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CONTRACEPTIVE TECHNIQUE
635
highest number of cases discovered in any region although the actual prevalence is not so high as in the North-East of England. It is worth noting that about half the active cases were infectious. The early minimal lesion of routine mass radiography is replaced in group radiography by a more extensive, sometimes cavitating, condition. It must be
A mass-radiography service combining a static unit for group radiography and a lightweight mobile unit for mass surveys is advocated. For information about mass radiography in their regions my thanks due to Dr. P. J. H. Clarke, Dr. J. 0. F. Davies, Dr. J. Fairley, Dr. J. Graham, Dr. G. H. Hall, Dr. T. F. Jarman, Dr. G. C. Kelly, Dr. J. S. B. Mackay, Dr. D. L. Murray, Dr. J. A. Rushworth, Dr. G. C. Taylor, Dr. A. B. Williamson, and Dr. F. L. Wollaston. are
conceded that such lesions should have been detected That they were not so detected makes the value of the service more significant, for a source of infection in the community has been found and removed. Thus the search for contacts, although important, has not the same urgency as when a minimal lesion is discovered and the infector remains at large in the
clinically.
community. These results enable us to see, although dimly, the pattern for the most effective use of mass radiography in the future. Units should consist of two parts-a static 100 mm. unit for group radiography, and a lightweight mobile component for mass surveys of selected highprevalence groups. The static unit should be placed in the main hospital for the industrial area, where the mass radiography organisation could use it according to the local demand: twice daily sessions would be needed in a city the size of Birmingham, in smaller cities sessions two or three times a week would suffice. At other times the unit would be available for routine X-ray of outpatients and for follow-up cases. The mass-radiography service could undertake this work now, for it already has the filing and record system as well as the trained personnel to handle the numbers likely to be referred for X-ray. The medical director is trained and experienced in reading miniature films, and through his present work has close contacts with the local general practitioners, who would be the main users of the service. The mobile unit, which would be used on a diminishing scale as time goes on, would concentrate mainly on groups or districts where there is a high incidence of tuberculosis. The policy of using mass radiography in both static and mobile roles widens considerably the line of attack on tuberculosis. It also enables a balanced service to be achieved. " Balance," according to Lord Montgomery of Alamein, " implies the disposal of available forces in such a way that it is never necessary to react to the enemy’s thrusts and moves; a balanced army proceeds relentlessly with its plans in spite of what the enemy may do." Tuberculosis is the enemy. Mass radiography must attack with a balanced army of two corps: the static corps for group radiography. and the mobile corps for mass It is only when thus deployed that it can radiography. " proceed relentlessly with its plans " and make victory
inevitable.
Summary The use of mass radiography in the Birmingham region in 1952-56 is described. During these five years more than 1000 cases of active tuberculosis have been discovered annually, giving a
prevalence-rate, in recent years, of 3-4 per 1000. The increasing value of group radiography of high prevalence groups is emphasised. In 1956, 30% of all the notified cases of respiratory tuberculosis in the region came from the mass-radiography service.
REFERENCES
Barr, A., Ritchie, J. (1955) Tubercle, 36, 228. Brett, G. Z., Benjamin, B., Craig, J. W., Freeman, V. (1956) Brit. med. J. i, 719. Medical Research Council (1953) Report of Subcommittee on Mass Miniature Radiography. Montgomery of Alamein, Lord (1948) El Alamein to the River Sangro. London.
Nash, F. A. (1956) NAPT Bull. 19, Nos. 1 and 2. Benjamin, B., Lee, T. J. (1953) Brit. med. J. i, 304. Sutherland H. (1952) Lancet, i, 152. —
Scotland in 1957 In his
preliminary report
of the Scottish vital statistics for
1957, the Registrar General estimates the population
as
the end of the year. The marriage-rate, though 5,159,500 still high at 83 per 1000, had fallen a little from the 1956 level, but the birth-rate rose to 19 per 1000; and as the death-rate stayed about the same there was a natural increase in the population-of 36,835. But the net migration from Scotland was 35,500-20,000 to Canada and most of the rest to England. The maternal mortality rate (1in 2000) and infant-mortality rate (29 per 1000) were the same as in 1956. The expectation of life, based on the 1957 figures, is 65-8 years for boys at birth and 71-3 years for girls. These figures are respectively 21 and 24 years more than those at the beginning of the century. at
Special
Articles
CONTRACEPTIVE
TECHNIQUE
ON March 4 Dr. Sylvia Dawkins gave a lecture-film demonstration on contraceptive technique for final-year students of all London medical schools. Prof. W. C. W. NixoN, the chairman, said that every medical student before qualification should be educated in this vital question, and that ideally such instruction should be given in a contraceptive clinic attached to each
teaching hospital’s postnatal department. Unfortunately was not done today, and it was left to the Family Planning Association to sponsor such lectures as this in an attempt to fill the gap in present-day medical training. Professor Nixon spoke of the 268 F.P.A. clinics throughthis
out the country and of the work of the Association, which had reached its present position only after twenty-seven years of struggle against the prejudice and misunderstanding which had for so long obscured this subject. Dr. DAWKINS described the medical indications for advice on contraception, and spoke of the social aspects of this question, stressed in the report of the Royal Commission on Population nearly ten years ago but still sadly neglected. It was not enough to recommend patients to limit or space their families; the doctor must be able to give practical advice on how to carry this out. Some municipal clinics gave advice on contraception, and this service was provided over a wide area by F.P.A. clinics. The various methods were discussed, and the techniques of fitting and using occlusive caps were described and illustrated by a film. In conclusion Dr. Dawkins said that this was a world problem necessitating continuous research for simpler and more acceptable methods of family limitation than those now available.
highest number of cases discovered in any region although the actual prevalence is not so high as in the North-East of England. It is worth noting that about half the active cases were infectious. The early minimal lesion of routine mass radiography is replaced in group radiography by a more extensive, sometimes cavitating, condition. It must be
A mass-radiography service combining a static unit for group radiography and a lightweight mobile unit for mass surveys is advocated. For information about mass radiography in their regions my thanks due to Dr. P. J. H. Clarke, Dr. J. 0. F. Davies, Dr. J. Fairley, Dr. J. Graham, Dr. G. H. Hall, Dr. T. F. Jarman, Dr. G. C. Kelly, Dr. J. S. B. Mackay, Dr. D. L. Murray, Dr. J. A. Rushworth, Dr. G. C. Taylor, Dr. A. B. Williamson, and Dr. F. L. Wollaston. are
conceded that such lesions should have been detected That they were not so detected makes the value of the service more significant, for a source of infection in the community has been found and removed. Thus the search for contacts, although important, has not the same urgency as when a minimal lesion is discovered and the infector remains at large in the
clinically.
community. These results enable us to see, although dimly, the pattern for the most effective use of mass radiography in the future. Units should consist of two parts-a static 100 mm. unit for group radiography, and a lightweight mobile component for mass surveys of selected highprevalence groups. The static unit should be placed in the main hospital for the industrial area, where the mass radiography organisation could use it according to the local demand: twice daily sessions would be needed in a city the size of Birmingham, in smaller cities sessions two or three times a week would suffice. At other times the unit would be available for routine X-ray of outpatients and for follow-up cases. The mass-radiography service could undertake this work now, for it already has the filing and record system as well as the trained personnel to handle the numbers likely to be referred for X-ray. The medical director is trained and experienced in reading miniature films, and through his present work has close contacts with the local general practitioners, who would be the main users of the service. The mobile unit, which would be used on a diminishing scale as time goes on, would concentrate mainly on groups or districts where there is a high incidence of tuberculosis. The policy of using mass radiography in both static and mobile roles widens considerably the line of attack on tuberculosis. It also enables a balanced service to be achieved. " Balance," according to Lord Montgomery of Alamein, " implies the disposal of available forces in such a way that it is never necessary to react to the enemy’s thrusts and moves; a balanced army proceeds relentlessly with its plans in spite of what the enemy may do." Tuberculosis is the enemy. Mass radiography must attack with a balanced army of two corps: the static corps for group radiography. and the mobile corps for mass It is only when thus deployed that it can radiography. " proceed relentlessly with its plans " and make victory
inevitable.
Summary The use of mass radiography in the Birmingham region in 1952-56 is described. During these five years more than 1000 cases of active tuberculosis have been discovered annually, giving a
prevalence-rate, in recent years, of 3-4 per 1000. The increasing value of group radiography of high prevalence groups is emphasised. In 1956, 30% of all the notified cases of respiratory tuberculosis in the region came from the mass-radiography service.
REFERENCES
Barr, A., Ritchie, J. (1955) Tubercle, 36, 228. Brett, G. Z., Benjamin, B., Craig, J. W., Freeman, V. (1956) Brit. med. J. i, 719. Medical Research Council (1953) Report of Subcommittee on Mass Miniature Radiography. Montgomery of Alamein, Lord (1948) El Alamein to the River Sangro. London.
Nash, F. A. (1956) NAPT Bull. 19, Nos. 1 and 2. Benjamin, B., Lee, T. J. (1953) Brit. med. J. i, 304. Sutherland H. (1952) Lancet, i, 152. —
Scotland in 1957 In his
preliminary report
of the Scottish vital statistics for
1957, the Registrar General estimates the population
as
the end of the year. The marriage-rate, though 5,159,500 still high at 83 per 1000, had fallen a little from the 1956 level, but the birth-rate rose to 19 per 1000; and as the death-rate stayed about the same there was a natural increase in the population-of 36,835. But the net migration from Scotland was 35,500-20,000 to Canada and most of the rest to England. The maternal mortality rate (1in 2000) and infant-mortality rate (29 per 1000) were the same as in 1956. The expectation of life, based on the 1957 figures, is 65-8 years for boys at birth and 71-3 years for girls. These figures are respectively 21 and 24 years more than those at the beginning of the century. at
Special
Articles
CONTRACEPTIVE
TECHNIQUE
ON March 4 Dr. Sylvia Dawkins gave a lecture-film demonstration on contraceptive technique for final-year students of all London medical schools. Prof. W. C. W. NixoN, the chairman, said that every medical student before qualification should be educated in this vital question, and that ideally such instruction should be given in a contraceptive clinic attached to each
teaching hospital’s postnatal department. Unfortunately was not done today, and it was left to the Family Planning Association to sponsor such lectures as this in an attempt to fill the gap in present-day medical training. Professor Nixon spoke of the 268 F.P.A. clinics throughthis
out the country and of the work of the Association, which had reached its present position only after twenty-seven years of struggle against the prejudice and misunderstanding which had for so long obscured this subject. Dr. DAWKINS described the medical indications for advice on contraception, and spoke of the social aspects of this question, stressed in the report of the Royal Commission on Population nearly ten years ago but still sadly neglected. It was not enough to recommend patients to limit or space their families; the doctor must be able to give practical advice on how to carry this out. Some municipal clinics gave advice on contraception, and this service was provided over a wide area by F.P.A. clinics. The various methods were discussed, and the techniques of fitting and using occlusive caps were described and illustrated by a film. In conclusion Dr. Dawkins said that this was a world problem necessitating continuous research for simpler and more acceptable methods of family limitation than those now available.