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thousand) in men occurred in the age group over 45 while in women (at 1.48 per
thousand) it was in the 15-44 years old group. The lowest incidence rates occurred in
the males aged 5-14 years and in females after 45.
Geographically the highest notification rates were in Deptford, Holborn, Camberwell
and Stepney, the lowest in Stoke Newington, Hackney, Hampstead and Chelsea.
Using a standard sensitivity test on groups of 13 year old children (not in contact
with known cases) highest positive tuberculin rates were found in those attending
schools in Shoreditch, Westminster, St. Marylebone and Hampstead, while schools
with lowest rates were in Hackney, Holborn, Lewisham and Fulham.
Tuberculosis death rates for all ages were highest in the City of London, Finsbury,
Holborn and Shoreditch. Lowest mortality rates occurred in Stoke Newington, Greenwich,
Hackney and Kensington. During 1955 no female under the age of 15 and only
three of that age among males died of tuberculosis of the lungs.
The highest rate of mortality in both sexes was in the over 45 years old, but the male
rate in this age group at 0.66 per thousand was six times as high as the female rate.
Among the various occupations pursued by London men newly notified, the highest
rates occurred in those classified as unskilled workers of all kinds, those engaged in
agriculture and horticulture and among retired persons (see Table T.9).
The largest total number of new cases (418) came from unemployed men followed
by 235 cases among transport workers.
New cases among defined groups of employed women showed highest rates of
notification in textile workers, wood and cane workers and unskilled workers. The
largest total number of female cases occurred among housewives (692 cases) followed
by clerks and typists (212 cases).
Nearly half the newly notified adult male lung cases were infective and exhaling
tubercle bacilli at the time of diagnosis.
Some fifteen thousand contacts of the 3,624 newly diagnosed cases during the year
were investigated and yielded a further 271 cases of tuberculosis.
The rate of discovery (1.9 per cent.) of new cases among contacts of recently notified
cases is more than 10 times that (0.11 per cent.) in the population as a whole.
Young children are usually infected from within the family circle while young
adults are infected mainly at work or among companions in recreation.
Principles in the control of tuberculous infection
Control
It is clear from what has already been stated that certain principles can be expressed
as the basis for applying measures designed to reduce the number of persons infected
by tuberculosis from developing disease after infection, transmitting such disease to
others or succumbing to the disease.
(i) To reduce infection in the community
Pasteurisation of all milk sold in London is now a compulsory practice but this does
not prevent unpasteurised infected milk from being drunk in places where such a
statutory regulation is not in force.
Since most infection is acquired from infectious human beings it is manifestly
necessary to keep uninfected persons who are the susceptible group of the population
from contact with known and unknown infective cases. This however in a densely
populated urban area is not really entirely practicable. Crowded housing conditions
are still far commoner than is healthy.
The children of known cases can be segregated from the infective household only
for a limited period. In practice most children of an infective new case are already
infected (though not yet necessarily diseased) by the time the index case is diagnosed.
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