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the chief hazard was from flies which, due to the unusually warm Autumn, were more than
usually numerous. However the foresight of the responsible officer in obtaining and distributing
ample supplies of plastic sacks and the help of the local Press in publicising the need to use
them for all discarded food scraps in which flies could breed, prevented much fly-borne
infection and helped to reduce the stench of the rotting garbage.
Tuberculosis notifications at 84 were marginally lower than last year (88) but no less
than 42 of these, 50% of the total, occurred in immigrants which is the highest proportion
experienced; percentages for years 1965/1968 being, in sequence, 18%, 27.7%, 34% and 33%.
The ratio of immigrants to the home population is not precisely known but was estimated last
year at 8/2%. During the year Port and Airport Health Officers notified us of a further 458
immigrants giving destination addresses in Waltham Forest but no estimate can be formed of
the numbers in transit, transferring to or from other Local Authority areas. We do know, however,
that Commonwealth Immigrant children make up 10.8% of children in our primary schools. While
only some of them are highly susceptible to tuberculous infection, even an average shows the
disease to be nine times as common among immigrants generally as among the local population.
It is to be hoped that there will be no phasing out of the Mass Miniature Radiography Units
while this situation continues. All new arrivals who can be traced are referred to the Chest
Clinic at Whipps Cross Hospital and over 300 were sent for investigation in 1969.
Contrary to our expectations of a few years ago T.B. cannot be written-off as conquered
and with a persisting pool of infected persons in the community it is as important as ever that
all schoolchildren receive B.C.G. vaccination which gives very substantial protection.
The place of Tuberculosis as "The Captain of the Men of Death" has, however, been
usurped - by Lung Cancer. In 1947 respiratory T.B. killed 20,156 people in England and Wales
and lung cancer only 9,204. By 1965 the deaths from respiratory T.B. had been reduced to
2,008 but 26,398 people died that year from cancer of the lung. By 1968 this figure had risen
to 28,836 nearly twenty times as many as died from respiratory tuberculosis, 1,456. It is plain
that despite the import of a large number of very susceptible people we are slowly winning the
battle against tuberculosis but over the past ten years deaths from lung cancer have shown an
inexorable increase from a rate of 782 per million (men) in 1958 to 1,012 per million in 1968.
For women the increase has been proportionately much greater from 118 per million to 198, a
rise of nearly 68%. Only in doctors, 70% of whom (including the writer!) have given up smoking
has a marked reduction in mortality from lung cancer occurred. Lung Cancer, especially in the
younger age groups (my youngest patient was 27) is almost exclusively a disease of cigarette
smokers who also provide most of the victims of coronary thrombosis and fatal chronic
bronchitis and emphysema.
Sir George Godber, in presenting his Report for 1968 to the Minister of Health, stresses
the importance of cigarette smoking in the causation of these diseases and gives as a conservative
estimate the attribution of practically all deaths from lung cancer and from coronary heart
disease occurring below the age of 55 years to cigarettes as well as 85% of such deaths at
later ages. For adult deaths from bronchitis two thirds are probably due to cigarettes.
In the face of such clearly expressed opinion by the Government's own Chief Medical
Officer it is surprising that the tobacco companies are still permitted to spend twelve million
pounds a year advertising such a dangerously addictive drug. Dare one suggest to the Chancellor
a pound for pound levy on such advertising, the resulting £12,000,000 revenue to be spent
making roads safer? To the usual cigarette smoker's retort "One must die of something" I
would reply that it is usually much less uncomfortable, and appears more sensible, to die from
a stroke at 75 rather than at 45 from lung cancer or a coronary; smoke a pipe or cigar if you
must but avoid cigarettes like poison.
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