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7
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 17).
The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 18).
The death rate has trebled in the last 15 years, and there is a marked sex difference; for every woman, six
men died from lung cancer. Ninety-eight per cent 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 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.
It is hoped that the establishment of smoke control areas under the Clean Air Act (see page 10) will lead
to further improvements.
Some 15 to 20 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 third winter the Group Clinic for the prevention of bronchitis, started in 1960 by Dr.
C. H. Wood, Department of Occupational Health, London School of Hygiene and Tropical Medicine, has
been continued under the auspices of the Willesden Chest Clinic. By arrangement with the Middlesex County
Council the Clinic is held one evening a week at Pound Lane 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,
inoculated against influenza, helped to stop smoking and given an "Airwick" bottle containing
ammonia for use at home during fog. The clinic has had a number of visitors who are considering starting
similar activities in other areas.
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: 20% 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 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 (94%) 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
Five workplaces were visited by the Medical Officer of Health and 36 immediate contacts of active
cases were encouraged to attend for examination by the Mass X-ray Unit at the Central Middlesex Hospital.
They were all found to be free from infection.
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 cooperation
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