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(d) Segregation wards were fumigated as soon as they became empty.
(e) Umbilical cords were covered with dressings.
(f) All staff wore masks in the wards, and were careful when removing them.
(g) Members of the staff found to have the infection were taken off duty and if Group A was isolated they
were admitted to the Flora Baker Wing for four days intensive treatment with penicillin and streptomycin,
until three negative swabs were obtained.
(h) Mass swabbing was repeated.
(i) Rooms of infected staff were fumigated.
At the second meeting a progress report was given, and it was agreed that admissions should be
re-commenced from the 22nd October.
A further report was given at the third meeting. 13 babies, all born in the hospital since the 2nd
September, had shown infections with different organisms after their discharge; none of these infections had
been generalised. 3 of those who had infected cords were known to have been infected with B haemolytic
streptococcus Group A, Type 28. There had been no umbilical infections since the cords had been covered
with dressings.
It was agreed that a segregation unit of six beds should be kept for infected or potentially infected
patients and a separate return made of their occupancy.
TUBERCULOSIS
Mortality and Morbidity
For the first time in the history of the borough there were no deaths from non-pulmonary tuberculosis.
In addition, the marked decline in the death rate from respiratory tuberculosis has continued
(tables 18 and 19).
Elderly men were mostly affected; four out of every five deaths occurred in men, and half of them
were over 65 years; there were no deaths under the age of 25 (table 20).
There has been a further reduction in the number of newly notified cases. The improvement has
occurred chiefly in young women from 20-25, among whom the number of new cases was half of that of last
year. There was no significant change for men (table 20).
Because of the fall in new notifications, less significance can be attached to the individual annual
figures (table 21) but over a period of three years a high incidence is revealed in the more overcrowded
wards, Carlton, Mapesbury, Kilburn, Roundwood, Stonebridge and Harlesden (table 22).
Prevention
The principal source of infection is the adult human case, particularly middle-aged and elderly
males. The search for and supervision of these patients is therefore an important preventive measure,
because they can easily spread the disease to their families and relatives in their homes and to their workmates
and the public in the factories and shops.
Apart from infection at home it is known that the disease may be contracted at work. Routine
mass X-rays 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 admission 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, mass X-rays, improving social conditions and B.C.G. vaccination, are the main
preventive 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.
B.C.G. Vaccination
The work of the Medical Research Council has now shown conclusively that B.C.G. vaccination of
school leavers is a very successful additional measure in the prevention of tuberculosis. The unvaccinated
tuberculin-negative school-leaver is five times more likely to develop tuberculosis than are his vaccinated contemporaries.
B.C.G. vaccination is now a fully and widely accepted preventive measure and has recently been
extended to school leavers throughout the whole country.
Protection is afforded to young people who are more susceptible to tuberculosis with the stresses
and strain of adolescence and when they are embarking upon a more arduous industrial or commercial life
where they must be exposed more freely to hidden infection.
This change may be accounted for by the reduction in the pool of infection and in the introduction
of a more reliable method of skin testing (multiple puncture) during last year. The advantage of the new
test lies not only in its greater reliability, but in its being more acceptable to the public, with only one attendance
required instead of two. The acceptance rate for B.C.G. has therefore improved since the test was
introduced (table 24). Nevertheless, many children who required vaccination failed to attend. It is sincerely
hoped that parents will co-operate more fully in the future and so help to protect their children.