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7
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 1958 the death rate from cancer of the
lung was nearly seven 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
During 1958 there were four deaths from tuberculosis among women (Table 20); 10 deaths occurred
in men over the age of 35. There has been a fall in the notifications of tuberculosis (Table 16) when
compared with last year. However, it does not indicate that tuberculosis has been defeated.
There has been a slight rise in the deaths from bronchitis (Table 18); generally, there has been a
wide fluctuation in the numbers of these deaths over the years. The sex differences probably relate to the
heavier smoking habits of middle-aged and elderly men. Also, smoke has probably played an important
part and was certainly responsible for the high peaks in 1952 and 1953 following a severe fog which caused
4,000 deaths in London during the winter.
The slight reduction in the numbers of deaths from cancer of the lung is unlikely to be significant,
and gives no cause for complacency (Table 19). The death rate has more than doubled in the last 12 years,
and there is a more marked sex difference: at present for every woman, six men die of lung cancer. Most of
these cancers occur in men over 45 years of age when they have already smoked enough cigarettes to produce
a 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 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.
Treatment
The treatment of cancer of the lung may still be said to be in its infancy, and hospital admission is
therefore needed for nearly every case. There is no shortage of hospital beds at present despite the increasing
number of cases, because fewer beds are now needed for tuberculosis. Beds for bronchitis sufferers are now
also being provided at the sanatoria.
Tuberculosis
Tuberculosis creates a special problem because of its infectious nature: nearly a third of the deaths
occurred in elderly men previously unknown to the health authorities. They obviously form a small but
significant minority of the population, difficult to discover before others have been infected.
In view of this " hard core" of tuberculosis infection, B.C.G. vaccination remains an important
preventive measure offered to all school-leavers to raise their resistance to infection, very necessary during
adolescence when the risk of infection is higher and many new stresses have to be faced. There has been
an increase in the number of children (Table 24) tuberculin tested, as compared with previous years; about
80 per cent were found to need B.C.G., and of these 93 per cent accepted vaccination.
Tuberculin testing of the younger children also continued and the results appear in Table 23. The
proportion reacting remained about the same but over the years there has been a marked decline in school
children, particularly entrants, reflecting the general reduction of tuberculosis in the community. Compared
with 1953, when children generally came in contact with infection before they entered school, today most of
them do so during their school life.