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INFECTIOUSNESS OF TUBERCULOSIS IN CHILDREN.
1053 he had no kind word to say for it. Psychologically he described superstition as suggestibility, based upon fear, and he condemned it as no innocent mistake but a wilful and shameless belief contrary to the laws of nature, to experience, and to common sense. This may certainly be applied to those who cling to superstitions or conventions when there is at hand the means of rational apprehension, but when the primitive mind is striving with inadequate equipment to grasp an idea beyond its capacity to understand, superstition may be but the stepping-stone to knowledge. The curious thing about superstitions is that they so often contain, buried deeply in apparent nonsense, the germ of the truth. Kipling has illustrated this in his tale of Nicholas Culpepper who, for the most fantastic
astrological reasons, set about destroying rats as a means of combating the plague and was more success-
ful than the half-educated scientific man of his time. Quaint beliefs still hold the field in many departments of life and medicine where knowledge has yet failed to give full illumination. We shall do better than our fathers if we investigate them with sympathetic interest, rather than despising them as foolish or harrying them as evil. Explored with intelligence they are apt to yield, as several courageous investigators have shown, an unexpected treasure of new
understanding.
--
INFECTIOUSNESS OF TUBERCULOSIS IN CHILDREN. WHILE the view that tuberculosis is essentially an infectious disorder is gaining ground it is generally held that only open cases of tuberculosis, with tubercle bacilli in sputum or excreta, are a danger to their associates. In children it is so difficult to obtain sputum for examination that the question of individual infectivity is a difficult one to settle. Dr. Vlademar Poulsen, of Copenhagen, has recently investigated! 67 children, ranging from 2 months to 8 years of age who gave a positive tuberculin reaction. His method of obtaining sputum was that first introduced by Meunier in 1898, and revived at the present day by P. F. Armand-Delille and his pupils, which consists in washing out the fasting stomach in the morning with 200-300 c.cm. of sterile water, centrifuging the result and staining the deposit for tubercle bacilli after Ziehl-Neelsen. Another portion of the sediment may be inoculated on Petroff’s medium or injected into a guinea-pig if further confirmation is desired. In this way 26 out of 67 children were found to have tubercle bacilli in the wash-out containing all the sputum swallowed overnight. The age distribution of these cases with positive findings was of interest ; every one of 14 cases under 1 year of age gave a positive result, a finding in keeping with the generalised nature of tuberculosis at this early period of life. In older children positive results were obtained less frequently ;-, over 3 years of age only two children had tubercle bacilli in the wash-out, of whom one had phthisis with cavitation and the other tuberculous pleurisy. The cases in Dr. Poulsen’s series of tuberculous meningitis were interesting because, as he points out, meningitis is rarely the sole localisation of tuberculosis, miliary disease in the lungs being, as a rule, present also. Out of six cases of meningitis in the series he was able to show that three were excreting tubercle bacilli. From these figures he argues the need for isolation of certain tuberculinpositive children according to their age and condition. All children under 1 year of age with a positive tuberculin reaction he regards as infectious, whether definite physical signs of disease can be found or not. Between 1 and 3 years of age, in most cases, such children are probably non-infectious unless they have meningitis or definite pulmonary localisation ;while above this age it is, he thinks, safe for tuberculinpositive children to mix with others, provided neither pulmonary tuberculosis nor pleurisy is present. Even 1Jahrb. f. Kinderh., 1929, cxxv., 206.
if the need for strict isolation is not generally admitted, Dr. Poulsen has done a useful service in calling attention to a method of obtaining proof of the presence of tubercle bacilli in the sputum of children. His lavage method warrants a trial in this country. MEDICAL WOMEN AT V.D. CLINICS. A FEW weeks ago a candidate for a post at a venereal diseases clinic in Scotland was rejected on the ground of sex, as apparently it had been decided that a woman qua woman could not hold such a post there. The incident naturally led to some discussion at the Medical Women’s Federation, when the council was satisfied of the existence of a definite desire on the part of many women patients to be treated by practitioners of their own sex. In England and Wales, although there is no official ruling to prevent the appointment of women, the number who hold office at V.D. treatment centres seems to be comparatively small. At the close of 1928, according to the report of the chief medical officer of the Ministry of Health, the number of such centres was 188-viz., 178 in England, 10 in Wales. Besides the treatment provided at the regular centres, special arrangements exist at 11 maternity and child welfare centres for the convenience of affected women and children, and besides these there are 14 hostels for the care of girls suffering from venereal diseases and 8 institutions for the reception of pregnant women. Inquiry at the Ministry has elicited the fact that there are 52 at treatment women practitioners holding posts centres, 18 in London and 34 in the provinces. In London there are women medical officers at Guy’s, King’s, London, South London, Royal Free, and Royal Northern, while in the provinces there are women medical officers at Ashton-under-Lyne,
Bradford, Birkenhead, Birmingham, Blackburn, Bolton, Hull, Leeds, Leicester, Lincoln, Liverpool, Newcastle-on-Tyne, Nottingham, Oxford, Plymouth, Preston, St. Helens, Southampton, Southend-on-Sea, Stroud, Sunderland, Waddon, and York. The Federation is not satisfied with this position and has passed a resolution urging that medical officers treating female
venereal disease cases whether in hospitals or clinics should be women practitioners where and whenever such practitioners are available. There is cumulative evidence that the clinics serve their purpose more fully where this is the case ; at the Royal Free clinic the medical officers see many of the most dangerous type of prostitute and their ability to get these women into hostels must prevent a large amount of infection. It may be that there are not at the moment enough women with sufficient experience to warrant appointment to such clinics, but if the demand was present there is little doubt that this defect would soon be remedied. ____
THE Nobel Prize for Chemistry for 1929 has been divided between Prof. Arthur Harden, D.Sc., F.R.S., and Prof. Hans von Euler. Dr. Harden is head of the Biochemical Department at the Lister Institute and Professor of Biochemistry in the University of London. Prof. von Euler holds the chair of organic chemistry in the University of Stockholm and is well known for his work on enzymes and vitamins.
ON Wednesday, Nov. 27th, the Duchess of Atholl will lay the foundation-stone of the new London Clinic and Nursing Home at the top of Harley-street. The ceremony will take place at noon at the Devonshireplace entrance to the Clinic, and will be followed by a luncheon at 1 P.M. at the Trocadero Restaurant,
Piccadilly. HEALTH EXHIBITION
IN
LONDON.——Lord Askwith
will open the New Health Society’s second annual exhibition at 3 P.M. to-day, Friday, Nov. 15th, at the Royal Horticultural Hall. Westminster. The exhibition will be open daily from noon to 10 P.M. until Nov. 22nd.
astrological reasons, set about destroying rats as a means of combating the plague and was more success-
ful than the half-educated scientific man of his time. Quaint beliefs still hold the field in many departments of life and medicine where knowledge has yet failed to give full illumination. We shall do better than our fathers if we investigate them with sympathetic interest, rather than despising them as foolish or harrying them as evil. Explored with intelligence they are apt to yield, as several courageous investigators have shown, an unexpected treasure of new
understanding.
--
INFECTIOUSNESS OF TUBERCULOSIS IN CHILDREN. WHILE the view that tuberculosis is essentially an infectious disorder is gaining ground it is generally held that only open cases of tuberculosis, with tubercle bacilli in sputum or excreta, are a danger to their associates. In children it is so difficult to obtain sputum for examination that the question of individual infectivity is a difficult one to settle. Dr. Vlademar Poulsen, of Copenhagen, has recently investigated! 67 children, ranging from 2 months to 8 years of age who gave a positive tuberculin reaction. His method of obtaining sputum was that first introduced by Meunier in 1898, and revived at the present day by P. F. Armand-Delille and his pupils, which consists in washing out the fasting stomach in the morning with 200-300 c.cm. of sterile water, centrifuging the result and staining the deposit for tubercle bacilli after Ziehl-Neelsen. Another portion of the sediment may be inoculated on Petroff’s medium or injected into a guinea-pig if further confirmation is desired. In this way 26 out of 67 children were found to have tubercle bacilli in the wash-out containing all the sputum swallowed overnight. The age distribution of these cases with positive findings was of interest ; every one of 14 cases under 1 year of age gave a positive result, a finding in keeping with the generalised nature of tuberculosis at this early period of life. In older children positive results were obtained less frequently ;-, over 3 years of age only two children had tubercle bacilli in the wash-out, of whom one had phthisis with cavitation and the other tuberculous pleurisy. The cases in Dr. Poulsen’s series of tuberculous meningitis were interesting because, as he points out, meningitis is rarely the sole localisation of tuberculosis, miliary disease in the lungs being, as a rule, present also. Out of six cases of meningitis in the series he was able to show that three were excreting tubercle bacilli. From these figures he argues the need for isolation of certain tuberculinpositive children according to their age and condition. All children under 1 year of age with a positive tuberculin reaction he regards as infectious, whether definite physical signs of disease can be found or not. Between 1 and 3 years of age, in most cases, such children are probably non-infectious unless they have meningitis or definite pulmonary localisation ;while above this age it is, he thinks, safe for tuberculinpositive children to mix with others, provided neither pulmonary tuberculosis nor pleurisy is present. Even 1Jahrb. f. Kinderh., 1929, cxxv., 206.
if the need for strict isolation is not generally admitted, Dr. Poulsen has done a useful service in calling attention to a method of obtaining proof of the presence of tubercle bacilli in the sputum of children. His lavage method warrants a trial in this country. MEDICAL WOMEN AT V.D. CLINICS. A FEW weeks ago a candidate for a post at a venereal diseases clinic in Scotland was rejected on the ground of sex, as apparently it had been decided that a woman qua woman could not hold such a post there. The incident naturally led to some discussion at the Medical Women’s Federation, when the council was satisfied of the existence of a definite desire on the part of many women patients to be treated by practitioners of their own sex. In England and Wales, although there is no official ruling to prevent the appointment of women, the number who hold office at V.D. treatment centres seems to be comparatively small. At the close of 1928, according to the report of the chief medical officer of the Ministry of Health, the number of such centres was 188-viz., 178 in England, 10 in Wales. Besides the treatment provided at the regular centres, special arrangements exist at 11 maternity and child welfare centres for the convenience of affected women and children, and besides these there are 14 hostels for the care of girls suffering from venereal diseases and 8 institutions for the reception of pregnant women. Inquiry at the Ministry has elicited the fact that there are 52 at treatment women practitioners holding posts centres, 18 in London and 34 in the provinces. In London there are women medical officers at Guy’s, King’s, London, South London, Royal Free, and Royal Northern, while in the provinces there are women medical officers at Ashton-under-Lyne,
Bradford, Birkenhead, Birmingham, Blackburn, Bolton, Hull, Leeds, Leicester, Lincoln, Liverpool, Newcastle-on-Tyne, Nottingham, Oxford, Plymouth, Preston, St. Helens, Southampton, Southend-on-Sea, Stroud, Sunderland, Waddon, and York. The Federation is not satisfied with this position and has passed a resolution urging that medical officers treating female
venereal disease cases whether in hospitals or clinics should be women practitioners where and whenever such practitioners are available. There is cumulative evidence that the clinics serve their purpose more fully where this is the case ; at the Royal Free clinic the medical officers see many of the most dangerous type of prostitute and their ability to get these women into hostels must prevent a large amount of infection. It may be that there are not at the moment enough women with sufficient experience to warrant appointment to such clinics, but if the demand was present there is little doubt that this defect would soon be remedied. ____
THE Nobel Prize for Chemistry for 1929 has been divided between Prof. Arthur Harden, D.Sc., F.R.S., and Prof. Hans von Euler. Dr. Harden is head of the Biochemical Department at the Lister Institute and Professor of Biochemistry in the University of London. Prof. von Euler holds the chair of organic chemistry in the University of Stockholm and is well known for his work on enzymes and vitamins.
ON Wednesday, Nov. 27th, the Duchess of Atholl will lay the foundation-stone of the new London Clinic and Nursing Home at the top of Harley-street. The ceremony will take place at noon at the Devonshireplace entrance to the Clinic, and will be followed by a luncheon at 1 P.M. at the Trocadero Restaurant,
Piccadilly. HEALTH EXHIBITION
IN
LONDON.——Lord Askwith
will open the New Health Society’s second annual exhibition at 3 P.M. to-day, Friday, Nov. 15th, at the Royal Horticultural Hall. Westminster. The exhibition will be open daily from noon to 10 P.M. until Nov. 22nd.