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

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London County Council 1950

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

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85
of producing identifiable tubercle bacilli, it is disturbing at tuberculin surveys to find
that 10 per cent, of London children at their fifth birthday have already met sufficient
infection to develop allergy and a positive tuberculin reaction. There is evidence that
the "minimal" and the "sputum negative "lesions are more infective than we have
hitherto believed.
Mortality from tuberculosis at all ages has fallen steadily during the past
century. This reduction has been most manifest in infancy and among nonpulmonary
infections. The age group 5-14 years has always in lung cases shown a
higher mortality rate among girls than among boys and this preponderance has also
become manifest in recent years in non-pulmonary cases.
London's cfiaracteristics affecting its tuberculosis epidemiology
The fact that it is the largest conurbation in the country exposes London to a
special disadvantage in sickness mortality. More than that, the daily working
population is considerably greater than the resident population so that the working
Londoner is exposed to tuberculosis infection not only from his fellow citizens but
also from an almost equal number of non-Londoners who come into town to work
or shop by day or to be amused in the evenings. Migration into and out of London,
and between its boroughs, goes on to a much larger extent than in most other towns,
especially as the result of housing programmes.
War-time "evacuation" and deaths of Londoners, many in air-raids, decreased
the civil population from over 4 million in 1938 to less than million during 1941-45.
By 1950, the population had risen to 3,389,620. A large number of London dwellings,
hospitals and other buildings were very severely damaged as a result of war-time
bombing. A post-war housing survey undertaken in Holborn in 1947 disclosed that
nearly one-third of the inhabitants of that Borough were living under conditions of
gross overcrowding.
There has been a steady growth of industrial and commercial buildings in
London at the expense of dwellings which tend now to extend upwards, thereby
increasing the population per acre of built-up areas and the occasions on which
they meet and pass and exchange bacterial exhalations.
London is unique in its richness in hospitals of all kinds. These better facilities
make for more accurate diagnosis and contribute to a higher incidence of discovered
cases of tuberculosis, especially of the non-pulmonary types. There is a growing
"coloured" population with a rising incidence of tuberculosis among them. There
appear to be greater opportunities in London for social mobility between classes,
particularly in an upward direction. The children of unskilled labourers tend to
become semi-skilled assemblers or machine operatives with better wages and
standards of living. The children of artisans and shopkeepers strive to enter the
professions. This "upgrading" of social classes must have a beneficial effect on the
mortality rates of diseases which reflect social class influences. The 1951 Census
will show to what extent such social class change has happened. Rising living costs
and the opportunities offered by increases in the numbers employed in distributive
trades, light engineering, wireless assembly and in restaurants and " snack bars,"
attracts much larger numbers of women into industry with consequent increased
exposure to infection. It has been suggested that married women who are gainfully
employed (in addition to housekeeping) have a higher risk of tuberculosis than single
women of the same age, though married women who are not working have a lower
incidence than single women. There have also been suggestions that sacrifices made
by mothers to make the rations "go round" have had their effect on tuberculosis
mortality in women of the older age groups. Whatever force there may or may not
be in these suggestions it is certain that the differential tuberculosis mortality and
morbidity of men in comparison with those of women (at least in the industrial age