detection of early cases
especially in the Forces where the tendency is to discharge and notify anyone suspected of
being tuberculous though it is by no means certain that the disease is active. Even some of
the active cases discovered by this means might otherwise have escaped notification altogether
since it is well known that tuberculosis may in some circumstances heal itself without special
treatment and without the patient being aware of any illness. The numbers of tuberculous
persons on both the notification and on the dispensary register have shown a steady rise in
numbers during the war years, the respective figures in 1938 being 964 and 813 and in 1945,
1,119 and 845. The notification register includes every person known to be suffering from
tuberculosis in the Borough; the dispensary register includes only those who have actually
attended the dispensary or had institutional treatment during the past two years. The
numbers have increased mainly because of a tendency during the war not to discharge patients
as cured. Usually this is done in the case of lung disease at the end of five years and of
disease in other parts of the body at the end of three years provided that during these periods
there has been no sign of activity; but war conditions seemed to justify prolonging this supervision
especially as it includes the provision of priority milk and other advantages which might
make all the difference in preventing a relapse.
Prolongation of supervision has led to an increase in the annual number of attendances
which fell to 2,825 in 1941 and has risen in the year of this report to 3,843, a figure which has
not been exceeded since 1928. Other causes have, however, contributed to the increase. One
of them is the need to obtain a certificate for priority milk which is undoubtedly responsible
for the more regular attendance of some patients. Another is the considerable increase in the
patients sent to the dispensary for diagnosis either by General Practitioners, Medical Boards
for National Service, or the Mass Radiography Units. This is shown by a comparison of the
number not diagnosed tuberculous in 1938 (257) with the number not diagnosed tuberculous
in 1945 (428). The number diagnosed tuberculous has on the contrary shown a decrease from
247 in 1938 to 216 in 1945 and it is to be hoped the increased tendency to refer suspected cases
to the dispensary has led not only to an increase in the work carried out there but also to the
diagnosis of the disease in an earlier stage when it is more amenable to treatment.
Associated with the preceding developments there has been a very marked increase in
the use of X-rays and of artificial pneumothorax treatment in recent years. X-ray examinations
have risen from 377 in 1938 to 982 in 1945 and artificial pneumothorax refills have risen from