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Central and local authorities
September, 1928J
IMMUNITY
rule no illness, and being attended by a very low death-rate. This resistance on a. first encounter with the tubercle bacillus must be an inherited trait. After this period the death-rate rises rapidly, and is maintained at a high level throughout life, thus contrasting sharply with the true immunity-conferring diseases. It would, in conse· quence, appear that natural first infection with the tubercle bacillus, even though well resisted, is followed by lessened. rather than by effectively increased, immunity. In pulmonary tuberculosis especially the altered tissue reaction following first infection seems to favour the development of dissemin· ated ulcerative phthisis. The fact that children of civilised stock resist their first tuberculous infection extremely well is explained by the writer on the .. simple evolutionary formula. of sur· vival," as is also the cognate fBoot that when tuberculosis is introduced among So race to which it is new it is many times more fatal than among even the
601
most ignorant and unhygienic of civilised people. The usual explanation of this latter fact, that the "savages" fail to resist because they have not had the immunising benefit of a first infection in childhood, is shown to be inadequate, because, if this were the whole truth, such acutely fatal cases of tuberculosis should be common among children of urbanised races, which is far from being the case. The evolutionary view seems to the writer to lI.ccount satisfactorily for the high resistance of children to first infection, assuming constant hygienic conditions. The writer agrees that experimental work with dead or attenuated Lacilli and with very small numbers of virulent bacilli has heen definitely shown to raise the resistance of animals to the tubercle bacillus, and that acquired immunity is therefore a II potential reality. But a.ny method, to succeed, must work better than natural first infection, which appears to sensitise more than it protects."
CENTRAL AND LOCAL AUTHORITIES. BRITISH LEGION VILLAGE, PRESTON HALL, KENT. REPORT FOB
1925-28.
Dr. J. B. McDougall, Medical Director, reports on the medical and economic aspects and results of the work done at the Village under the auspices of the British Legion. The principles underlying the scheme are briefly outlined, these being: (a) the treatment and education of the tuberculous patient; (b) occupational therapy; (e) adequate after-care by the provision of permanent employment and residence in the Village Settlement. Occupational therapy is given speoial consideration at Preston Hall, Dr. McDougall believing this to be one of the most valuable adjuncts in the treatment of pulmonary tuberoulosis. During 1927-8, 71'7 per cent. of all the cases admitted failed, for ROme reason or other, to gradua.te to the settlement. The technical sta.ndard has purposely been flxed high, in order to ensure the position of the industries as a commeroial undertaking able to pay their way. It is Dr. McDougall'S conviction that the higher the standard set for admission to III Settlement of this kind, the better will be the end results, even if there is less to show in the actual numbers of settlers in the Village.
No attempt is made at Preston Hall to train men at a new occupation In order that they may be able to follow it up on their return home, the attempt being rather to get the patient to co-operate with the existing system, and to become sufficiently expert technically to share in the profits of the work at Preston Hall. All settlers work at least 98 hours per week in the absence of medical instructions to the contrary, and no settler is refused work if be is medically fit. A medical survey of the 122 settlers in residence on March 81, 1928, shows that 86, or 70'5 per cent., have had tubercle bacilli in thA sputum, or hremoptysis, or pleurisy with effusion. In the rerolOining cases no such history was obtained, and 10'6 per cent. of the settlers are, in the opinion of the medical director, doubtfully tuberculous. Dr. McDougall concludes that the total number of ex.pa,tients who may be ultiroa.tely employed on 110 remunerative financial basis in a settlement must form only a small fraction of all who should be employed. if no subsidy to wages or maintenance be forthcoming. .. For those patients who are selected for the Settlement the scheme Is probably the most oom. prehensive and ideal method of solving the medic..l and economio difficulties with which the tuberculOUS individual is confronted."
602
[September, 1928
'l'UBERCLE
HERTFORDSHIRE COUNTY COUNCIL. FIFTEENTH ANNUAL REPORT ON TUBERCULOSIS IN THE C"UNTY OF HERTFORD, FOR THE YIIlAR 1927. Dr. H. Hyslop Thomson, County Medical Officer of Health and Tuberculosis Officer reports that the number of cases of tuberculosi~ notified during the year was 712, of which 588 were pulmonary cases. The death rate from pulmonary tuberculosis during the year was 0'6 'per 1,000, the figures being practically statIOnary for the past Silt years. A table is given showing the present condition of all patients under all forms of treatment since January 1, 1925, the return showing also the immediate results of treatment of patients and of ohservation of doubtful cases discharged from residential ins~itutions during the year 1927. Three hundred and sixty-five patients were admitted for sanatorium treatment, including 29 early, 134 intermediate and 171 advanced oases. Of 311 patients disoharged during the year, 210 were able to work, 56 were improved, 31 not improved, 14 were worse, and 44 patients died. Artificial pneumothorax treatment wa3 advised in 16 per oent. of the sputum positive cases, most of the other cases being considered unsuitable in view of tbe extent (}f bilateral disease. Dr. Thomson reports that the results of treatment during the year have been satisfactory on the whole. Of patients who have had artificial pneumothorax, partial or complete, for at least two years, 87 per cent.
are much improved or improved; of those who havehad at least one year's treatment, 77 per cent. are much improved or improved; while of those who refused treatment, 83 per cent. w eredead within twelve months. Progress is also being made in the direction of improved housing, fresh air, good food, clean milk and cleanliness, the importance of all of which is well recognized as factors in the prevention of tuberculosis.
WINSLEY SANATORIUM. RE PORT FOR 1927. Dr. J. D. Macfie, Senior Resident Medica.l Officer, reports that during the past year, 354 patients were admitted to the sanatorium, making a total of 7,881 admissions since its opening in 1904. The average duration of stay for each patient was 122 days. Tbe discharged patients included 134 in Stage I, of whom 114 were fit for work; 161 in Sta.ge II, with 90 fit for work; 53 in Stage III, with 16 fit for work. Dr. Macfie empha.sises the value of graduated labour, more especially from the psychological point of view, believing it to be one of the most Important factors in the treatment of pulmonary tuberculosis. Arlificial pneumothorax is being increasingly empbyed at the sanatorium, and in 23 out of 30 cases a good collapse was obtained. Sanocrysin and zomine have also been used, but no final conclusions have been arrived at as to their value.
BIBLIOGRAPHY. ORIGINAL ARTICLES PUBLISHED. APRIL-JULY, 1928. (See also previous Numbers.)
American Journa.l of Surgery.--JuLY.
Acta Obstetrlcia. et Gynecologia. Scandinavica.-Vol. vii, Fasc. 1-2. Ein Fall von tuberkuloser Ovarialzyst. E. A. BJORKENHEIM--p. 13. Acta Radiologica.-Vol. ix, Fasc. 3. Contribution to the Knowledge of the Rontgenologicllol Appearance of Silicosis. R. C. UHMAN - p. 266. Contribution to the Pyelographic Diagnosis of Renal Tuberculosis. G. ANDREN-p. 289.
American Journal of Medic&l ScIences.
JULY. Artificial Pneumothorax in the United States Veterans' ~ureau. P. B. MATZ- p. 87.
.lmerlc&n Jourui of Opbtbalmology.-JuLY. Tuberculosis of the Conjunctiva. and III. P. MOTTO-p. 033.
E. BARTOS
.lmeric&n Journ&! of Public Health.-JuLY. Bacillus Calmette-Guerin (B.C.G.). PETROFF and A. BRANCH-p. 843.
The Preventorium School. A Factor in the Community Tuberculosis Program. W. P. SHEPARD and ~L L. SPIERS-po 871.
S. A.
Tuberculosis of the Kidney. p. 76.
M. GOLDMAN-
American Review of Tuberculosis.-JuLY. Relapse in Pulmonary Tuberculosis. H. L. TAYLOR-p. 1. Massive Collapse (Atelectasis) Associated with Pulmonary Tuberculosis and Tumor. E. N. PACKARD-p. 7. Plleumonrography as a Diagnostic Aid in Clllldrdn. C. B. GIBSON and W. E. CARROLL -p.26. Rembrks on the Clinical Diagnosis of PUlmonary Tuberculosis. C. R. AUSTRIAN-
p. 37.
Remarks on the Laboratory Diagnosis of Pulmonary Tuberculosis. A. K. KRAUSE--po 51. Results of Heliotherapy in Pulmonary Tuberculosis. A. T. COOPER-po 66. Heliotherapy in Pulmonary Tuberculosis. A. T. LAIRD-p. 80.
IMMUNITY
rule no illness, and being attended by a very low death-rate. This resistance on a. first encounter with the tubercle bacillus must be an inherited trait. After this period the death-rate rises rapidly, and is maintained at a high level throughout life, thus contrasting sharply with the true immunity-conferring diseases. It would, in conse· quence, appear that natural first infection with the tubercle bacillus, even though well resisted, is followed by lessened. rather than by effectively increased, immunity. In pulmonary tuberculosis especially the altered tissue reaction following first infection seems to favour the development of dissemin· ated ulcerative phthisis. The fact that children of civilised stock resist their first tuberculous infection extremely well is explained by the writer on the .. simple evolutionary formula. of sur· vival," as is also the cognate fBoot that when tuberculosis is introduced among So race to which it is new it is many times more fatal than among even the
601
most ignorant and unhygienic of civilised people. The usual explanation of this latter fact, that the "savages" fail to resist because they have not had the immunising benefit of a first infection in childhood, is shown to be inadequate, because, if this were the whole truth, such acutely fatal cases of tuberculosis should be common among children of urbanised races, which is far from being the case. The evolutionary view seems to the writer to lI.ccount satisfactorily for the high resistance of children to first infection, assuming constant hygienic conditions. The writer agrees that experimental work with dead or attenuated Lacilli and with very small numbers of virulent bacilli has heen definitely shown to raise the resistance of animals to the tubercle bacillus, and that acquired immunity is therefore a II potential reality. But a.ny method, to succeed, must work better than natural first infection, which appears to sensitise more than it protects."
CENTRAL AND LOCAL AUTHORITIES. BRITISH LEGION VILLAGE, PRESTON HALL, KENT. REPORT FOB
1925-28.
Dr. J. B. McDougall, Medical Director, reports on the medical and economic aspects and results of the work done at the Village under the auspices of the British Legion. The principles underlying the scheme are briefly outlined, these being: (a) the treatment and education of the tuberculous patient; (b) occupational therapy; (e) adequate after-care by the provision of permanent employment and residence in the Village Settlement. Occupational therapy is given speoial consideration at Preston Hall, Dr. McDougall believing this to be one of the most valuable adjuncts in the treatment of pulmonary tuberoulosis. During 1927-8, 71'7 per cent. of all the cases admitted failed, for ROme reason or other, to gradua.te to the settlement. The technical sta.ndard has purposely been flxed high, in order to ensure the position of the industries as a commeroial undertaking able to pay their way. It is Dr. McDougall'S conviction that the higher the standard set for admission to III Settlement of this kind, the better will be the end results, even if there is less to show in the actual numbers of settlers in the Village.
No attempt is made at Preston Hall to train men at a new occupation In order that they may be able to follow it up on their return home, the attempt being rather to get the patient to co-operate with the existing system, and to become sufficiently expert technically to share in the profits of the work at Preston Hall. All settlers work at least 98 hours per week in the absence of medical instructions to the contrary, and no settler is refused work if be is medically fit. A medical survey of the 122 settlers in residence on March 81, 1928, shows that 86, or 70'5 per cent., have had tubercle bacilli in thA sputum, or hremoptysis, or pleurisy with effusion. In the rerolOining cases no such history was obtained, and 10'6 per cent. of the settlers are, in the opinion of the medical director, doubtfully tuberculous. Dr. McDougall concludes that the total number of ex.pa,tients who may be ultiroa.tely employed on 110 remunerative financial basis in a settlement must form only a small fraction of all who should be employed. if no subsidy to wages or maintenance be forthcoming. .. For those patients who are selected for the Settlement the scheme Is probably the most oom. prehensive and ideal method of solving the medic..l and economio difficulties with which the tuberculOUS individual is confronted."
602
[September, 1928
'l'UBERCLE
HERTFORDSHIRE COUNTY COUNCIL. FIFTEENTH ANNUAL REPORT ON TUBERCULOSIS IN THE C"UNTY OF HERTFORD, FOR THE YIIlAR 1927. Dr. H. Hyslop Thomson, County Medical Officer of Health and Tuberculosis Officer reports that the number of cases of tuberculosi~ notified during the year was 712, of which 588 were pulmonary cases. The death rate from pulmonary tuberculosis during the year was 0'6 'per 1,000, the figures being practically statIOnary for the past Silt years. A table is given showing the present condition of all patients under all forms of treatment since January 1, 1925, the return showing also the immediate results of treatment of patients and of ohservation of doubtful cases discharged from residential ins~itutions during the year 1927. Three hundred and sixty-five patients were admitted for sanatorium treatment, including 29 early, 134 intermediate and 171 advanced oases. Of 311 patients disoharged during the year, 210 were able to work, 56 were improved, 31 not improved, 14 were worse, and 44 patients died. Artificial pneumothorax treatment wa3 advised in 16 per oent. of the sputum positive cases, most of the other cases being considered unsuitable in view of tbe extent (}f bilateral disease. Dr. Thomson reports that the results of treatment during the year have been satisfactory on the whole. Of patients who have had artificial pneumothorax, partial or complete, for at least two years, 87 per cent.
are much improved or improved; of those who havehad at least one year's treatment, 77 per cent. are much improved or improved; while of those who refused treatment, 83 per cent. w eredead within twelve months. Progress is also being made in the direction of improved housing, fresh air, good food, clean milk and cleanliness, the importance of all of which is well recognized as factors in the prevention of tuberculosis.
WINSLEY SANATORIUM. RE PORT FOR 1927. Dr. J. D. Macfie, Senior Resident Medica.l Officer, reports that during the past year, 354 patients were admitted to the sanatorium, making a total of 7,881 admissions since its opening in 1904. The average duration of stay for each patient was 122 days. Tbe discharged patients included 134 in Stage I, of whom 114 were fit for work; 161 in Sta.ge II, with 90 fit for work; 53 in Stage III, with 16 fit for work. Dr. Macfie empha.sises the value of graduated labour, more especially from the psychological point of view, believing it to be one of the most Important factors in the treatment of pulmonary tuberculosis. Arlificial pneumothorax is being increasingly empbyed at the sanatorium, and in 23 out of 30 cases a good collapse was obtained. Sanocrysin and zomine have also been used, but no final conclusions have been arrived at as to their value.
BIBLIOGRAPHY. ORIGINAL ARTICLES PUBLISHED. APRIL-JULY, 1928. (See also previous Numbers.)
American Journa.l of Surgery.--JuLY.
Acta Obstetrlcia. et Gynecologia. Scandinavica.-Vol. vii, Fasc. 1-2. Ein Fall von tuberkuloser Ovarialzyst. E. A. BJORKENHEIM--p. 13. Acta Radiologica.-Vol. ix, Fasc. 3. Contribution to the Knowledge of the Rontgenologicllol Appearance of Silicosis. R. C. UHMAN - p. 266. Contribution to the Pyelographic Diagnosis of Renal Tuberculosis. G. ANDREN-p. 289.
American Journal of Medic&l ScIences.
JULY. Artificial Pneumothorax in the United States Veterans' ~ureau. P. B. MATZ- p. 87.
.lmerlc&n Jourui of Opbtbalmology.-JuLY. Tuberculosis of the Conjunctiva. and III. P. MOTTO-p. 033.
E. BARTOS
.lmeric&n Journ&! of Public Health.-JuLY. Bacillus Calmette-Guerin (B.C.G.). PETROFF and A. BRANCH-p. 843.
The Preventorium School. A Factor in the Community Tuberculosis Program. W. P. SHEPARD and ~L L. SPIERS-po 871.
S. A.
Tuberculosis of the Kidney. p. 76.
M. GOLDMAN-
American Review of Tuberculosis.-JuLY. Relapse in Pulmonary Tuberculosis. H. L. TAYLOR-p. 1. Massive Collapse (Atelectasis) Associated with Pulmonary Tuberculosis and Tumor. E. N. PACKARD-p. 7. Plleumonrography as a Diagnostic Aid in Clllldrdn. C. B. GIBSON and W. E. CARROLL -p.26. Rembrks on the Clinical Diagnosis of PUlmonary Tuberculosis. C. R. AUSTRIAN-
p. 37.
Remarks on the Laboratory Diagnosis of Pulmonary Tuberculosis. A. K. KRAUSE--po 51. Results of Heliotherapy in Pulmonary Tuberculosis. A. T. COOPER-po 66. Heliotherapy in Pulmonary Tuberculosis. A. T. LAIRD-p. 80.