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The causes of death have also shown a change and the cancers and degenerative
diseases of later life now predominate.

Bronchitis and pneumonia still take their toll especially in the elderly and
the role of atmospheric pollution in their causation is being increasingly recognised.
The problem of arterial degeneration in the brain and in the coronary arteries still
awaits elucidation. Though the exact cause of cancer is not known, the indications
are that several factors may be involved and vary with the site of the cancer.
Throughout the world cancer varies widely in relation to incidence and site, but wherever
it has been investigated the association between cigarette smoking and cancer of
the lung remains constant. The problem now is how to discourage the smoking of
cigarettes, especially in the young as it is obvious to all that the habit, once acquired,
is not easy to break. "The habitual use of tobacco is related primarily to
psychological and social drives" and cigarette smoking must, like spitting, become
socially unacceptable if it is to be abandoned by the young. Youth ape the habits of
adults and the main responsibility of securing a new outlook on cigarette smoking must
rest with parents and all who have dealings with children. The toll from road and home
accidents is still too high and should be the personal concern of everyone at all times.
Our forefathers well knew the risks then associated with pregnancy and childbirth,
especially the dreaded childbirth fever. Fortunately, one can record steady improvement
here and the maternal mortality rate of 2.3 per 1,000 live and stillbirths
of 1939 43 has fallen to 0.3 in 1959-63.
Apart from a small outbreak of poliomyelitis in 1947-49, the record of the
Borough in regard to infectious disease has been relatively uneventful. The fears engendered
by infectious diseases among our grandparents are no longer with us and the
present tendency, except when smallpox or other infectious disease starts a scare, is to
belittle the precautions and preventive measures still recommended. This is due to decreased
incidence of many of these diseases, to the diseases generally being milder
and to the reduction in deaths brought about by improved treatment (see Table VII).
The reduction in the incidence of tuberculosis, diphtheria, typhoid and paratyphoid
fevers, erysipelas and to a lesser extent in scarlet fever is noticeable, but the increase
in dysentery, food poisoning and gastro-intestinal illness of unknown origin is
still a matter of concern Fortunately, these conditions are seldom fatal, but as
human carriers play such a large part in their spread, they indicate the need for improvement
in our standards of personal hygiene. The steady elimination of tuberculosis
in cattle, the pasteurisation of milk, and the new drugs have greatly reduced the incidence
of tuberculosis, eased the dangers of spread and markedly improved the prospects
of cure, but there is no excuse for complacency. Mass X-ray surveys still find
previously unrecognised cases of pulmonary tuberculosis to the extent of nearly 3 per
1,000 of persons submitting themselves for X-ray in the Greater London area.
The Borough was one of the pioneers in immunisation and started their campaign
against diphtheria in 1930. For this work they were fortunate in securing the services
of Dr. Guy Bousfield whose work in this field continued till 1963. The meticulous
standards he set and the stimulus of his alert and enquiring mind laid a foundation of
excellence which it is hoped can be maintained. Since these early days advances in
immunisation have been made and protection is now available, at clinics or through
general practitioners, against smallpox diphtheria, whooping cough, tetanus and
Poliomyelitis. To children in their later years at school B.C.G. inoculation against
tuberculosis is also available. It is sad to relate that the very success of these
measures has resulted in local authorities having to intensify their efforts to induce
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