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

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Willesden 1949

[Report of the Medical Officer of Health for Willesden]

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Table B

PULMONARY TUBERCULOSIS.

Period between Notification and Death—Years 1945.49.

Period between Notification and DeathPercentage of Total Deaths
194519461947194819491945.49
Not notified9.416.513.616.022.715.2
0.12 months41.739.534.134.125.735.6
1.5 years35.434.134.134.027.433.3
Over 5 years13.59.918.215.924.215.9
Total number of Deaths9691889466435

The percentages of deaths from tuberculosis without previous notification rose during the year; almost
50 per cent of the deaths took place within a year of notification.
It is impossible, on the basis of these figures, to estimate the number of people who contracted the
disease yet remained undiagnosed, thus spreading the infection to other people.
Numbers on the Tuberculosis Register. (See Table A).
But for the early war years, when the population was reduced by evacuation, there has been a steady
increase in the numbers on the register. The increase, however, is not a reliable guide, for it includes people
who contracted the disease outside the district and moved in, and excludes those who have recovered, and
those who contracted the disease in the district and moved out. It does, however, give an indication of the
number of people in the district who, at any one time, are suffering from tuberculosis, and the doubling of the
numbers on the register shows that there must be more active cases in the community today.
Number of Gases of Tuberculosis. (See Table A).
The number of cases detected during the year gives a better picture of the spread of the disease in the
district even though some people died undiagnosed, and some were notified but later proved not to be suffering
from the disease. It is presumed that these numbers did not fluctuate much from year to year.
The case rates remained stationary in the pre.war period 1936.39, but during the war rose sharply
because the resistance of the people to the disease was undermined by the stresses and strains of war. Overcrowding
is an important factor in the spread of the disease, and although the decrease in the population during the war
relieved overcrowding, the stresses and strains of war, especially in the periods of bombing, offset this;
consequently the case rates rose. The stresses and strains of war were followed by post.war difficulties. Overcrowding
was increased by the increase in requisitioning and the return of evacuees to accommodation reduced
by bombing. The lack of hospital or sanatorium accommodation helped to spread infection—more persons
had to be treated at home. In May, 1950, the waiting period for hospitals in Middlesex was: women 11 months,
men 9| months, and children 6 months.
In 1949, the number of new cases added to the register, other than those entering the district, showed
a welcome fall, but although 1949 was a favourable year and 1939 a bad year, the case rates in the post.war
period 1946.49 were higher than those of the pre.war period 1936.39.
Comparative Statement of Tuberculosis Case Rate 1936.39—1946.1949 (See Table C).
A study of case and death rates in the individual wards shows the effects of tuberculosis on different
classes of the community. The case rates rose in the wards where overcrowding increased because of the greater
return of evacuees and the reduction in the available accommodation by bombing and requisitioning. Carlton
and Mapesbury were particularly affected as they both had relatively big increases in their population, and
in addition, Mapesbury had by far the largest number of families in the Borough (347 out of 1,602) placed
in requisitioned property. Carlton, Kilburn and Kensal Rise Wards, which had appreciable reductions in populations,
with a consequent improvement in overcrowding, had a change in their case rates which compared favourably
with the rest of the Borough. These wards, together with Cricklewood and Brondesbury Park (two middle.class
wards) actually had a slight reduction in cases for the post.war period 1946.49, as compared with the pre.war
period 1936.39. Nevertheless, Carlton and Kilburn, together with Stonebridge and Roundwood Wards, which
had relatively small increases in the case rates in 1946.49, were still the worst wards in the Borough, for, in
spite of some improvement in the living conditions of the people, they still remained the worst overcrowded
in the Borough.
If, in the period 1936.49, the housing and living conditions in the worst ward, Carlton, had been raised
to that of the best ward, 131 people would have been saved from the scourge of tuberculosis; 84 in the period
1936.39, and 47 in the period 1946.49. Similarly, if the case and death rates for the Borough as a whole had
been raised to those of the best ward, 641 persons would have been saved, with a reduction of approximately
250 in the number of deaths. The treatment of these cases, which includes sanatorium and clinic provision,
and their loss to production, must have cost the community at least a million pounds. This money could have
been spent on the improvement of the housing and living conditions of the people with much greater profit
and with the relief of a great deal of misery and suffering.