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12
Puerperal Pyrexia
134 cases of puerperal pyrexia were notified and confirmed.
Since August 1st, 1951, puerperal pyrexia applies to any "febrile condition occurring in a woman
in whom a temperature of 100.4 degrees Fahrenheit (or 38 degrees centigrade) has occurred within fourteen
days after childbirth or miscarriage".
Food Poisoning
49 cases of food poisoning were notified (25 confirmed).
TUBERCULOSIS
Morbidity and Mortality
For the first time since the end of the war there has been an appreciable rise in the tuberculosis
mortality, with most of the deaths occurring below the age of 55 (Table 2). The case rate also showed
an increase, and the number on the register reached a new high record of 2,184, almost three times the prewar
figure. Every fortnight at least one person dies from tuberculosis in Willesden, and 10 new cases are
discovered (Table 1).
It is still hoped that this is merely a reflection of the detection of more early cases and that they
are cured satisfactorily with the new forms of treatment including rest, control of cough, better diet and
chemotherapy. But it must give rise to some anxiety that tuberculosis is not quite so much under control
as it was thought to be.
One conclusion clearly emerges f'rom these figures : the general decline in the mortality with an
increase in notifications and morbidity must mean that prevention lags behind treatment. The fall in mortality
is probably due to the introduction of chemotherapy, with more effective isolation of infectious cases
and some improvement in social conditions, particularly nutrition. However, warning signs are now given
by the rising case rates which cannot be attributed entirely to mass radiography and the detection of more
early cases.
The marked differences between rates in different social classes and occupations showed that there
has been no marked improvement in social and working conditions (Table 3). The fact that there are so
many infectious cases unknown to the Public Health Department indicates a serious menace in the possible
spread of the disease. The rising costs of food may, in the future, have an effect in causing malnutrition
and lowering resistance to disease.
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 4). Carlton had three times as many cases as Manor in 1954 (Table 5).
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 treatment.
The reduction of overcrowding in homes, schools, factories, transport, and places of recreation
and amusements, 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 risk
to others, particularly susceptible adolescents.
The improvement in hospital facilities has resulted in the early removal of infective cases from
the community. Finally, the improvement in health education and a knowledge of hygiene has permitted
the treatment of cases in the home without placing members of the family at risk. Health visitors, home
nurses, and home helps have played a very important part in this, and it is probably true to say that where
suitable precautions are taken, contacts in homes where a known case of tuberculosis is treated are safer than
some members of the public who repeatedly come in contact with unknown cases.
B.C.G. Vaccination
Another way of increasing resistance is by B.C.G. vaccination. In this country where the incidence
of tuberculosis is relatively low, B.C.G. vaccination must be selective.
On January 1st, 1953, arrangements were made to commence vaccinating susceptible tuberculinnegative
school-leavers to protect them before they enter the vulnerable age groups when they undergo the
stresses and strains of adolescence, the more arduous work of travelling in commerce or industry, and
the greater risks of contact with infectious cases.
Those who are tuberculin-negative attend for a Mantoux test and if negative, they are vaccinated
with B.C.G.; they are X-rayed annually until the age of 21. It is gratifying to record that 9 out of 10
parents of school-leavers accepted the tests. The proportion who were negative to both the patch and