London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1937

[Report of the Medical Officer of Health for London County Council]

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The mortality rates of the non-pulmonary patients classified according to the location of the disease are as follows :— Table 64

Location of diseaseTotalPercentage alive five years after dischargePercentage dead
Hip51 (42)94.1 (92.9)5.9 (7.1)
Spine62 (52)79.0 (73.1)21.0 (26.9)
Other bones89 (88)93.3(94.3)6.7 (5.7)
Glands186 (231)95.2 (93.1)4.8 (6.9)
Other parts37 (22)86.5 (90.9)13.5 (9.1)

Of the 389 surviving non-pulmonary patients, 158 were at school and 144 at
work.
The pulmonary class A (i.e., T.B. minus) patients have again been the subject of
inquiry in some detail by Dr. F. J. Bentley, divisional medical officer.

During 1932, 136 T.B. minus children were discharged from residential treatment. In seven instances the diagnosis was not confirmed during subsequent supervision and these are omitted. Of the remaining 129, the following results are noted five years later:—

No.Percentage
Alive10682.2
Dead107.7
Untraced1310.1
Total129100.0

As regards the 10 children who were ascertained to have died by the end of the 5 year period,
detailed inquiry has again confirmed the opinion that the commonly encountered childhood
type of pulmonary tuberculosis fares favourably, and that children who die within five years
from the date of receiving treatment for pulmonary tuberculosis are either acutely ill when under
residential treatment or suffer from the adult type of the disease with definite lesions of the
lung substance, or that they succumb to some other illness.
The following are short notes relating to the 10 patients who died from pulmonary tuberculosis,
indicating the condition found whilst under residential treatment:—
(1) Infiltration middle zone ; haemoptysis ; treated as adult with positive sputum
4 months later.
(2) Acute bilateral caseating tuberculosis.
(3) Widespread disease with cavitation.
(4) Involvement of two lobes of left lung and one lobe of right.
(5) Deposits upper part of right lung.
(6) Deposits upper parts of both lungs ; T.B. plus a few months later.
(7) Infiltration in two lobes.
(8) Both upper lobes involved ; T.B. plus in following year.
(9) Left apical striation and diminished translucence.
(10) High fever ; acute, advanced pulmonary disease.
It will be seen that with the exception of case no. 9, no child died of pulmonary tuberculosis
who was not at the outset either seriously ill or found to be suffering from gross pulmonary
involvement.
Of the 106 traced survivors, as many as 100 (94 3 per cent.) are well and at full work or school,
while 56 have already been removed from the tuberculosis registers as " recovered."
The subsequent history of the children who suffered with pleural effusion is of interest.
During 1931, 39 children were discharged after treatment for this condition. Patients recorded
as " pleurisy " and " thickened pleura " are not included. Of these 39 patients, only 8 were
females. Five years later one child could not be traced, but this child was well and at work a
year previously. Of the remaining 38, no less than 23 were already (at the fifth anniversary
from discharge) marked off the tuberculosis registers as " recovered," thus signifying uninterrupted
quiescence since discharge. Of the remaining 15, 8 were arrested, 4 were quiescent, two
were not attending the dispensary, while one was under residential treatment for debility.
This last child is marked " arrested " in 1938, and is in full work as a shop assistant. Only one
other child besides the one just referred to underwent a further spell of residential treatment
for tuberculosis after discharge in 1931. Out of the total 39 patients who suffered from pleurisy
with effusion, 38 were well and at full work or school at the end of five years. These results
demonstrate that the prognosis in cases of children who are treated for pleurisy with effusion
in the absence of any other sign of lung involvement is extremely favourable.