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13
The gradual increase in the proportion of cases which have survived over five years (see Table III)
is probably an indication of the improved results of treatment. Modern surgical methods, the new drugs
(streptomycin, P.A.S., etc.), and the earlier detection of cases are responsible for some of this improvement.
Full employment and better nutrition have also played a part. Undoubtedly modern methods of treatment
have improved the prognosis in tuberculosis but one must not be too optimistic since included in the figures
of recovery may be cases which would not have been discovered previously and yet would have recovered
without treatment. The better prognosis may also result in an increase in the number of deaths in the
future, when the increasing number of cases over the past few years who have had their lives prolonged
with the new methods of treatment finally fail to make further progress. The new surgical methods
(including lobectomy) and the new drugs, have an unchallenged place in the treatment of tuberculosis and
should be provided for every patient who has the disease, but, by and large, the treatment of the moderate
and advanced cases remains disappointing and consequently efforts must be directed to the discovery of the
early cases and to the prevention of the disease.
B.C.G. vaccination is a useful preventive measure. Although the exact degree of its effectiveness has
not yet been determined, serious consideration should be given to its more extended use for T.B. negative
cases (particularly school leavers) in areas where the rate is high.
The best way of dealing with tuberculosis is to prevent it. The most important way of defeating
tuberculosis is by improving the standards of living, particularly in the reduction of the amount of overcrowding
and under-nourishment. There is an understandable tendency among research students to try and
discover the exact significance of overcrowding as compared with malnutrition. In this country there is a
higher correlation of tuberculosis with overcrowding, but the war experiences in other countries, particularly
Malta, reveal the importance of nutrition. In Malta the tuberculosis rates rose in 1942 and 1943 when the
island was almost completely cut off from food supplies, but they decreased again in 1944 when food
supplies began to come in, although of course at this time there was no improvement in the overcrowding,
which had been made worse by the destruction of dwellings. In practice, in peace-time, it is usually the
people who are overcrowded who are under-nourished as well; consequently the question resolves itself into
how to generally improve the standards of living, and not necessarily in concentrating on one aspect.
Occupation is also probably a factor, but there is no evidence that it is of any great significance in
Willesden. This may, however, be due to the fact that little research has been done on the effect of occupations
on the evolution of the disease.
The ward figures (see Table IV) again illustrate the importance of environmental conditions. Nine
wards show an increase in their rates and one (Mapesbury) an increase of more than 50 per cent. The
possible reason for the increase in Mapesbury has been discussed in the previous report: it had the largest
increase in population and the largest number of families in requisitioned properties. The ward with the
lowest rate (Cricklewood) had a pulmonary case rate of 1 per 1,000 as compared with the highest rate of
1.804 for the Carlton ward, where it was almost double. The wards with the lowest rates (Cricklewood
and Neasden) are those that are least overcrowded in the borough, while the wards with the highest rates
(Carlton and Stonebridge) are those with the greater number of families overcrowded. If the standards of
living in Carlton were raised in 1946 to that of the best ward, there would have been a saving in the years
under review of 24 lives and 61 cases; for the whole borough the saving would have been 150 lives and 326
cases. Since the treatment of tuberculosis is very costly, not only in medical treatment but also in production
and in lives, it is much more economical in the long run to spend the money in improving housing and
nutrition and thus preventing the disease.