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AGE AT ONSET OF TUBERCULOSIS
876 is related to the " unusual epidemic " you more than I can tell. But all our patients have a few features in common. MOUCIIOT. GABRIEL MOUCHOT. Messei, Messci, Orne. France.
Normandy
describe, is
AGE AT ONSET OF TUBERCULOSIS
SiR,-Your leading article on contact examination (March 8) points out the difficulty, and importance, of
the age at which the risk of tuberculosis increases. agreed that resistance to the disease is lowered during the period of sexual development, and that ideally the incidence should be related to physiological rather than chronological age. The term " puberty " (which means the state of being capable of procreation ; legally, in this country, achieved at the age of 14 years in boys and 12 years in girls) is commonly used rather vaguely to describe the period of transition from childhood to adolescence. Some degree of accuracy may be obtained in females by using the menarche as a fixed point, but no such convenient incident occurs in males. In practice, therefore, the use of puberty as an epidemiological landmark must be considered unsatisfactory. Furthermore, as your article emphasises, the Ministry. of Health age-group classifications are not ideal, though they probably are the best that can be con’trived for the analysis of large-scale notification
fixing It is
figures. A
more
rewarding
line of
approach
is to
study
the
clinical histories of children with manifest phthisis (progressive pulmonary tuberculosis of "adult" type).
4. Between 11years and 15years there times as many cases in females as in males.
are
nearly
three
If this analysis is acceptable, one may say with some confidence that the age at which the risk of tuberculosis
begins to increase is 10 years in girls, and, less definitely. 12 years in boys. The striking agreement in ageincidence between the six reports, despite differences of race and environment (racial differences in
the
at
age
puberty probably not great), seems to give authority to are
Fig. 2-Age
on
culosis in 60
diagnosis of pulmonary tuber. in North-East England,
cases
this observation. The low total incidence of phthisis in childhood reported in the two publications referred to in your leading article can be confirmed from other sources, Combined information from notifications, tuberculin surveys, mass radiography, and published work on this subject suggest a total incidence in tuberculin-positive white children of not more than 0-1% below 10 years of age, rising at 15 years to about 0-5% in girls, and 0-2% in boys. Poole Sanatorium,
Nunthorpe,
near
Middlesbrough.
P ANDERSON. J P. J. A NDERSON. ’ ..
RHESUS NOMENCLATURE SiR,-Since my letter appeared on Feb. 2, I have encountered numerous other C-D-E equivalents for the phenotype Rh1rh, in addition to the dozen previously listed. Some of these are
++-+++ CDe,e CDece CDEede. c
It is significant that only a single champion has come forward to defend the Fisher-Race notations. As his solution," Dr. Allan (March 22) suggests still another modification of the C-D-E notations, thus confounding confusion. A. S. WIENER. Brooklyn, New York, U.S.A. "
Fig. I-Average age on diagnosis of pulmonary tuberculosis in five in the U.S.A. and Germany (a total of 614 cases).
series
discovery of such disease nearly always leads early treatment, sanatorium and clinic records should yield the age of each individual at the time of diagnosis. Reports of such investigations have been published in America by Chadwick and Zacks,l Gibson and Carroll,2 Karan,3 and Morgan,4 and in Germany by Pietsch.5 The averages from these five reports are shown in fig. 1. The graph from each approximates closely to the average. Fig. 2 illustrates the findings in a series of 60 personally collected cases from Poole Sanatorium and the neighbouring chest clinics, observed during the period In all the reports the patients were white 1938-51. Since the
to
children. Several 1.
Only
occur
of interest emerge from all these series : about 13% of the cases of phthisis in children
points
below 10 years of age, and the sex-incidence in these is
equal. 2. In girls the incidence rises sharply after the age of 10 years. 3. A less distinct rise in boys is seen after the age of 12 years, and the male graph roughly parallels the female with an interval of 2 years. 1. Chadwick, H. D., Zacks, D. J. Amer. med. Ass. 2. Gibson, C. B., Carroll, W. E. Amer. Rev. Tuberc. 3. Karan, A. A. Ibid, 1932, 26, 571. 4. Morgan, R. Ibid, 1934, 29, 577. 5. Pietsch, W. Z. Tuberk. 1939, 82, 28.
1927, 89, 670. 1927, 15, 665.
MORE MANURE
SiR,-Yours are not the columns in which to compare the merits of muck and magic " with the views of the devotees of hydroponics, but we are all sensitive to the prospects of our food-supply. The county engineer of Dumfries, to whom you refer in your annotation of April 12, is to be congratulated on a practical attempt to remedy one effect of the .agricultural tractor; and, whilst doctors are understandably more concerned with the pathogenic bacteria, there is a view that the compost heap and farmyard manure owe their usefulness to the contribution that is made to the bacterial flora of the soil, for there is no reason to assume that the soil flora is always self-balancing. It would be a pity if the innocence of the Dumfries compost failed to be proved and the matter were abandoned: for, whilst the presence of pathogens is demonstrable in our sewage effluents, this may be a reflection moreof existing treatment difficulties. If these matters needed exploration one would suggest that the sewage froma sanatorium or general hospital might provide an abundance oftesting material, but against this bacteria logists would be saddened by the thought ’of the massof antiseptic which goes down the same drains. It sometimes happens that a new hospital or sanatoriumis "
Normandy
describe, is
AGE AT ONSET OF TUBERCULOSIS
SiR,-Your leading article on contact examination (March 8) points out the difficulty, and importance, of
the age at which the risk of tuberculosis increases. agreed that resistance to the disease is lowered during the period of sexual development, and that ideally the incidence should be related to physiological rather than chronological age. The term " puberty " (which means the state of being capable of procreation ; legally, in this country, achieved at the age of 14 years in boys and 12 years in girls) is commonly used rather vaguely to describe the period of transition from childhood to adolescence. Some degree of accuracy may be obtained in females by using the menarche as a fixed point, but no such convenient incident occurs in males. In practice, therefore, the use of puberty as an epidemiological landmark must be considered unsatisfactory. Furthermore, as your article emphasises, the Ministry. of Health age-group classifications are not ideal, though they probably are the best that can be con’trived for the analysis of large-scale notification
fixing It is
figures. A
more
rewarding
line of
approach
is to
study
the
clinical histories of children with manifest phthisis (progressive pulmonary tuberculosis of "adult" type).
4. Between 11years and 15years there times as many cases in females as in males.
are
nearly
three
If this analysis is acceptable, one may say with some confidence that the age at which the risk of tuberculosis
begins to increase is 10 years in girls, and, less definitely. 12 years in boys. The striking agreement in ageincidence between the six reports, despite differences of race and environment (racial differences in
the
at
age
puberty probably not great), seems to give authority to are
Fig. 2-Age
on
culosis in 60
diagnosis of pulmonary tuber. in North-East England,
cases
this observation. The low total incidence of phthisis in childhood reported in the two publications referred to in your leading article can be confirmed from other sources, Combined information from notifications, tuberculin surveys, mass radiography, and published work on this subject suggest a total incidence in tuberculin-positive white children of not more than 0-1% below 10 years of age, rising at 15 years to about 0-5% in girls, and 0-2% in boys. Poole Sanatorium,
Nunthorpe,
near
Middlesbrough.
P ANDERSON. J P. J. A NDERSON. ’ ..
RHESUS NOMENCLATURE SiR,-Since my letter appeared on Feb. 2, I have encountered numerous other C-D-E equivalents for the phenotype Rh1rh, in addition to the dozen previously listed. Some of these are
++-+++ CDe,e CDece CDEede. c
It is significant that only a single champion has come forward to defend the Fisher-Race notations. As his solution," Dr. Allan (March 22) suggests still another modification of the C-D-E notations, thus confounding confusion. A. S. WIENER. Brooklyn, New York, U.S.A. "
Fig. I-Average age on diagnosis of pulmonary tuberculosis in five in the U.S.A. and Germany (a total of 614 cases).
series
discovery of such disease nearly always leads early treatment, sanatorium and clinic records should yield the age of each individual at the time of diagnosis. Reports of such investigations have been published in America by Chadwick and Zacks,l Gibson and Carroll,2 Karan,3 and Morgan,4 and in Germany by Pietsch.5 The averages from these five reports are shown in fig. 1. The graph from each approximates closely to the average. Fig. 2 illustrates the findings in a series of 60 personally collected cases from Poole Sanatorium and the neighbouring chest clinics, observed during the period In all the reports the patients were white 1938-51. Since the
to
children. Several 1.
Only
occur
of interest emerge from all these series : about 13% of the cases of phthisis in children
points
below 10 years of age, and the sex-incidence in these is
equal. 2. In girls the incidence rises sharply after the age of 10 years. 3. A less distinct rise in boys is seen after the age of 12 years, and the male graph roughly parallels the female with an interval of 2 years. 1. Chadwick, H. D., Zacks, D. J. Amer. med. Ass. 2. Gibson, C. B., Carroll, W. E. Amer. Rev. Tuberc. 3. Karan, A. A. Ibid, 1932, 26, 571. 4. Morgan, R. Ibid, 1934, 29, 577. 5. Pietsch, W. Z. Tuberk. 1939, 82, 28.
1927, 89, 670. 1927, 15, 665.
MORE MANURE
SiR,-Yours are not the columns in which to compare the merits of muck and magic " with the views of the devotees of hydroponics, but we are all sensitive to the prospects of our food-supply. The county engineer of Dumfries, to whom you refer in your annotation of April 12, is to be congratulated on a practical attempt to remedy one effect of the .agricultural tractor; and, whilst doctors are understandably more concerned with the pathogenic bacteria, there is a view that the compost heap and farmyard manure owe their usefulness to the contribution that is made to the bacterial flora of the soil, for there is no reason to assume that the soil flora is always self-balancing. It would be a pity if the innocence of the Dumfries compost failed to be proved and the matter were abandoned: for, whilst the presence of pathogens is demonstrable in our sewage effluents, this may be a reflection moreof existing treatment difficulties. If these matters needed exploration one would suggest that the sewage froma sanatorium or general hospital might provide an abundance oftesting material, but against this bacteria logists would be saddened by the thought ’of the massof antiseptic which goes down the same drains. It sometimes happens that a new hospital or sanatoriumis "