It is hard nowadays to appreciate the misery and deaths caused by infectious diseases, which were common and potentially lethal. In there were 3, cases of diphtheria with deaths.
Tuberculosis remained a major problem although notifications to the medical officer of health MOH and deaths were steadily getting fewer. There were , notifications of measles with deaths, and , of whooping cough with deaths. A long-forgotten clause in a Public Health Act gave local authorities the power to do so.
Whooping cough, tetanus and polio immunisation followed. There had been small sporadic outbreaks of poliomyelitis for many years but the disease assumed epidemic proportions in Thereafter the numbers fluctuated, but remained at a historically high level for several years with deaths annually. It was the custom for cases to be admitted to isolation hospitals, and then transferred to orthopaedic hospitals for the convalescent and chronic stages.
Oxford established a team including specialists in infectious disease, neurology and orthopaedics so that patients with severe paralysis could be assessed jointly from the start. The tide turned when Jonas Salk developed an inactivated vaccine in the USA and reported the success of field trials in Bacterial food poisoning was an increasing problem.
Imported egg products from North and South America and, after the war, from China, sometimes contained Salmonella. Synthetic cream was associated with many outbreaks of paratyphoid fever, and spray-dried skim-milk was responsible for outbreaks of toxin-type food poisoning.
Cases of smallpox occurred intermittently. In there was an outbreak in Brighton, introduced by a fully vaccinated RAF officer recently returned from India. There were 26 cases, 13 of which were among nursing and medical staff, domestics and laundry workers at the hospital to which the earliest cases were admitted, and ten deaths. The death rate from tuberculosis had begun to decline after the first world war, but the incidence was still high and primary infection occurred in nearly half the children before they were When the NHS began there were 50, notifications a year and 23, deaths.
To reduce the movement of diseased lung tissue, in the hope that this would assist healing, sections of the rib cage were removed thoracoplasty , air was introduced to collapse the lung artificial pneumothorax or the phrenic nerve would be divided to paralyse the diaphragm. Antibiotics attacked the tubercle bacillus directly.
There was insufficient streptomycin to treat everyone who might benefit, and supplies went to those in whom the best results could be expected, young adults with early disease.
In a second trial the newly discovered para-aminosalicylic acid PAS was proved to prevent the development of bacterial resistance and a third trial examined the level of dose required. Given alone it was no better than streptomycin and PAS, and patients could rapidly develop drug resistance. However MRC trials and the work of Professor Sir John Crofton in Edinburgh showed that it was not which drugs were given that mattered, but in what combination and for how long.
As success could only be assessed by the absence of a relapse in subsequent years, it took time to establish the best options. Triple-drug therapy over 18 months to 2 years greatly reduced the problem of the emergence of resistant strains of tubercle bacilli but some clinicians were slow to adopt the protocols that gave such excellent results.
The results were so good that collapse therapy and surgical methods of treatment were used far less frequently. There was no need to admit patients for long periods to reduce the risk of infection to families and the community. For the first time, early treatment of tuberculosis had major benefits, yet there was an average delay of four months between the first consultation and a diagnostic X-ray; GPs were urged to refer patients more rapidly. In the waiting list figures had convinced the Manchester Regional Hospital Board that a new sanatorium was urgently required.
By it had not been built but it was now no longer needed as the waiting time for admission had fallen from nine months to a few weeks. The vans would visit centres such as colleges and hospitals where there were many young people, and 35mm pictures were taken of images produced by fluorescent screening. People piled coal onto their fires to keep warm. To most, smog was no more than an inconvenience. Those with chronic heart and lung disease were less lucky.
Their illnesses got worse and many died. Dying people, their lips blue from lack of oxygen were forced to walk to the hospital for ambulances stopped running.. It came under pressure and immediately restricted non-urgent admissions, but the media were first to spot the severity of the problem.
Florists ran out of flowers for funerals. Newspaper articles drew attention to the death of prize cattle at the Smithfield show. Not until the death certificates had been assembled was the full severity of the episode apparent; there were 3,, excess deaths. A committee chaired by Sir Hugh Beaver was set up in July , which rapidly identified the importance of pollution from solid fuels. Its recommendations, which smoke abatement groups had been suggesting for almost a century formed the basis of a single comprehensive Clean Air Act on 5th July Emission control was required; industry had to change and methods of manufacturing had to alter.
It became an offence to emit dark smoke from a chimney, and local authorities could establish smoke control areas. Following the legislation the age-specific death rates of men in Greater London fell by almost half.
The opposition to the control of atmospheric pollution, for example from industry, was slight. Rheumatic fever, associated with streptococcal throat infection, was another common disease of childhood normally requiring admission to hospital. More frequent among the poor, there would be fever, pain and stiffness in the larger joints. Although some children might die of the acute illness in , falling to in , the main problem was that about half developed rheumatic disease of heart valves, which became incompetent they leaked or stenosed they obstructed blood flow.
The result was progressive heart failure in adolescence or later in adult life. Milder infections were not ignored. At Salisbury the Common Cold Research Unit had been established before the war to examine this difficult problem. Volunteers turned up every fortnight to help the scientific work. By they numbered more than 2,, including married couples, several being on their honeymoon. After the level began to fall and many venereologists thought seriously of leaving what seemed to be a dying specialty.
Venereal disease responded to antibiotics: The reduction in gonorrhoea, however, levelled off and drug-resistant strains became apparent. By the levels were rising again, and they continued to do so.
Dr Charles, the CMO, said that sexual promiscuity was as rife as it had ever been in times of peace, and while this was the case the venereal peril would be ever with us. Increasingly the laboratories were located on the site of acute hospitals and came to provide bacteriological services to the hospital as well as to the local authorities responsible to assist the control of infectious disease. From its weekly summary of laboratory reports contained hospital as well as community data, and became a comprehensive account of the prevalence of infection.
The PHLS was also deeply involved in the study of hospital-acquired staphylococcal infection, for patients in surgical wards were increasingly infected by resistant strains. First detected in , the problem spread rapidly and led to the appointment, in most hospitals, of infection-control nurses.
The management of the service was reviewed in and the MRC was asked to continue to run it. Orthopaedics and trauma War has always produced medical innovations. The Korean War saw the introduction of helicopter evacuation, which in turn led to a reappraisal of the early treatment of injury. Thereafter, when they were not flying search-and-rescue missions, they pitched in to get the wounded to hospitals. In the first month alone, the Air Rescue choppers evacuated 83 critically wounded soldiers, half of whom, the Eighth Army surgeon general said, would have died without the airlift.
The system was soon formalised and the infantry came to see that if not killed outright, their chance of survival was now good. During their first 12 months of operation in , Army helicopters carried 5, wounded. By mid Army choppers evacuated 1, casualties in a single month.
It was many years before the lessons learned were applied to civilian trauma care. Barbara Hepworth painted a series of 60 images of surgeons and nurses circa The war had given orthopaedic surgery impetus. During the latter part of the war, orthopaedic surgeons began to encounter, among prisoners of war repatriated from Germany, fractures treated by inserting a nail throughout the length of the marrow cavity.
In Robert Danis, of Brussels, described a system of rigid internal fixation that allowed anatomically accurate reduction, compressing the fracture surfaces. This made it easier to get patients up and moving. Because of early rehabilitation, complications of treatment were reduced and there were far fewer bed sores and deaths from thrombosis and pulmonary embolism.
As understanding of fracture healing improved, there was growing recognition that stable fixation of a fracture had immense benefits in terms of restoring the soft tissues for which the bone serves as a scaffold. In addition to the techniques of internal fixation, putting strong inert screws into the fragments of bone and holding them with a light but rigid external fixation system made it possible to correct major damage to soft tissue, vessels and nerves.
The other major pressure on orthopaedic departments was osteoarthritis. Osteoarthritis of the hip was a common and painful condition.
Several operations had been devised that relieved pain at the cost of mobility, for example arthrodesis that fused the femur to the pelvis. Re-operation was sometimes required. Arthroplasty, the total replacement of the joint by an artificial socket and femoral head made to fit each other, gave patients a new and mechanical joint. The procedure was first carried out by Kenneth McKee in Norwich around , using cobalt-chrome components.
Friction in the joint was high and there were both failures and successes. Some of his patients were seen by John Charnley at a meeting of the British Orthopaedic Association, who considered that the procedure might be improved. The engineering problems were substantial and the results to begin with were not always predictable.
In passengers were killed and were seriously injured in a three-train collision at Harrow. By modern standards the fire and ambulance services were hopelessly inadequately equipped, and were untrained to keep trapped people alive. All that could be done was a little bandaging and to take people to hospital as fast as possible. Edgware General Hospital learned of the crash when a commandeered furniture van arrived with walking wounded. Among those responding to the disaster were US teams from nearby bases, who were trained in battlefield medicine.
They were disciplined, brought plasma and undertook triage - sorting casualties into those needing urgent attention, those who could wait and those who were beyond help. It was a new experience for the rescue services; they were amazed and full of admiration. In December another train crash occurred in thick fog near Lewisham. The ambulances moved people, and 88 died in the accident.