London's Pulse: Medical Officer of Health reports 1848-1972

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Southall 1958

[Report of the Medical Officer of Health for Southall]

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"Post-Primary" Lesions
Fifteen had lesions which appeared "post primary"; 8 were unilateral (2 with cavities)
and 7 bilateral (3 with cavities). Five had non-pulmonary lesions—3 nodes of neck, 1 knee
and 1 kidney.
Contact Examinations
In spite of a very wide investigation of home contacts it was impossible in any instance
to discover a specific source case. Fifteen men were married but only 2 had their wives and
families in this country and none of the contacts had a tuberculous lesion. The husband of
one of the women with pulmonary tuberculosis had a primary lesion and it was thought that
he had acquired the infection from his wife.
Social and Environmental
Most of the patients were Sikhs; the 3 women were all from villages and had been
associated with farming; 23 men were from village or country—18 were farmers. Only 6
men were from town or city.
Five patients were diagnosed within a year of arrival in this country, 7 in one to two
years, 8 in two to three years, 7 in three to four years and 2 in four to five years; 4 had been
here over five years. Information was not obtained in 2 patients.
The date of infection was roughly estimated from the time lapse after arrival in this
country and the clinical and radiographic type of disease at notification. Also considered
were the history of previous disease in India (admitted by none), and contact or family
contact in India (admitted in 2 cases). Of the 35 patients, 21 were thought to have acquired
the disease in this country and 2 possibly to have acquired it here; 12 persons probably had
the disease on entry—10 pulmonary and 2 non-pulmonary.
Comment
Springett and others (1958) in Birmingham decided that amongst Asians there (Indians
and Pakistanis) the disease was predominantly of chronic pulmonary type; in their opinion
most were already tuberculous on arrival. The Uxbridge experience, on the other hand,
appears to indicate that the majority of the local Indian immigrants acquired the disease in
this country. This appeared to be confirmed by the large proportion with primary disease,
pleural effusion and miliary tuberculosis of the lungs (15 of 35), as compared with the Birmingham
series.
From September, 1958, 44 Indians referred to the chest clinic for X-ray were Mantoux
tested (O.T. 1 in 1,000): of these, 29 were tuberculin negative and only 15 tuberculin positive;
it was thus apparent that a high proportion had not been infected prior to arrival. These
findings might be related to the fact that most came from isolated country districts in India.
The health of the coloured immigrants is a problem which the health authorities in this
country are having to face. Their standard of living is generally lower than that of the British
people of comparable economic status. Efforts are therefore necessary to ensure that this is
improved, particularly with regard to the overcrowded conditions in which they live. In
attempting to control the problem close co-operation between the public health department,
the general practitioner, factory medical officers and the chest clinic is essential. The local
Indian Workers Association can be encouraged to co-operate with propaganda and education.
All Indians should be X-rayed as soon after arrival as possible. At the same time they could
be tuberculin-tested and those proving tuberculin negative should be offered B.C.G.
vaccination. In a small compact community this programme can be carried out reasonably
well, as has been the experience at this clinic where the co-operation of the Indians has been
very good.
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