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117
The term "acute primary pneumonia," somehow or other,
suggests acute lobar pneumonia, and so primary bronchopneumonias
are often not notified. A common disease of
young children, known as capillary bronchitis, is now classified
as a pneumonia by the Registrar General, but is still regarded
by some doctors as a bronchitis—if death ensues, the terminal
condition may be said to be due to the onset of a complication
—a secondary pneumonia.
I do not believe that the objects of notification will ever
be attained until we have notification of all acute pneumonias.
Secondary pneumonias were excluded from notification
because it was considered that, as these were usually secondary
to the infectious diseases, further notification was not needed.
Unfortunately for this premise, measles and whooping cough
are not notifiable in every area, and so secondary pneumonias
complicating these diseases do not always get known. Similarly,
a pneumonia following on an acute bronchitis is not
notifiable. In any event, if the practical reason for notification
is the provision of nursing, it is difficult to justify the
non-inclusion of acute secondary penumonias in cases where
the primary disease is not notified, when regard is paid to the
fact that out of the total deaths from pneumonia in England
and Wales in 1924 (38,970) all but 7,253 were of persons under
45 years of age. There were only 32,690 deaths from tuberculosis.
Administrative measures for the control of pneumonia
should include more efficient and wider notification, a greater
use and extension of existing nursing facilities, and the provision
of hospital beds where cases can be moved at an early
stage of the disease—they cannot safely be removed in the
later stages. When the general practitioner knows that by
notification he can be helped and that his patient can be
assisted by the local authority, then you will find that the