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What is Tuberculosis? Its Control and Prevention
PUBLIC HEALTH, February, 1946
70 cannot be attracted, nor can he be expected to give of his best, unless he feels he is getting a fair deal and is free from financial worry. A national scale is imperative. For better or for worse we live in a commercial age, and the present disparity in remuneration for similar service fosters discontent. The entire success of this or any other scheme depends on the provision of adequate finance. Promotion is another most important aspect of any service, and the great increase in staff required to run the proposed service will give greatly improved prospects in this field. Facilities for refresher courses, both for medical and technical staff, are essential, and the opportunities afforded wiU not only benefit the workers in smaller units but will give the senior men a chance to assess the personnel they have at their disposal for promotion and their relative merits. While I am on this subject, the connection with the universities might well be broached. T h e teaching and research departments should remain under their present control, but close co-operation with the laboratories of the national scheme would result in mutual aid, on the one hand in providing material, and on the other in providing facilities for courses of study. O n the knotty problem of control, I submit that the Chief Pathologist should be responsible to the Minister. T h e regional pathologists should be responsible to representatives of the local practitioners, the medical officer of health and the voluntary hospitals and allied institutions for the local work, and to the Chief Pathologist for the general running of the laboratory and through him to the Medical Research Council in connection with any research work undertaken. T h e local pathologists should again be responsible to the representatives of the local practitioners, the medical officer of health, the voluntary hospitals, and such other institutions as he serves. Guidance may be forthcoming in the White Paper on this subject. I n conclusion, I submit that what we want is a comprehensive laboratory service which will receive and report on any specimen submitted by any responsible person ; which will make arrangements for the efficient collection of specimens where necessary, and the prompt and reliable dispatch of reports. I n this connection the importance of an intelligent and efficient transport and clerical staff should not be overlooked. A life may depend on the proper discharge of their duties. We should be entitled to call upon the best brains in the country to solve our problems, either on the spot or in their own laboratories. A splendid nucleus exists at the present, and it is in the spheres of coordinating, extending and raising the general level of existing facilities to that of the best of them that the sure way to improvement lies.
NEWS A N D SUMMARY JOINT TUBERCULOSIS COUNCIL At their meeting on November 17th, the Joint Tuberculosis Council paid tribute to the late Dr. Ernest Ward. For a long period Dr. Ward was Hon. Secretary of the Council and he did much to organise it in its early days. T h e chief business of the meeting was to consider a report drafted by the Council's Committee on the Development of the Tuberculosis Services. T h e main points of the report, which was approved with some amendments, were : - 1. Tuberculosis work should be organised regionally, and joint boards should be set up for the purpose. 2. The joint boards should have executive powers. 3. The areas served by tuberculosis boards should be approximately the same size as the new regions under the projected National Health Service ; local administrative units, however, should serve a population of about 250,000. 4. The senior clinical tuberculosis officer for each region should have access to the joint board as of right. 5. The environment and preventive aspects of tuberculosis work, i.e., the dispensary and domiciliary work, should not be divorced from the clinical aspect. Tuberculosis clinicians, therefore, should have responsibility for their work at all its stages. 6. A not inconsiderable advantage of a remodelled tuberculosis service would be the opportunities for promotion which it would create, thus providing the incentive for the best clinicians to devote themselves to the work.
7. The Council reiterated their frequently expressed conviction t h a t a sine q u a n o n of a successful tuberculosis service was recogni-
tion of the tuberculosis clinician as a specialist, accorded rank and pay appropriate to his status. At the same meeting, the Joint Tuberculosis Council approved the final draft of a Memorandum of Advice on Mantoux Conversion of Hospital and Sanatorium Staffs. Copies of the completed Memorandum (and copies of the Development Committee's report) may be obtained from the Hon. Secretary of the Council, Dr. Norman England, 1, Becket Street, Oxford. T h e officers of the Joint Tuberculosis Council reported on a recent meeting with the Ministry of Health representatives, at which the Council's draft report on tuberculosis notification was discussed. There was a frank exchange of views, and the Ministry promised to give the Council's ideas the fullest consideration. T h e Nursing Committee was asked to consider Pamphlet P.L. 177, forwarded by the National Advisory Council on Nurses and Midwives, which contained recommendations about the recruitment of nurses and midwives for training in institutions. Dr. D. P. Sutherland, Senior Tuberculosis Officer, Manchester, was nominated as next year's chairman of the Council, with Ors. Peter W. Edwards and G. Jessel as vice-chairmen. Drs. A. P. Ford and Norman England were re-nominated as Hon. Treasurer and Hon. Secretary respectively.
II
BOOK REVIEWS Introduction to Diseases of the Chest. By JAMES MAXWELL. Second Edition. 1945. London : Hodder and Stoughton, Ltd. Pp. 292. Price, 12s. 6d. net. With the development of m o d e m methods of diagnosis and treatment, diseases of the chest have become a vast subject, and the author has been wise not to attempt to cover it all in this introductory volume. T h e text falls into two main sections. T h e first gives an account of the six chief symptoms of intra-thoracic disease, and stresses the importance of obtaining a complete and accurate history. T h e general and special methods used for investigation are described. T h e second part deals with the commoner disorders of the respiratory apparatus in detail, and some rarer ones more briefly. It is a sound and on the whole orthodox account, though there may not be complete agreement with all the author's opinions on some of the more controversial points. T h e book is written essentially from the medical aspect, so that in order to obtain a fairly balanced view of diseases of the chbst the student is advised to read it in conjunction with one of the comparable works on thoracic surgery. T h e recent habit of grouping the illustrative x-rays together is probably due to publishers' difficulties, but it does not make for easy reading, and we look forward to the return of their insertion in the appropriate places in the text. What is Tuberculosis ? Its Control and Prevention. By MILOSH SEKULICH, M.D. Preface by H.M. Queen Marie of Yugoslavia. L o n d o n : Research Books, Ltd., in association with Wm. Heinemann. 1945. Pp. 96. Price 3s. 6d. This book is intended for the instruction of the layman. T h e tuberculosis problem is dealt with from a Continental, and especially from a Balkan point of view; and unless it was to introduce us to this it is not easy to understand why the book has been written in English. T h e author's command of our language is not quite good enough to enable him to express his views clearly. T h e style of the book is muddled ; there is frequent repetition and even some contradiction. An example of the Continental outlook is the regarding of typhus and rrmlaria as diseases comparable with tuberculosis. We feel that this book is unlikely to be much in demand in this country ; but, translated into the languages of those to whose conditions of life it applies the book may be a powerful weapon in their struggie against tuberculosis.
70 cannot be attracted, nor can he be expected to give of his best, unless he feels he is getting a fair deal and is free from financial worry. A national scale is imperative. For better or for worse we live in a commercial age, and the present disparity in remuneration for similar service fosters discontent. The entire success of this or any other scheme depends on the provision of adequate finance. Promotion is another most important aspect of any service, and the great increase in staff required to run the proposed service will give greatly improved prospects in this field. Facilities for refresher courses, both for medical and technical staff, are essential, and the opportunities afforded wiU not only benefit the workers in smaller units but will give the senior men a chance to assess the personnel they have at their disposal for promotion and their relative merits. While I am on this subject, the connection with the universities might well be broached. T h e teaching and research departments should remain under their present control, but close co-operation with the laboratories of the national scheme would result in mutual aid, on the one hand in providing material, and on the other in providing facilities for courses of study. O n the knotty problem of control, I submit that the Chief Pathologist should be responsible to the Minister. T h e regional pathologists should be responsible to representatives of the local practitioners, the medical officer of health and the voluntary hospitals and allied institutions for the local work, and to the Chief Pathologist for the general running of the laboratory and through him to the Medical Research Council in connection with any research work undertaken. T h e local pathologists should again be responsible to the representatives of the local practitioners, the medical officer of health, the voluntary hospitals, and such other institutions as he serves. Guidance may be forthcoming in the White Paper on this subject. I n conclusion, I submit that what we want is a comprehensive laboratory service which will receive and report on any specimen submitted by any responsible person ; which will make arrangements for the efficient collection of specimens where necessary, and the prompt and reliable dispatch of reports. I n this connection the importance of an intelligent and efficient transport and clerical staff should not be overlooked. A life may depend on the proper discharge of their duties. We should be entitled to call upon the best brains in the country to solve our problems, either on the spot or in their own laboratories. A splendid nucleus exists at the present, and it is in the spheres of coordinating, extending and raising the general level of existing facilities to that of the best of them that the sure way to improvement lies.
NEWS A N D SUMMARY JOINT TUBERCULOSIS COUNCIL At their meeting on November 17th, the Joint Tuberculosis Council paid tribute to the late Dr. Ernest Ward. For a long period Dr. Ward was Hon. Secretary of the Council and he did much to organise it in its early days. T h e chief business of the meeting was to consider a report drafted by the Council's Committee on the Development of the Tuberculosis Services. T h e main points of the report, which was approved with some amendments, were : - 1. Tuberculosis work should be organised regionally, and joint boards should be set up for the purpose. 2. The joint boards should have executive powers. 3. The areas served by tuberculosis boards should be approximately the same size as the new regions under the projected National Health Service ; local administrative units, however, should serve a population of about 250,000. 4. The senior clinical tuberculosis officer for each region should have access to the joint board as of right. 5. The environment and preventive aspects of tuberculosis work, i.e., the dispensary and domiciliary work, should not be divorced from the clinical aspect. Tuberculosis clinicians, therefore, should have responsibility for their work at all its stages. 6. A not inconsiderable advantage of a remodelled tuberculosis service would be the opportunities for promotion which it would create, thus providing the incentive for the best clinicians to devote themselves to the work.
7. The Council reiterated their frequently expressed conviction t h a t a sine q u a n o n of a successful tuberculosis service was recogni-
tion of the tuberculosis clinician as a specialist, accorded rank and pay appropriate to his status. At the same meeting, the Joint Tuberculosis Council approved the final draft of a Memorandum of Advice on Mantoux Conversion of Hospital and Sanatorium Staffs. Copies of the completed Memorandum (and copies of the Development Committee's report) may be obtained from the Hon. Secretary of the Council, Dr. Norman England, 1, Becket Street, Oxford. T h e officers of the Joint Tuberculosis Council reported on a recent meeting with the Ministry of Health representatives, at which the Council's draft report on tuberculosis notification was discussed. There was a frank exchange of views, and the Ministry promised to give the Council's ideas the fullest consideration. T h e Nursing Committee was asked to consider Pamphlet P.L. 177, forwarded by the National Advisory Council on Nurses and Midwives, which contained recommendations about the recruitment of nurses and midwives for training in institutions. Dr. D. P. Sutherland, Senior Tuberculosis Officer, Manchester, was nominated as next year's chairman of the Council, with Ors. Peter W. Edwards and G. Jessel as vice-chairmen. Drs. A. P. Ford and Norman England were re-nominated as Hon. Treasurer and Hon. Secretary respectively.
II
BOOK REVIEWS Introduction to Diseases of the Chest. By JAMES MAXWELL. Second Edition. 1945. London : Hodder and Stoughton, Ltd. Pp. 292. Price, 12s. 6d. net. With the development of m o d e m methods of diagnosis and treatment, diseases of the chest have become a vast subject, and the author has been wise not to attempt to cover it all in this introductory volume. T h e text falls into two main sections. T h e first gives an account of the six chief symptoms of intra-thoracic disease, and stresses the importance of obtaining a complete and accurate history. T h e general and special methods used for investigation are described. T h e second part deals with the commoner disorders of the respiratory apparatus in detail, and some rarer ones more briefly. It is a sound and on the whole orthodox account, though there may not be complete agreement with all the author's opinions on some of the more controversial points. T h e book is written essentially from the medical aspect, so that in order to obtain a fairly balanced view of diseases of the chbst the student is advised to read it in conjunction with one of the comparable works on thoracic surgery. T h e recent habit of grouping the illustrative x-rays together is probably due to publishers' difficulties, but it does not make for easy reading, and we look forward to the return of their insertion in the appropriate places in the text. What is Tuberculosis ? Its Control and Prevention. By MILOSH SEKULICH, M.D. Preface by H.M. Queen Marie of Yugoslavia. L o n d o n : Research Books, Ltd., in association with Wm. Heinemann. 1945. Pp. 96. Price 3s. 6d. This book is intended for the instruction of the layman. T h e tuberculosis problem is dealt with from a Continental, and especially from a Balkan point of view; and unless it was to introduce us to this it is not easy to understand why the book has been written in English. T h e author's command of our language is not quite good enough to enable him to express his views clearly. T h e style of the book is muddled ; there is frequent repetition and even some contradiction. An example of the Continental outlook is the regarding of typhus and rrmlaria as diseases comparable with tuberculosis. We feel that this book is unlikely to be much in demand in this country ; but, translated into the languages of those to whose conditions of life it applies the book may be a powerful weapon in their struggie against tuberculosis.