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14
Puerperal Pyrexia
147 cases of puerperal pyrexia were notified and confirmed.
Since August 1st, 1951, puerperal pyrexia applies to any "febrile condition occuring 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."
There was an outbreak of a streptococcal infection which began on the 15th March, 1955 in the maternity
wards of the Central Middlesex Hospital.
From the 15th March to 1st June, 42 patients were infected by Group A streptococci, but with the
exception of two deaths of children and one woman who yielded positive blood culture, none of these patients
had been seriously ill. Many of the staff were affected, and the organism B haemolytic streptococcus Group
A Type 8/25 was resistant to all the sulphonamides tested (sulphathiazole, sulphadimidine, sulphadiazine, sulphamerazine,
and sulphamegathene), but was sensitive to penicillin. Even after treatment with a million units
of crystalline penicillin per day, a large number relapsed and three of the nursing staff had their tonsils removed,
but their throat swabs still yielded haemolytic streptococci several weeks after their operation.
The maternity wards were closed from the 5th to 23rd June, and the Public health staff supervised
the disinfection of the wards, bedding, clothing and linen, and also of the two houses (91 and 99 York Road,
Acton) where the pupil midwives lived. There were no further cases of' puerperal pyrexia that could be
attributed to the outbreak after the wards were re-opened for admissions.
At the meeting of the Central Middlesex Group Hospital Management Committee held on the 30th
December, 1955, it was agreed that a Control of Infection Committee be set up, with the Medical Officer of
Health.
Food Poisoning
39 cases of food poisoning were notified (24 confirmed).
TUBERCULOSIS
Morbidity and Mortality
It is gratifying to see that the death rate from tuberculosis this year has fallen below that of 1953,
the previous lowest recorded in Willesden. Small fluctuations from year to year are not so important as the
trend over the last 10 years, which has shown a decline of nearly two thirds in the death rate (Table I).
In 1955, four-fifths of the deaths from respiratory tuberculosis occurred in men over 25 years of
age, the majority of whom were over 45 (Table 2). This reflects the national experience, with more deaths
occurring among middle-aged and elderly men, and far fewer deaths among young women. Because of the
high incidence of chronic bronchitis and emphysema in men of this age, tuberculosis is often difficult to diagnose
and treat.
Perhaps of even greater significance than the falling death rate is a marked drop in the number of
new notifications for the first time in many years. This has occurred at a time when concentrated efforts
were being made for the detection of new cases, so that there is probably an actual decline in the incidence of
tuberculosis (Table I). Most pleasing is the marked reduction in the number of new cases in children under
15 years of age (Table 2); there were only 5 new cases in the year under review, compared with 20 in 1954,
and an average of 28 per annum over the last 4 years. Social conditions have not changed so much in recent
years to account for this reduction. It is probable that modern chemotherapy is not only reducing the death
rate in the more effective treatment of advanced cases, but is also reducing their infectivity and thus the total
infectious pool.
Mapesbury, Kilburn and Harlesden still have a high notification rate but there has been a drop in the
rate in Carlton (Table 3).
Prevention
The principal source of infection is the adult human case, particularly middle-aged and elderly
males. The search for and control of these patients is therefore an important preventive measure. Even the
non-pulmonary cases are almost certainly due to the human bacillus, now that raw milk is unobtainable in
London.
Poor social conditions have a marked bearing on the incidence of tuberculosis, and this is demonstrated
in the higher notification rate in the three more overcrowded wards of Mapesbury, Kilburn and Harlesden.
Apart from infection at home it is known that the disease may be contracted at work. Routine radiography
of factory workers, particularly when they are known to be contacts, is essential, and short talks at
the factory have been given to emphasise this method of prevention.
With the drop in the notification rate, the demand for admision to hospital has fallen, and it is now
possible to admit without delay all those patients needing treatment. Early treatment of these patients together
with the remarkable effects of long term chemotherapy in the home, have diminished the danger of
known infectious cases. In Willesden, as elsewhere, it is the undiagnosed infectious patient who is the main
source of danger.
Health education, routine radiography, improving social conditions and B.C.G. vaccination, are the
main preventative measures. The school doctors in their talks on tuberculosis to school leavers, the health
visitors with their education in the home, and the Council with its rehousing programme are all contributing
to this important work.