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7
BRONCHITIS, CANCER OF THE LUNG AND TUBERCULOSIS
The causes of many respiratory diseases are interlinked; for example, bronchitis and cancer of the
lung sometimes occur together in a cigarette smoker; so it is advisable to consider these conditions together.
Other causes, though often less important, are smoky atmosphere, dust and fumes. Smoking may also
contribute to the development of pulmonary tuberculosis, especially in middle-aged and elderly people. The
risk may well extend beyond the lungs and be a factor in coronary thrombosis and delayed healing of peptic
ulcers.
Over the last sixteen years, bronchitis and lung cancer have displaced tuberculosis as an important
cause of invalidity and death. In Willesden the death rate from cancer of the lung in 1963 was almost eight
times that from pulmonary tuberculosis, and from bronchitis nearly eleven times (Tables 16, 17 and 18).
The campaign against tuberculosis has been successful because of the wide use of highly effective
drugs. Cancer, however, presents a sombre picture because smoking is still widespread, and treatment, except
in the early stages, is rarely successful.
Early diagnosis of chest diseases is essential if treatment is to be effective, but a change in social
habits is necessary if we are to eliminate them. Health education and reform can also help; school children
and members of social, religious and political organisations have been given talks on chest diseases, and in
particular on the dangers to health from smoking cigarettes.
Mortality and morbidity
There were nine deaths from pulmonary tuberculosis among men and five among women with the
now usual shift to the older age groups. There was a slight decrease in notifications of tuberculosis (113)
as compared with the previous year (131). Although there was only a very slight decrease in the number of
cases on the register, the downward trend which began in 1958 continued. This is encouraging, but complacency
must be avoided.
Bronchitis remains a serious problem. 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 more than trebled between 1924 and 1962, and there was a marked sex difference; for every
woman who died there were six men. In 1963, 96 per cent, of the deaths occurred in men over 45 years of
age. The death rate for cancer of the lung fell from 78 per 100,000 in 1962, to 63 in 1963. This, however,
runs contrary to current trends and is probably just a transient local phenomenon.
Prevention and diagnosis
To prevent chest diseases 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. It is
hoped that the establishment of smoke control areas under the Clean Air Act will lead to further improvements.
Some 15 to 20 years of smoking is normally required before a cancer develops, but it is better to
take no risk at all. Talks have therefore been given to school children in their early teens when temptation
backed by the enormous resources of the tobacco industry is at its strongest. Visual aids have also been
used to explain clearly the relationship between smoking and respiratory diseases. It is hoped to stimulate
a more active opposition to smoking among these children, like the Junior Anti-smoking League which has
been formed in Camberwell in south London. Talks have also been given to political, religious and social
organisations, endeavouring to persuade adults to give up smoking, not only for the sake of their own health
but for the children who might follow their example.
Bronchitis cannot be diagnosed easily by radiography, but X-ray surveys continue to play a very
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 fourth winter the Group Clinic for the prevention of bronchitis, started by Dr. C. H. Wood,
Department of Occupational Health, London School of Hygiene and Tropical Medicine, has been continued
under 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, 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 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.
T uberculosis
Tuberculosis creates a special problem beca'ise of its infectious nature: 14% of the deaths occurred
in elderly men and women previously unknown to the health authorities (Table 24). This indicates that, in
spite of the improvement in case-finding methods, there is still a reservoir of infection among older people
in the community, which holds special hazards for the young and unprotected.