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Clearly, overcrowding and poverty must be relentlessly attacked if we are to conquer tuberculosis.
Our main weapons of attack must be : improving the resistance of the population, detecting cases earlier,
and preventing spread to susceptible contacts. There is no question that it is more economical in the long
run to spend money on improving housing and nutrition and thus helping to prevent tuberculosis, than to
spend money on modern methods of treatment, which are so costly, particularly when hospital or sanatorium
is required.
The role played by bad factory conditions and dust at work has not yet been studied in Willesden.
Another way of increasing resistance of the people is by B.C.G. vaccination. Admittedly, the exact
effect of B.C.G. has not yet been determined and there are some contradictory reports on its value, but
it certainly has helped to raise the resistance of children and tuberculin.negative nurses. After all, typhoid
vaccination and diphtheria immunisation proved their value even though the exact degree of their effectiveness
has not been determined yet.
In this country, where the incidence of tuberculosis is relatively low, selective B.C.G. vaccination
must be the rule. Already vaccination is carried out in child contacts and susceptible tuberculin.negative
nurses. Surely there is an unanswerable case for the vaccination of susceptible tuberculin.negative school.
leavers to protect them before they enter the age groups which have an increased incidence of tuberculosis,
due in the main to the stresses and strains of adolescence, the more arduous work and travelling in
commerce or industry, and the greater risks of contact with infectious cases.
As it is difficult to detect tuberculosis in early cases without X.rays, it is essential to have the general
practitioners acting promptly in referring patients with suspicious symptoms to the chest physician. Meetings
of general practitioners are held at the local hospital where the chest physician demonstrates the results
of early diagnosis and treatment.
Mass miniature radiography for special groups is also important. An attempt was made to use
M.M.R. for detecting cases in five wards with the highest rates (Carlton, Kilburn, Roundwood, Harlesden
and Church End); Stonebridge was deliberately omitted because it included the factory area where there
had been M.M.R. surveys in the past. School.leavers were also offered the opportunity of being X.rayed.
Two units were set up at Kilburn Grammar School and Roundwood Social Centre during the Easter
holidays. The first two days were devoted to examination of school.leavers, teachers and domestic staff, and
the rest of the period (7 days one unit and 13 days the other) was reserved for the public. To achieve a good
response a widespread publicity campaign was undertaken (see page 13) and the local authority and regional
hospital board contributed £50 each towards it.
The total number X.rayed was 6,135, 83.4 per cent, of the capacity of the units (7,350); 1,490 were
school children, about 75 per cent, of the school.leavers. A better response could probably have been
obtained from school children if their fares had been paid. The school.leavers were also tuberculin.tested,
but no accurate comparison can be made with the previous results obtained in the national survey in 1949,
when methods were somewhat different. Since only about 10 per cent, of the adult population in the
wards were X.rayed, it is quite likely that those suffering from unsuspected tuberculosis did not attend
for X.ray.
Of the 4,645 adults X.rayed, 240 were recalled for a large film; 29 showed partially calcified or
minimal lesions that could be followed up while the people remained at work, and two (a man aged 70 and a
woman aged 43) were sputum.positive, but their contacts, two adult and four child contacts, were free from
the infection. None of the 1,490 children X.rayed had pulmonary tuberculosis; one school child had
sarcoidosis.
It was surprising to find only two positive cases in the survey; the public were however made aware
of the importance of tuberculosis and how to conquer the disease. It would appear more profitable in the
future to concentrate on suspected sections of the community rather than aim at the whole population
indiscriminately.
Arrangements have now been made for the examination of the following groups at the static M.M.R.
unit established at the Central Middlesex Hospital in August, 1952 :—people with suspected diseases of the
lungs, particularly those under the care of their family doctor; contacts of infectious cases of tuberculosis;
health workers, for instance, nurses and medical students; people who come in frequent contact with
children, namely teachers, domestic staff in schools and day nurseries; all hospital admissions and outpatients
and expectant mothers.
In addition, children will be tuberculin.tested at infant welfare clinics at yearly intervals and at the
periodical medical inspections at school. Those showing evidence of infection, by converting from negative to
positive, will be thoroughly investigated, together with their social and family history, to determine the
source and extent of the infection. All school.leavers who are tuberculin.negative will have a Mantoux
test, and if this is negative, they will be vaccinated with B.C.G.
The centre for detecting cases is the chest clinic, and it is essential that facilities should be adequate
for its increasing activities. Work was started on extensions to the clinic early in June, 1952. The Council
provided accommodation at a temporary clinic at 159, Willesden Lane, and office staff were transferred to
the clinic at the Neasden Hospital which had previously been used as a scabies and lice treatment centre.
The Pound Lane clinic will be opened in the spring of 1953 with a new X.ray department, which will have
an adjacent dark room and a miniature camera unit (Watson 5" x 4") added to the existing 4 valve set; a
separate chest.screening stand will also be available in the main consulting room. Accommodation for
patients in the waiting and dressing room cubicles has been increased and additional accommodation has
also been provided for the medical and nursing staff.
If more cases are to be discovered, it is also essential to provide hospital beds for them as required.
Hospital accommodation has therefore been increased; there are 30 female and 28 male beds in the Central