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8
Prevention and diagnosis
To prevent chest diseases 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,
ft is hoped that the establishment of smoke control areas under the Clean Air Act (see page 10) 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 were also used
to explain clearly the relationship between smoking and respiratory diseases. By these measures it is hoped to
prevent young people smoking before the habit becomes difficult to break. Talks have also been given to factory
workers during lunch-hour breaks and to political, religious and social organisations. It is hoped that these
talks will encourage adults to give up smoking.
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 reports of doctors at the Chest
Clinic, mass X-ray units, the public health department and general practitioners ensure that many suspected
cases are X-rayed early.
For the second winter, the Group clinic for the prevention of bronchitis has been organised one
evening a week at Pound Lane Clinic. The clinic has been run by Dr. C. H. Wood from the Department of
Occupational Health, London School of Hygiene and Tropical Medicine, working with a research grant
from the North-West Metropolitan Regional Hospital Board. In the winter of 1962, the clinic will be run by
the Willesden Chest Clinic. Patients with early evidence of chest trouble such as chronic cough, or who have
been absent from work on account of chest colds, are referred to the clinic by general practitioners, industrial
medical officers at their place of work, or mass X-ray units. They attend for two hours a week for four to six
weeks, and are helped to understand the disease by talks, films, records, individual and group discussions.
They are taught breathing exercises, and the use of antibiotics, innoculated against influenza, helped to stop
smoking and given an 'Airwick' bottle containing ammonia for use at home during fog. During the winter,
the Medical Superintendent of the Central Middlesex Hospital, the Consultant Physician in Cardiology and
General Medicine, the Medical Officer of Health of Salford. the Medical Director of Clare Hall Hospital, the
Chest Physician and the Medical Officer of Health have taken part in discussions at the clinic. The national
press published reports of the activities, a short film for showing overseas was made, and some of the patients
appeared on a BBC. television programme concerned with smoking.
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: nearly 50% of the deaths
occurred in elderly men and women previously unknown to the health authorities (Table 24). 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 theirresistance 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 (98%) were vaccinated (Table 23).
The proportion of younger children reacting to the tuberculin test remained about the same (Table 22)
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.
Factories and workshops
Three factories were visited by the Medical Officer of Health and thirty-four 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 old healed tuberculosis was found but no further action was necessary.
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.
SANITARY CIRCUMSTANCES OF THE AREA
Water
The Metropolitan Water Board and the Colne Valley Water Company supply Willesden with water.
These supplies are not subject to plumbo-solvent action and have been satisfactory both in quantity and
quality. All dwelling houses and flats have a piped supply direct from the mains and there were no complaints
of any contamination during the year. Frequent bacteriological and chemical examination of the
water are carried out by the: Metropolitan Water Board and Colne Valley Water Company.
Sewage and drainage
Most of the sewage of the borough is discharged into the London County Council main sewers, but a
small amount from the Park Royal area is discharged into the West Middlesex Main Drainage system.