- Email: [email protected]
Current topics
338
TUDERCLE
observe is that the work dono since his book was published supports bim too. Ta.ke for instance the ideo. of the naturally small, feeble heart as overcommon amongst consumptives. The obvious ground of opposition is of course that it is due to cachexia, Galen perhaps, Ilokitansky certainly, did not think that it was. Laenneo was undecided. Some of lesser name wero sure of it. Then came the radiologists, finding it small, not post mortem, but before tuberculo-toxmmin and cachexia. had time to net. They pronounce for congenital smallness. Romantic event -tho triumph of an idea thousands of i'oars old ! It would astonish many an eminent sort of person who reckons himself knowledgeable in tuberculosis as in much else, to see one of these little inner box nostaof special literature, like this on the Tropfmhcrz. Auseful argument of Schlliter'sagainst phthisical habitus being acquired an-l tuborculo-toxic is simply this-that one sees it in those who after all havo not become consumptive. Medical examiners for life assurance in 0.11 tho loading coun-
[April, 1020
tries penalise underweights, tall, reedy youths, subjects with thorax p1tthisicll~ and so on-penalise them when actually they are in normal health. And tho commercial statistics accumulated by these examiners' cffices show that many more of such persons than might bo expected do develop tubercle, bitt not all. That their physical characteristics are tuberculo-toxicis'therefora quite unlikely. The work in the book is of high standard. It might havo taken two years of any body's time to write, On every page is manifest a wholosomn horror of smattering. It neutralises provincialism, cocksureness, onesidedness, to read it: makes one realise that tho phthisiologicnl fashion of the moment or of the year, or of the lustrum, is not necessarily the truth. And it usefully proves thlLt use of the apparatus of the physical laboratory is no infalliblo organon, showing that those who rely on this alone can be as full of error ns -well, as a jingo leader writer in war time. But one grants of course tba~ theirs is an honest error.
CURRENT TOPICS. A NEW SOCIETY,
tees were appointed to collect informaAs 0. result of a Conference of the tion and to formulate recommendations Medical Superintendents of Sana- for report to tho next meeting of tho toriums, Trainins Colleges, and Hos- Socioty, to bo held in May, upon pitals for Tuberculosis, held at 122, questions concerning standards of treatHarley Street, London, on ~'ebrull.ry 23, ment and udministration in institutions. 0. now Society was formed. The memo The subjects selected include scales bcrship of this Society is limited to of dietary, atandards of medical and medical men and women whoso duties nursing staffs, tho method of dealing lie mainly in the medical charge of with advanced and hopeless cases, tho institutions for .tuberculoais. " Asso- co-ordination of statistics, the relativo elate members" may bo elected from values of different methods of treatment among those who have formerly held and tho construction and equipment of such posts, and Irom junior otllccrs at institutions. Tho programme and aims of the now present at such institutions. Tho annual subscription is fixed at lOs. Gd. for Society are Cull of ambition and leave members and os. for aasocinte members. nothing to bo desired. We shall look Tho Society aims o.t tho improvement forward with much pleasure to tho results of the methods of admlnlstration, dia- of its deliberations and labours. It ig gnosis, and treatment of tuborculosis in good to soo enthusiasm and the will resiuontial institutions. Sma.ll commit- to progress, and when we consider tho
April,1020]
339
TUDEnCLE
shadow which is continually cast upon the value of sanatorium treatment, the present moment is very opportune for enlightenment concerning the real position which will be held by the sanatorium of the Iuture, and also concerning the reason (or the so-called failures of tho past. - Many figures have recently been given displaying the after-results of sanatorium treatment, and in our present number appear the results of investigation into after-histories of cases treated in 1909 in Newca.stle·upon-Tyno; apparently the treatment of those cases has involved an alarming waste of money. Institutions have long needed a. uniform programme, and we are glad to see that such & programme is to be marked out. Insulation, however, brings its dangers as well as its special advantages, and tho ract that superintendents of institutions are iliscussing such wide problems (rom their necessarily somewhat limited standpoint is not altogether fortunate. His sanatorium life is but an episode in tho career of tho consumptive, and this fraction must bo welded into the whole with as little alteration from horne conditions as is compatible with efficient treatment. 'Ve would rather have seen , all workers in tuberculosis entering into tho controversies which surround many of the subjects cited in the programme, and tho natural place lor the discussions would have been under the auspices of a thoroughly live Tuberculosis Society. That this has not been found possible is a matter of much regret to tuberculosis workers. We imagine that the Tuberculosis Society will regret that manv quostions of the greatest interest to 11011 its members should be debated only around the high table of the privilegod few, and will perhaps grieve that in tho l>a8t they have confined themselves so strictly to discussing the status of tho tuberculosis officer and the formation or a Tuberculosis Service. We ourselves have regretted that the Society should have treated with comparative neglect the clinical aspects of tubercu-losis. Although at first sight compromise and conciliation between parties may
seem difficult, we hopo that in time there
will be a happy union of 0.11 tuberculosis workers in 0. firm determination for progress. How best this may be obtained it is difficult to foresee, but an idea which commends itself is the formation of n. Section devoted to Tuberculosis within the compass of the Royal Sociely of Medicine, which Section could afford ample opportunitics for discussing every side of the subject. Our strong desire to see complete unity in the ranks does not lessen the warmth of our welcome to this ardent hand of workers, ana wo wish them every success in their enterprise. The officers of the Society arc: Dr. Jane Walker (President); Dr..Tames Watt (Secretaryand Treasurer). Executive Committeo : Drs. Esther Carling, Elwin 11. P. Nash, Marcus Paterson. A. Niven Robertson, P. C. VarrierJones, R. C. Wingfield. George Jones and Sir Henry Gauvain, ANNUAL HEPOnTS.
In a memorandum issued in January by tho Ministry of Health, details aro set out upon which Medical Officers of Health are requested to base their Annual Reports for 191D. In dealing with tuberculosis the Ministry would be glad to have information of the extent to which the requirements as to notification are observed by medical practitioners, and of any action taken to enforce the regulations and secure prompt notification. With regard to treatment the report should include: ((I) details of the Council's scheme : (b) tho extent to which the scheme has already been developed ; (c) the adequacy or otherwise of tho provision mado : (d) the lines on which experience shows tho scheme to stand in need of extension or modification; (e) tbo oxtent to which the co-operation of the medical profession has been obtained; (j) tho readiness or otherwise of patients to avail themselves of tho facilities provided lor diagnosis and treatment, and (0) tho ltl'rangements at the dispensary for providing for homo visitation, search for contacts, after care work, and so forth.
3JO
[April, 1020
The memorandum is accompanied by 0. tho lockers of every well-organised disleLLer signed by tho lamented Sir Hobert pensary there lies 0. mass of vnluablo Morant, drawing attention to tho ex- information which should he extrueted treme importance of ascertaining with- by the oilicer in charge and included in out further delay tho general health the annual report of the medical ollicer condition of the population now that tho of health; only when this is done can War is over, and pointing out tho object an opinion be Iormed of the success of tho unification of health adminis- or failure of nny particular scheme. tration in ono Ministry for this purTUE MEDICAL PUBLIC HEALTIl pose: Little, however, can bo effected SERVICE AS A CAUEER, by such centrulisntion without 0. eorrespouding co-ordination of all local In the Medical Officer for Septemhealth activities : local councils aro ber Glast, Professor Delepine gives an asked to assist in this co-ordination to outline and survey of the Public Health enable tho Ministry 0101'0 effectively Son'ice as a. career, While pointing to consiller tho valuable information out the impediments to progress, he afforded in such reports. Further- praises the status of tho service in commore, they 0.1'0 requested to give the pnrison with tha.t of other countries, reports tho widest possible publicity and comes to tho conclusion that in order thnt an enlighten od public Englund takes second place to none, opinion may support to the utmost the Ofiicially the Public Health Service aotivitics of tho local body. The reo commenced in 1848 with the pnssing of quircd details of tho tuberculosis the first Public Health Act. In 1858 schemes nrc still no 0101'0 than general ; the powers of tho General Board of it is to bo regretted that the Ministry Health were transferred to tho Privy of Health has not sone further and in- Council, and later, in 1B71, to the Locul dicated the lines upon which the statis- Government Board, and the laws passed tics and information should be collected in 1875 have boon those under which in each dispensary nren. During tho we have worked up till tho present time, war it has boon necessary for tuber- and tho formation of the Ministry of culosis oflicors to undertake 0101'0 than Health. The first Medical Oflicer of thoir aharo of work with a depleted Health for Liverpool was appointed stl\fT, nnd consequently only in ono or in 1817, and Sir John Simon 0. little two isolntcd placos has tho presentation later for the City of London. Thoso of tuberculosis officers' reports been entering the Public Health Sorvices maintninod. During 1010 the records should road Sir John Simon's classical havo improved, but not sulllcioutly to work on Englisb Sanitary Institutions Sivo very full information, Wo 0.1'0 with which should be coupled Si; now well into 1020, nnd it is important Malcolm Morris's II Tho Story of to know without delay what details English Publio lIt:alth." In these will bo required for tho current year. volumes will bo clearly seen tho difllWhon nn attempt is made in this culties occasioned by public ignoro.nco direction it is Iound thnt no information Government inertia, political intriguos' hus boon forthcoming from tho Central departmental and professional jealousies' Authority since tho formation of the which have obstructed progress. Yet Ministry of Health; it is folt thnt tho with 0.11 this, Sir Arthur Shadwell was 0111 order may bo changed and now nble to SIlY that tho Public Honltl, methods ndoptod. In tho past it wns System in England is still tho most tho hahit of tho Local Government complete and efficient in tho world. Board to i8,8uO demands at tho end of tho Many branches are open to thoso your for statistics of which no previous with suitable qualifico.tioDs-mcuicl\l notice 1I0.d .boou given, and we hope ofllcors of health, school, child welfo.re that in order to obtain uniformity tho tuborculoais, venereal disease, and feye; Mil1istr)' of lIoolth will avoid this mise hospital medical officers, and at tho top to.ko and let us know ih requirements a Iew selected appointments in tho o.ttho v~ry earliest possible moment. In Ministry of Health, the llomo Offico
April, 19~OJ
'1'OnnnCLE
and the Board of Education. The atandard of qualifieation is high, and demands several years' experience after the final examinations are passed, including in some cases the Diploma in Public Health. In comparison with the standard of qualification, the remuneration is remarkably low; in the case of tuberculosis officers running at £500 a rear, and reasonable expenses. Recently, however, these have shown a tendency to increase, but the' importance of the work in the future well-being of the nation is sure to improve the conditions. The inducements held out by the Service include the possibility of devoting one's life to work of undoubted interest and usefulness and of being occupied in well-defined work, and with regular hours. LYMPHOID TUDEncLE.
Docs
early
II
lymphoid"
tubercle
confer immunity to phthisis? The ahstracts we publish on this topic are fairly typical of the current literature. The material is plentiful, but badly sorted, and tho deductions made are vague and even contradictory. The most definite observation emerging {rom Wallgren's laborious investigations seems to bo that pulmonary tuberculosis runs a more chronic nod benign course if preceded by .. lymphoid" tuberculosis, than under other circumstances. More light would, no doubt, bo thrown on this problem could we differentiate between tbe various diseases at present loosely classified as "lymphoid." It is a peculiarly nebulous term, covering, in all probability, several distinct varieties of intection. The task of differentiation with our present tests may be compared with solving a jig-saw puzzle with the colour scheme face down. Could we but reverse the components of the puzzle, we might hope to explain why some children in a tuberculous family contract fatal pulmonary tuberculosis, while' others who develop .. lymphoid .. [uberculoais in childhood retain healthy lUDgS. Diathesis and extraneous circumstances cannot, of course, be ignored, Lut the phenomena. of immunisation
:Hl
must undoubtedly pInyan important part, though at present we sec them only as through a glasa darkly. JUVENILE
TUBERCULOSIS AND THE BOVINE BACILLUS.
At. the rocentConference of tho League of Red Cross Societies in Geneva tho plan of organising a world wide inquiry into rickets and the influence of tho bovine bacillus on juvenile tuberculosis wns -approvod. On what lines will this inquiry be conductod? If it is confined to sifting tho evidence at present available, it does not promise to be very instructive, bountiful as this evidence may be. And if the sponsors of this inquiry propose a scheme of original research, how do they intend to investigute the problem? Of the many questions which this problem evokes, two uro of supreme importance, yet we can give a definito answer to neither. We do not know how common bovine tuberculosis is in infancy, and if we attempt to compare the Edinburgh and Berlin figures we find the estimates so contradictory that doubt arises as to thoir accuracy. Again, we are sublimely ignorant or tho influence of bovine infection in childhood on the evolution of tuberculosis in adult lifo. Does early infection with the bovine, avian or other typeof tubercle bacillus confer immunity to activo pulmonary tuberculosis for tho rost of the patient's Ii Co ? In this connection it will be of great interest during tho next decades to follow the career of tho numerous children given prophylactic injections of his turtle vaccine by Friedmann, shortly before the war. They were recruited from the homes of the tuberculous, and many were suspoets ItS well as II contacts," Probably this is tho only instance of wholesale prophylactic vuccination with living acid-fast bacilli on record, and it it provo successful, a definite advance will have been made, Meantime the information at our disposal depends on the researches of less audacious investigators than Friedmann, and we o.ro driven to the conclusion that, in these matters, wo are merely standing on tho threshold of knowledge.
TUDERCLE
observe is that the work dono since his book was published supports bim too. Ta.ke for instance the ideo. of the naturally small, feeble heart as overcommon amongst consumptives. The obvious ground of opposition is of course that it is due to cachexia, Galen perhaps, Ilokitansky certainly, did not think that it was. Laenneo was undecided. Some of lesser name wero sure of it. Then came the radiologists, finding it small, not post mortem, but before tuberculo-toxmmin and cachexia. had time to net. They pronounce for congenital smallness. Romantic event -tho triumph of an idea thousands of i'oars old ! It would astonish many an eminent sort of person who reckons himself knowledgeable in tuberculosis as in much else, to see one of these little inner box nostaof special literature, like this on the Tropfmhcrz. Auseful argument of Schlliter'sagainst phthisical habitus being acquired an-l tuborculo-toxic is simply this-that one sees it in those who after all havo not become consumptive. Medical examiners for life assurance in 0.11 tho loading coun-
[April, 1020
tries penalise underweights, tall, reedy youths, subjects with thorax p1tthisicll~ and so on-penalise them when actually they are in normal health. And tho commercial statistics accumulated by these examiners' cffices show that many more of such persons than might bo expected do develop tubercle, bitt not all. That their physical characteristics are tuberculo-toxicis'therefora quite unlikely. The work in the book is of high standard. It might havo taken two years of any body's time to write, On every page is manifest a wholosomn horror of smattering. It neutralises provincialism, cocksureness, onesidedness, to read it: makes one realise that tho phthisiologicnl fashion of the moment or of the year, or of the lustrum, is not necessarily the truth. And it usefully proves thlLt use of the apparatus of the physical laboratory is no infalliblo organon, showing that those who rely on this alone can be as full of error ns -well, as a jingo leader writer in war time. But one grants of course tba~ theirs is an honest error.
CURRENT TOPICS. A NEW SOCIETY,
tees were appointed to collect informaAs 0. result of a Conference of the tion and to formulate recommendations Medical Superintendents of Sana- for report to tho next meeting of tho toriums, Trainins Colleges, and Hos- Socioty, to bo held in May, upon pitals for Tuberculosis, held at 122, questions concerning standards of treatHarley Street, London, on ~'ebrull.ry 23, ment and udministration in institutions. 0. now Society was formed. The memo The subjects selected include scales bcrship of this Society is limited to of dietary, atandards of medical and medical men and women whoso duties nursing staffs, tho method of dealing lie mainly in the medical charge of with advanced and hopeless cases, tho institutions for .tuberculoais. " Asso- co-ordination of statistics, the relativo elate members" may bo elected from values of different methods of treatment among those who have formerly held and tho construction and equipment of such posts, and Irom junior otllccrs at institutions. Tho programme and aims of the now present at such institutions. Tho annual subscription is fixed at lOs. Gd. for Society are Cull of ambition and leave members and os. for aasocinte members. nothing to bo desired. We shall look Tho Society aims o.t tho improvement forward with much pleasure to tho results of the methods of admlnlstration, dia- of its deliberations and labours. It ig gnosis, and treatment of tuborculosis in good to soo enthusiasm and the will resiuontial institutions. Sma.ll commit- to progress, and when we consider tho
April,1020]
339
TUDEnCLE
shadow which is continually cast upon the value of sanatorium treatment, the present moment is very opportune for enlightenment concerning the real position which will be held by the sanatorium of the Iuture, and also concerning the reason (or the so-called failures of tho past. - Many figures have recently been given displaying the after-results of sanatorium treatment, and in our present number appear the results of investigation into after-histories of cases treated in 1909 in Newca.stle·upon-Tyno; apparently the treatment of those cases has involved an alarming waste of money. Institutions have long needed a. uniform programme, and we are glad to see that such & programme is to be marked out. Insulation, however, brings its dangers as well as its special advantages, and tho ract that superintendents of institutions are iliscussing such wide problems (rom their necessarily somewhat limited standpoint is not altogether fortunate. His sanatorium life is but an episode in tho career of tho consumptive, and this fraction must bo welded into the whole with as little alteration from horne conditions as is compatible with efficient treatment. 'Ve would rather have seen , all workers in tuberculosis entering into tho controversies which surround many of the subjects cited in the programme, and tho natural place lor the discussions would have been under the auspices of a thoroughly live Tuberculosis Society. That this has not been found possible is a matter of much regret to tuberculosis workers. We imagine that the Tuberculosis Society will regret that manv quostions of the greatest interest to 11011 its members should be debated only around the high table of the privilegod few, and will perhaps grieve that in tho l>a8t they have confined themselves so strictly to discussing the status of tho tuberculosis officer and the formation or a Tuberculosis Service. We ourselves have regretted that the Society should have treated with comparative neglect the clinical aspects of tubercu-losis. Although at first sight compromise and conciliation between parties may
seem difficult, we hopo that in time there
will be a happy union of 0.11 tuberculosis workers in 0. firm determination for progress. How best this may be obtained it is difficult to foresee, but an idea which commends itself is the formation of n. Section devoted to Tuberculosis within the compass of the Royal Sociely of Medicine, which Section could afford ample opportunitics for discussing every side of the subject. Our strong desire to see complete unity in the ranks does not lessen the warmth of our welcome to this ardent hand of workers, ana wo wish them every success in their enterprise. The officers of the Society arc: Dr. Jane Walker (President); Dr..Tames Watt (Secretaryand Treasurer). Executive Committeo : Drs. Esther Carling, Elwin 11. P. Nash, Marcus Paterson. A. Niven Robertson, P. C. VarrierJones, R. C. Wingfield. George Jones and Sir Henry Gauvain, ANNUAL HEPOnTS.
In a memorandum issued in January by tho Ministry of Health, details aro set out upon which Medical Officers of Health are requested to base their Annual Reports for 191D. In dealing with tuberculosis the Ministry would be glad to have information of the extent to which the requirements as to notification are observed by medical practitioners, and of any action taken to enforce the regulations and secure prompt notification. With regard to treatment the report should include: ((I) details of the Council's scheme : (b) tho extent to which the scheme has already been developed ; (c) the adequacy or otherwise of tho provision mado : (d) the lines on which experience shows tho scheme to stand in need of extension or modification; (e) tbo oxtent to which the co-operation of the medical profession has been obtained; (j) tho readiness or otherwise of patients to avail themselves of tho facilities provided lor diagnosis and treatment, and (0) tho ltl'rangements at the dispensary for providing for homo visitation, search for contacts, after care work, and so forth.
3JO
[April, 1020
The memorandum is accompanied by 0. tho lockers of every well-organised disleLLer signed by tho lamented Sir Hobert pensary there lies 0. mass of vnluablo Morant, drawing attention to tho ex- information which should he extrueted treme importance of ascertaining with- by the oilicer in charge and included in out further delay tho general health the annual report of the medical ollicer condition of the population now that tho of health; only when this is done can War is over, and pointing out tho object an opinion be Iormed of the success of tho unification of health adminis- or failure of nny particular scheme. tration in ono Ministry for this purTUE MEDICAL PUBLIC HEALTIl pose: Little, however, can bo effected SERVICE AS A CAUEER, by such centrulisntion without 0. eorrespouding co-ordination of all local In the Medical Officer for Septemhealth activities : local councils aro ber Glast, Professor Delepine gives an asked to assist in this co-ordination to outline and survey of the Public Health enable tho Ministry 0101'0 effectively Son'ice as a. career, While pointing to consiller tho valuable information out the impediments to progress, he afforded in such reports. Further- praises the status of tho service in commore, they 0.1'0 requested to give the pnrison with tha.t of other countries, reports tho widest possible publicity and comes to tho conclusion that in order thnt an enlighten od public Englund takes second place to none, opinion may support to the utmost the Ofiicially the Public Health Service aotivitics of tho local body. The reo commenced in 1848 with the pnssing of quircd details of tho tuberculosis the first Public Health Act. In 1858 schemes nrc still no 0101'0 than general ; the powers of tho General Board of it is to bo regretted that the Ministry Health were transferred to tho Privy of Health has not sone further and in- Council, and later, in 1B71, to the Locul dicated the lines upon which the statis- Government Board, and the laws passed tics and information should be collected in 1875 have boon those under which in each dispensary nren. During tho we have worked up till tho present time, war it has boon necessary for tuber- and tho formation of the Ministry of culosis oflicors to undertake 0101'0 than Health. The first Medical Oflicer of thoir aharo of work with a depleted Health for Liverpool was appointed stl\fT, nnd consequently only in ono or in 1817, and Sir John Simon 0. little two isolntcd placos has tho presentation later for the City of London. Thoso of tuberculosis officers' reports been entering the Public Health Sorvices maintninod. During 1010 the records should road Sir John Simon's classical havo improved, but not sulllcioutly to work on Englisb Sanitary Institutions Sivo very full information, Wo 0.1'0 with which should be coupled Si; now well into 1020, nnd it is important Malcolm Morris's II Tho Story of to know without delay what details English Publio lIt:alth." In these will bo required for tho current year. volumes will bo clearly seen tho difllWhon nn attempt is made in this culties occasioned by public ignoro.nco direction it is Iound thnt no information Government inertia, political intriguos' hus boon forthcoming from tho Central departmental and professional jealousies' Authority since tho formation of the which have obstructed progress. Yet Ministry of Health; it is folt thnt tho with 0.11 this, Sir Arthur Shadwell was 0111 order may bo changed and now nble to SIlY that tho Public Honltl, methods ndoptod. In tho past it wns System in England is still tho most tho hahit of tho Local Government complete and efficient in tho world. Board to i8,8uO demands at tho end of tho Many branches are open to thoso your for statistics of which no previous with suitable qualifico.tioDs-mcuicl\l notice 1I0.d .boou given, and we hope ofllcors of health, school, child welfo.re that in order to obtain uniformity tho tuborculoais, venereal disease, and feye; Mil1istr)' of lIoolth will avoid this mise hospital medical officers, and at tho top to.ko and let us know ih requirements a Iew selected appointments in tho o.ttho v~ry earliest possible moment. In Ministry of Health, the llomo Offico
April, 19~OJ
'1'OnnnCLE
and the Board of Education. The atandard of qualifieation is high, and demands several years' experience after the final examinations are passed, including in some cases the Diploma in Public Health. In comparison with the standard of qualification, the remuneration is remarkably low; in the case of tuberculosis officers running at £500 a rear, and reasonable expenses. Recently, however, these have shown a tendency to increase, but the' importance of the work in the future well-being of the nation is sure to improve the conditions. The inducements held out by the Service include the possibility of devoting one's life to work of undoubted interest and usefulness and of being occupied in well-defined work, and with regular hours. LYMPHOID TUDEncLE.
Docs
early
II
lymphoid"
tubercle
confer immunity to phthisis? The ahstracts we publish on this topic are fairly typical of the current literature. The material is plentiful, but badly sorted, and tho deductions made are vague and even contradictory. The most definite observation emerging {rom Wallgren's laborious investigations seems to bo that pulmonary tuberculosis runs a more chronic nod benign course if preceded by .. lymphoid" tuberculosis, than under other circumstances. More light would, no doubt, bo thrown on this problem could we differentiate between tbe various diseases at present loosely classified as "lymphoid." It is a peculiarly nebulous term, covering, in all probability, several distinct varieties of intection. The task of differentiation with our present tests may be compared with solving a jig-saw puzzle with the colour scheme face down. Could we but reverse the components of the puzzle, we might hope to explain why some children in a tuberculous family contract fatal pulmonary tuberculosis, while' others who develop .. lymphoid .. [uberculoais in childhood retain healthy lUDgS. Diathesis and extraneous circumstances cannot, of course, be ignored, Lut the phenomena. of immunisation
:Hl
must undoubtedly pInyan important part, though at present we sec them only as through a glasa darkly. JUVENILE
TUBERCULOSIS AND THE BOVINE BACILLUS.
At. the rocentConference of tho League of Red Cross Societies in Geneva tho plan of organising a world wide inquiry into rickets and the influence of tho bovine bacillus on juvenile tuberculosis wns -approvod. On what lines will this inquiry be conductod? If it is confined to sifting tho evidence at present available, it does not promise to be very instructive, bountiful as this evidence may be. And if the sponsors of this inquiry propose a scheme of original research, how do they intend to investigute the problem? Of the many questions which this problem evokes, two uro of supreme importance, yet we can give a definito answer to neither. We do not know how common bovine tuberculosis is in infancy, and if we attempt to compare the Edinburgh and Berlin figures we find the estimates so contradictory that doubt arises as to thoir accuracy. Again, we are sublimely ignorant or tho influence of bovine infection in childhood on the evolution of tuberculosis in adult lifo. Does early infection with the bovine, avian or other typeof tubercle bacillus confer immunity to activo pulmonary tuberculosis for tho rost of the patient's Ii Co ? In this connection it will be of great interest during tho next decades to follow the career of tho numerous children given prophylactic injections of his turtle vaccine by Friedmann, shortly before the war. They were recruited from the homes of the tuberculous, and many were suspoets ItS well as II contacts," Probably this is tho only instance of wholesale prophylactic vuccination with living acid-fast bacilli on record, and it it provo successful, a definite advance will have been made, Meantime the information at our disposal depends on the researches of less audacious investigators than Friedmann, and we o.ro driven to the conclusion that, in these matters, wo are merely standing on tho threshold of knowledge.