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15
In contrast to the steady pre-war decline there was a sharp rise in mortality in
1940 and 1941, mainly due to the impact of the hard conditions of war on existing
advanced cases. For this reason the rise soon exhausted itself: it reached a peak
in 1941 at a level of about 70 per cent, above that of 1938 (72 per cent, for pulmonary
and 67 per cent, for non-pulmonary disease). Subsequently the mortality has fallen
at a gradually increasing pace, and in 1946 the death-rates for both pulmonary and
non-pulmonary tuberculosis were just below the corresponding rates for 1938.
The rate of occurrence of new cases of pulmonary tuberculosis (including noncivilians)
rose by nearly 50 per cent, between 1938 and 1941, and remained at that
level until the end of the war when it began to fall. The 1946 rate, 1-57 primary
notifications per 1,000 total population is still 23 per cent, above the rate for 1938,
and corresponds roughly to the level to which it had been reduced in the late
"twenties." The war-time increase in non-pulmonary tuberculosis, 25 per cent.
between 1938 and 1942, was not so extensive as for pulmonary tuberculosis, and the
1946 rate is the lowest hitherto attained.
A detailed review of the causes of the increased war-time incidence has already
been published*. Consideration of space prevents complete recapitulation here,
but the main conclusions were:—
(1) At ages over 25, males were more affected than females in the
initial war-time rise. Below 25, it appeared that there was no conclusive
evidence that one sex had been more affected than the other, though there
was a suggestion that at very young ages the increase was greater in boys
than girls.
(2) The increase in non-pulmonary tuberculosis occurred almost
equally in all the principal sites, except in abdominal tuberculosis, in which
the increase was significantly lower.
(3) New cases of pulmonary tuberculosis increased more in adults
than new cases of the non-pulmonary disease. This fact, coupled with the
evidence of site distribution for non-pulmonary forms in children, suggested
that contact and droplet infection had been an important feature in
London.
(4) There was evidence both that pasteurization of milk had held back
the spread of bovine infections, and that the principal infecting source was
human.
(5) Factors influencing the incidence of tuberculosis included changes
in the age and sex distribution of the population as a result of evacuation
and of recruitment to the Forces, the strain and overcrowding resulting
from bombing, fatigue and lack of rest, restriction of diet, and, on the other
hand, increased employment and financial resources for those formerly on
the verse of do vert v.

Food
poisoning
The following information has been supplied by the Ministry of Health.
In 1946, 14 outbreaks of food poisoning in the county of London were reported
to the Ministry of Health by the medical officers of the metropolitan boroughs. The
number of persons suffering from illness as a result of poisoning was 376 in twelve
of the outbreaks, in the remaining two outbreaks the number of persons affected was
not specified. No fatal cases were reported.
• B.M.J. 1942. ii. 417 and 1943. ii. 712.