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8
A wide fluctuation in the deaths from bronchitis over the years shows 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 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 doubled in the last 14 years, and there is a more marked sex difference: for every woman,
five 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.
Measurements of smoke and other impurities in the air continues, and small improvements have been noted
around power stations. It is hoped that the establishment of smoke control areas under the Clean Air Act
will lead to further improvements.
Some fifteen to twenty years of smoking is normally required before a cancer develops, but it is
advisable to take no risk at all. Talks have therefore been given to school children in their early 'teens when
the environment to start smoking is favourable and the temptation strong. Visual aids are also used to
explain clearly the relationship between smoking and respiratory disease. By these means it is hoped to
prevent young people smoking before the habit becomes difficult to break.
Bronchitis cannot be diagnosed radiographically but X-ray surveys continue to play the important
role in discovering early cases of tuberculosis and cancer. The combined efforts of doctors at the Chest
Clinic, Static X-ray units, the public health department and general practitioners ensure that many suspected
cases are X-rayed early.
Tn 1959, plans were made for the study and treatment of chronic bronchitis, with the help of a
research grant of £750 from the North West Metropolitan Regional Board. A special clinic is held at the
Central Middlesex Hospital one evening a week, with day-time sessions at neighbouring factories where
managements are willing to release employees during working hours. An analysis of the detailed records
of 50 patients suggests that the prophylactic use of drugs (tetracycline 05 grams daily throughout the winter)
has not been very effective in preventing spells of illness. It is possible that after further analysis the regime
will be modified but the group will be followed up for the information which is being obtained on the natural
history of the disease.
In October, 1960, an experimental clinic was started at Pound Lane Clinic for a therapeutic group
for chronic bronchitis. Patients attend for two hours one night a week for four to eight weeks. They are
helped to understand the disease by talks, films, records, individual and group discussions. An attempt is
made to prevent exacerbations by inoculating them against influenza, giving them antibiotics for use early
in chest infections, and by giving then ah 'Airwick' bottle containing ammonia for use at home during fog.
Smokers are encouraged to stop smoking by group discussions. Part of each session is devoted to breathing
exercises, and they are encouraged to do exercises at home. Postural drainage is included for some patients.
Measurement of forced expiratory volume, chest expansion and early morning sputum volume, is made at
each attendance. Tt is hoped to extend the clinic in 1961.
Treatment
The treatment of cancer of the lung is still in its infancy, and hospital admission is therefore usually
needed. There is no shortage of hospital beds at present notwithstanding 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: a third of the deaths occurred
in elderly men and women previously unknown to the health authorities (Table 25). 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. About 80% of school
leavers were found to need B.C.G., and practically all of them (96%) were vaccinated.
The proportion of younger children reacting to the tuberculin test remained about the same (Table
23), but over the years there has been a marked deciine 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.
Factories and workshops
Four factories were visited by the Medical Officer of Health and eighteen immediate contacts of
active cases were encouraged to attend for examination by the Mass X-ray Unit at the Central Middlesex
Hospital. One case with dilatation of the aorta was referred to his private medical practitioner; no action
was taken in four other cases with slight abnormalities as the lung fields were clear and the heart normal.
Eight factories were re-visited at six-monthly intervals to encourage contacts of old cases to re-attend for reexamination;
107 workers went to the Central Middlesex Hospital. One case with elevation of the left
diaphragm with gas distended bowel beneath was referred to her general practitioner.
Co-operation
The need for integration of all services provided by the Chest Physician, Medical Officer of Health,
Welfare Officers, Disablement Resettlement Officer and Home Visitors is self-evident when dealing with
diseases having such wide social implications as tuberculosis, bronchitis and cancer. The closest co-operation
between all services for the patients and their families has continued throughout the year.