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(3) On the 16th November, 1953, 4 children developed symptoms at the Central Middlesex Children's
Homes, Barretts Green Road, and were transferred to the Neasden Isolation Hospital. 8 other
children were found to be carriers and isolated from the remaining 3 children in the nursery; they
cleared up rapidly after a 5-day course of Chloromycetin. One member of the staff was also a
carrier and was excluded from the nursery until clear of infection. The Home was again reopened
for admissions on 5th December.
Smallpox
There were no cases of smallpox occurring in the Borough in 1953.
Ophthalmia Neonatorum
Three cases were notified in 1953 (1.13 per 1,000 live births); there was complete recovery with
unimpaired vision in all three.
Puerperal Pyrexia
150 cases of puerperal pyrexia were notified during the year (150 confirmed).
Since August 1st, 1951, puerperal pyrexia applies to any "febrile condition occurring in a woman
in whom a temperature of 100 4 degrees Farenheit (or 38 degrees centigrade) has occurred within fourteen
days after childbirth or miscarriage".
Food Poisoning
20 cases of food poisoning were notified during the year (9 confirmed).
TUBERCULOSIS
Morbidity and Mortality
There has again been a welcome decline in mortality, which is now less than a quarter of that of
before the war. This satisfactory result is probably due to improved methods of diagnosis and treatment;
more patients are now detected in the early stages when they are most amenable to simple methods of treatment
such as rest, control of cough, better diet and chemotherapy.
However, the total number of cases on the register has increased, and the number of new cases
has remained about the same for the past four years and is higher than in the years before the war. It is
difficult to determine whether this increase is the result of more efficient diagnosis or a general deterioration
in the tuberculosis situation. It may be that the new methods of treatment with antibiotics is responsible
for the reduction in deaths and that a fatal termination is merely being postponed. It is hoped the reason
is that more cases are being discovered earlier and therefore more patients are cured. The death rates in
the next few years will be followed with some interest to decide this (see table I).
The diagnosis of tuberculosis today is no longer a death sentence: an early diagnosis usually
ensures a complete cure, and at the same time the spread of infection can be more effectively halted.
Nevertheless, tuberculosis still remains the most important infectious disease in the Borough:
every fortnight 10 people are notified and 1 dies. More than half the deaths are people under 55 years, and
most patients are under 45 (see table II).
Missed Notifications
Although the disease is now more often detected in an earlier phase, many people still die unnotified,
and together with those who die within a year of notification contribute almost one-third of the deaths;
the actual number of deaths, however, was lower in 1953, and so fewer patients were involved (see table
III).
Prevention
Non-pulmonary tuberculosis is caused by drinking milk containing bovine tubercle bacilli, and can
therefore be prevented by eliminating infected cows and milk. It is now an offence to sell raw milk in
Willesden (see page 32).
Pulmonary tuberculosis is mainly spread by droplet infection and therefore more often to people
who live and work in overcrowded conditions and whose resistance is lowered by poor nutrition. Wards
such as Mapesbury and Carlton, where there is the most overcrowding among the poorer sections of the
population, have rates well above the average, contrasting badly with Brentwater and Manor Wards (see
table IV).
Clearly, overcrowding and poverty must be relentlessly attacked if we are to conquer tuberculosis.
Our main weapons of attack must be: improving resistance, detecting cases earlier, and preventing spread
to susceptible contacts. There is no question that it is more economical to spend money on improving
housing and nutrition than to spend it on the modern and costly methods of treating tuberculosis.
The reduction of overcrowding in homes, schools, factories, transport and places of recreation and
amusement will help to prevent the spread of the disease. It is also important to remove the chronic
infective cases from industry and provide sheltered workshops where they can earn their living without