View report page

7
The epidemic appeared in Willesden about the third week in September. On the 23rd September,
four schools reported absentee rates of more than 20 per cent.—42 per cent, of 320 pupils ; 32 per cent, of
311 ; 24 per cent, of 494 ; 21 per cent, of 427. The local office of the Ministry of Pensions and National
Insurance reported that sickness claims received during the week ending 24th September, 1957, showed an
increase of 30 per cent, on the figure for the previous week.
It was difficult to ascertain precisely how many children were away because of influenza, but
according to reports and messages reaching head teachers the majority of the children has symptoms of
influenza. The disease reached its peak during the week ending 14th October, 1957, when 17 schools were
affected ; of the total of 7,714 pupils involved, 1,672 or 22 per cent, were absent, the majority with influenza
symptoms. Thereafter, attendances continued to improve and were back to normal after the half-term holiday
on the 29th October.
Unfortunately there is no precise information on the absentee rate of workers from factories, but
the experience of influenza in those visited varied considerably. The Medical Officer gave 46 talks on Asian
influenza to factory staffs during lunch-hour breaks, and more than 3,500 workers attended the talks.
During the outbreak there was no significant increase in the number of notifications of acute primary
or influenza pneumonia or deaths from influenza, influenzal pneumonia or broncho-pneumonia.
Vaccination was offered to general practitioners, home nurses, ambulance staff and other health
workers likely to come in contact with cases of influenza, but the material for vaccination arrived too late
to have any appreciable effect in protecting health workers. Fortunately absenteeism among them was not at
any time so high as to require special emergency arrangements.
BRONCHITIS. CANCER OF THE LUNG. AND TUBERCULOSIS
It has become increasingly clear of recent years that the more serious respiratory diseases must be
considered together rather than separately. Common causes are at work ; for lungs already damaged may
have a lowered resistance to infection or worse still to cancer.
The major common factor is the exposure of lungs to smoke, from cigarettes and the atmosphere.
Evidence for this has been accumulated over the last few years, particularly for cancer of the lung and also
to a less extent for bronchitis and tuberculosis.
The attack on tuberculosis has been very successful chiefly because of the wide use of new effective
drugs. Not so with cancer of the lung where treatment is rarely successful except in the very earliest stages
of the illness, and because cigarette smoking is still popular and widespread.
Over the last ten years bronchitis and cancer of the lung have steadily assumed increasing importance
as tuberculosis has declined (Tables 17. 18 and 19). In Willesden in 1957 the death rate from cancer of the
lung was eight times that from tuberculosis.
Early diagnosis of chest illness is still essential if treatment is to be effective, but a change in social
habits is necessary if we are to eliminate these killing diseases. Health education and social reform can also
help. Young people have been given talks on the major chest diseases and in particular on the dangers to
health and life from smoking cigarettes.
Mortality and morbidity
For the first time there have been no deaths from tuberculosis among women (Table 20): 13 deaths
occurred in men over the age of 35, 4 of these in elderly men not previously known to have tuberculosis
(Table 20). There has been a rise in notifications of tuberculosis (Table 16) compared with last year but too
much significance should not be attached to them as the overall figures are small. It does, however, indicate
that tuberculosis has not yet been defeated.
There has been a wide fluctuation in the deaths from bronchitis (Table 18) over the years with no
apparent trend. Smoke has probably played an important part and was certainly responsible for the high
peaks in 1952 and 1953 following the severe fog which caused 4,000 deaths in London during the winter. The
sex difference in the numbers of deaths probably relates to the heavier smoking habits of middle-aged and
elderly men and to a lesser extent to conditions of dust and smoke at work (Table 18).
The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 19).
The death rate has more than doubled in the last 11 years, and there is a more marked sex difference: for
every woman, six men died from lung cancer. Most of these cancers occurred in men over 45 years of age
when they had already smoked enough cigarettes to produce the cancer.
Prevention and diagnosis
To prevent chest disease it is clear we must deal with smoke from cigarettes and the atmosphere.
Measurement of smoke and other impurities in the air continues, and small improvements have been noted
around power stations. It is hoped that the new Clean Air Act will encourage further improvements in the
future.
Some fifteen to twenty years of smoking is normally required before a cancer develops, but it is
advisable to take no risk at all and therefore talks have been given to school children in their early teens when
the environment to start smoking is favourable and the temptation becomes strong. Visual aids are also used
to explain clearly the relationship between smoking and respiratory disease. It is hoped by these means
to prevent young people smoking before the habit becomes difficult to break.
Bronchitis cannot be diagnosed radiographically but X-ray surveys continue to play an important
role in discovering early cases of tuberculosis and cancer.
The combined efforts of Chest Clinic, Static X-ray units, general practitioners and the public health
department ensure that most of the suspected cases are X-rayed early.