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6
Puerperal pyrexia
Since 1st August, 1961, puerperal pyrexia applies to any "febrile condition occurring in a woman
in whom a temperature of 100.4 degrees Fahrenheit has occurred within 14 days after childbirth or miscarriage." [
The number of cases notified (129) was slightly less than last year (134).
Smallpox
There were no notified cases of smallpox. Eighty-four contacts of the disease were kept under surveillance
for 21 days from the last date of contact.
In accordance with the International Sanitary Regulations, the signatures of doctors on 3,150 certificates
of vaccination were authenticated by the department.
Typhoid fever
There were no cases in Willesden, but a Willesden resident who was a patient in a mental hospital
in Hertfordshire died of the disease which she contracted in the hospital. The organism isolated was salmonella
typhi Type N which is rare in Britain, though it was found in a previous case at the hospital in 1952.
Whooping cough
The incidence of whooping cough decreased in 1964 compared with the previous year. The case rate
per 1,000 population( -74) was a little below that of England and Wales.
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 17 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 1964 was almost 25 times
that from pulmonary tuberculosis, and from bronchitis 21 times (Tables 15, 16 and 17).
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
have been given talks on chest diseases, and in particular on the dangers to health from smoking cigarettes.
Mortality and morbidity
There were four deaths from pulmonary tuberculosis among men and one among women with the
now usual shift to the older age groups. There was a slight decrease in notifications of tuberculosis (98) as
compared with the previous year (114). 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. 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 16).
The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 17).
The death rate more than trebled between 1924 and 1964, and there was a marked sex difference; for every
woman who died there were four men. In 1964, 99 per cent of the deaths occurred in men over 45 years of
age. The death rate for cancer of the lung increased from 63 per 100,000 in 1963 to 73 in 1964.
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.
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 fifth 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 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, 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.