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Mass miniature radiography
168
P U B L I C H E A L T H , June, 1942
OBITUARY RICHARD K ~ o BROWN, M.D., D.P.H. Dr. R. King Brown, formerly M . O . H . for Bermondsey, died at his home at Goring-by-Sea on April 28th. He was born in 1864 at Athlone, Co. Roscommon, and was educated at Coleraine and the University of Belfast. In 1891 he graduated B.A., M.B., B.Ch. of the old Royal University of Ireland. I n 1891 he proceeded to the M.D., with gold medal. In 1894 he had taken the D.P.H., R.C.P.S., London, and was a fellow of the Royal Institute of Public Health and Hygiene. While serving as M.O.H. and bacteriologist for Bermondsey he also lectured on public health at Guy's Hospital and examined for the M.D. in State Medicine of London University, and also for the B.A. (Architecture). He was a m e m b e r of the Sanitary Inspectors Examination Board, and medical editor of the British ffournal of
Physical Medicine.
Dr. King Brown was one of the early workers in actinotherapy, and edited the English edition of Bach's Bestrahlung mit ~mrtzlampe. He had travelled widely, knew German well, and translated several books on similar subjects, including Sunlight in Surgery by Dr. Bernhard, of St. Moritz, and Schliephake's Short-wave Therapy.
BOOK REVIEW When We Build Again. A S t u d y Based o n R e s e a r c h into C o n d i t i o n s of L i v i n g a n d W o r k i n g i n B i r m i n g h a m . A B o u r n v i l l e Village T r u s t R e s e a r c h P u b l i c a t i o n , w i t h a F o r e w o r d b y L o r d Balfour. London: George Allen & U n w i n . 1941. 138 pp., 7 p l a n s , 37 tables, 9 plates, 11 pp. illustrations. Price 8~, 6d. net. T h i s b e a u t i f u l l y p r o d u c e d book will be of great i n t e r e s t a n d value to all those c o n c e r n e d w i t h p u b l i c h e a l t h . I n 1935 t h e B o u r n v i l l e Village T r u s t i n a u g u r a t e d a p r o g r a m m e of research into h o u s i n g in B i r m i n g h a m . T h e t e r m s of reference were, roughly, to i n q u i r e into t h e h o u s i n g c o n d i t i o n s of t h e city a n d t o e x a m i n e t h e effect of past policy, i n o r d e r t o p l a n f u t u r e policy. T h e m e t h o d was to collect i n f o r m a t i o n o n t h e basis of v i s i t i n g e v e r y t h i r t y - f i f t h address of all working-class houses. I n all, 7,161 h o u s e h o l d e r s were q u e s t i o n e d . A t least o n e - t h i r d of t h e interviews h a d to b e w i t h m e n . Besides t h e q u e s t i o n of a c c o m m o d a t i o n , etc., w h i c h all h o u s i n g i n q u i r i e s deal w i t h , special a t t e n t i o n was p a i d to g a r d e n s a n d t h e j o u r n e y to work. T h e 42 p h o t o g r a p h s , s h o w i n g examples of h o u s i n g types i n B i r m i n g h a m , are a m o s t a d m i r a b l e b e g i n n i n g to t h e b o o k ; s t r a i g h t away o n e has a lively p i c t u r e t h a t serves as a b a c k g r o u n d to t h e w h o l e a r g u m e n t , w h i c h is actually n o m o r e t h a n a s t a t e m e n t of p l a i n f a c t s - - s o m e of these s t a r t l i n g enough. T h e first public park was not opened in Birmingham until 1846. The first, entirely purchased by the Corporation, was Highgate Park, opened by Joseph Chamberlain in 1876. T h e first provision of playgrounds was in 1877, and it was in ]879 that George Cadbury moved his firm out of the city; the Bournville Village Trust, responsible for an estate of 1,100 acres, was set up in 1893. This was a bright spot in Birmingham housing history, another good feature being that by 1938 one-third of the working-class population were living in houses built since the end of 1918. Except for the newer houses, however, the words of the recent Summary Report by the Ministry of H e a l t h - - " In housing, as in other Public Health services, the nation began this war well equipped "---are hardly applicable to Birmingham. T h e 1935 overcrowding survey, for instance, revealed that the city still contained 38,733 back-to-back houses, 51,794 houses without a separate w.c., and 13,650 houses without even a separate water supply. I t was in 1841 that Lord Normanby, then Home Secretary, moved a Bill in the House of Lords that houses were not to be built back to back, yet they did not become illegal u n t i l 1909; another 30 years later there were still nearly 40,000 of them in one city alone. A survey of housing needs in Birmingham under the 1919 Housing Act estimated that 14,500 new houses would be needed in the ensuing three years: 10,000 were planned, 3,234 were actually built between 1919 and 1923. At their meeting in December, 1938, the City Council adopted a report of a joint committee which proposed building 25,000 houses in the next five-year period. Even this total " was actually 5,000 less than the very conservative estimate of the m i n i m u m actually required..." to abate slums, overcrowding, and to meet the normal need for new municipal houses. T h e problem of housing is not solved by erecting a large n u m b e r of well-planned houses at economic rentals. Two major aims are to clear central slums and to develop outlying parts without creating new problems. Questions of sites, transport, and relation to areas
outside the city have to be considered. Very properly these research workers included a survey of an area round the city totalling 1,000 square miles or so. As they wisely point out, " T h e whole lesson of the modern world is the explosion of the fallacy of isolationism." Finally there are their recommendations, or rather suggestions. There must be a National planning authority, under whose aegis local planning would be carried out, and this authority must control the use of land in the public interest. Birmingham, they think, is big enough, and those industries that must be removed from the centre of the city to ease congestion should be set up in satellite towns 20 or 30 miles outside. A further interesting industrial suggestion for smaller firms is the building of flatted factories, on the same system as blocks o f dwelling fiats. They recommend also t h e adoption of the principle of licensing the life of buildings as a method of facilitating and of synchronising ordered reconstruction. The' remainder of their suggestions follow more standard lines. Throughout the book the facts are simply and plainly stated and frequently illusfrated by charts.
MASS MINIATURE RADIOGRAPHY In June, 1940, the Medical Advisory Committee appointed to advise the Minister of Labour and National Service made a report on the detection of pulmonary tuberculosis in recruits for the armed forces in which it came to the conclusion that the adoption of mass miniature radiography was impracticable at that time. A further report o n the subject was issued two months ago by the same Committee, which met on b o t h occasions under the chairmanship of Lord Horder. T h e concluding paragraph to the 1942 report states : " T h e Committee have accordingly come to the definite conclusion that they must confirm their previous recommendation in this matter." In the evidence leading up to this conclusion, the Committee observe that the carrying out of the recommendations made to Medical Boards in 1940 has reduced to an almost negligible figure the n u m b e r of eases of tuberculosis passed into the armed forces-namely, making available to the Boards information in the possession of tuberculosis authorities ; careful questioning of recruits about previous history of tuberculosis ; reference to tuberculosis officers in any case where a previous history of the disease had been elicited ; and reference by Boards to tuberculosis officers of cases of general ill health to which no specific cause could be assigned. According to sample statistics which have been taken, it is stated, these measures have resulted in the rejection of about 1% of recruits on account of pulmonary tuberculosis. Referring to the experience of mass miniature radiography in the Navy, R.A.F., and Army, the report observes that active pulmonary tuberculosis has been found by this method in about 0.3% of 100,000 naval personnel, and it is stated that naval experience shows it to be more important to examine trained men than recruits " as the majority of non-symptomic carriers of tubercle bacilli are found after they have been some time in the Service rather that at the time of joining." In the R.A.F. an X-ray examination of about 12,000 new entrants for air-crew duties disclosed pulmonary tuberculosis in less than 0-2%. T h e report points out that under their terms of reference the Committee's concern was with the methods employed by the Medical Boards in the examination of persons before entering the Forces, and it believes that a decentralising of examinations at over 200 places throughout the country militates against the use of mass miniature radiography. They therefore consider that the most satisfactory alternative is to undertake radiological examination to the greatest extent practicable after entry of recruits into the Services, and accept the view that the method of mass miniature radiography is the best means of conducting radiological examinations where there are large numbers to be examined. The Committee repeats the observation made in 1940 that there would be delay in acquiring a sufficient n u m b e r of X-ray units, and that a sufficient n u m b e r of experts capable of interpreting the films does not exist.
SCABIES ORDER, 1941 We print below the substance of the first eight paragraphs of a Circular (2645) just issued by the Ministry of Health. 1. In some counties doubts have arisen as to the respective functions of the County Council and District Councils in giving effect to the Scabies Order, 1941, referred to in Circular 2517 of November 14th, 1941. County Councils and District Councils have concurrent powers under the Scabies Order and the proper distribution of functions should therefore be that which is most convenient and effective in the circumstances of each County. It is for the County Council and the District Authorities to decide in collaboration on the most appropriate arrangement and the following general suggestions are made in the hope that they may be of some help in resolving local difficulties. 2. I n general, the Minister considers, the onus for initial action under the Scabies Order should rest with the District Authority, and
P U B L I C H E A L T H , June, 1942
OBITUARY RICHARD K ~ o BROWN, M.D., D.P.H. Dr. R. King Brown, formerly M . O . H . for Bermondsey, died at his home at Goring-by-Sea on April 28th. He was born in 1864 at Athlone, Co. Roscommon, and was educated at Coleraine and the University of Belfast. In 1891 he graduated B.A., M.B., B.Ch. of the old Royal University of Ireland. I n 1891 he proceeded to the M.D., with gold medal. In 1894 he had taken the D.P.H., R.C.P.S., London, and was a fellow of the Royal Institute of Public Health and Hygiene. While serving as M.O.H. and bacteriologist for Bermondsey he also lectured on public health at Guy's Hospital and examined for the M.D. in State Medicine of London University, and also for the B.A. (Architecture). He was a m e m b e r of the Sanitary Inspectors Examination Board, and medical editor of the British ffournal of
Physical Medicine.
Dr. King Brown was one of the early workers in actinotherapy, and edited the English edition of Bach's Bestrahlung mit ~mrtzlampe. He had travelled widely, knew German well, and translated several books on similar subjects, including Sunlight in Surgery by Dr. Bernhard, of St. Moritz, and Schliephake's Short-wave Therapy.
BOOK REVIEW When We Build Again. A S t u d y Based o n R e s e a r c h into C o n d i t i o n s of L i v i n g a n d W o r k i n g i n B i r m i n g h a m . A B o u r n v i l l e Village T r u s t R e s e a r c h P u b l i c a t i o n , w i t h a F o r e w o r d b y L o r d Balfour. London: George Allen & U n w i n . 1941. 138 pp., 7 p l a n s , 37 tables, 9 plates, 11 pp. illustrations. Price 8~, 6d. net. T h i s b e a u t i f u l l y p r o d u c e d book will be of great i n t e r e s t a n d value to all those c o n c e r n e d w i t h p u b l i c h e a l t h . I n 1935 t h e B o u r n v i l l e Village T r u s t i n a u g u r a t e d a p r o g r a m m e of research into h o u s i n g in B i r m i n g h a m . T h e t e r m s of reference were, roughly, to i n q u i r e into t h e h o u s i n g c o n d i t i o n s of t h e city a n d t o e x a m i n e t h e effect of past policy, i n o r d e r t o p l a n f u t u r e policy. T h e m e t h o d was to collect i n f o r m a t i o n o n t h e basis of v i s i t i n g e v e r y t h i r t y - f i f t h address of all working-class houses. I n all, 7,161 h o u s e h o l d e r s were q u e s t i o n e d . A t least o n e - t h i r d of t h e interviews h a d to b e w i t h m e n . Besides t h e q u e s t i o n of a c c o m m o d a t i o n , etc., w h i c h all h o u s i n g i n q u i r i e s deal w i t h , special a t t e n t i o n was p a i d to g a r d e n s a n d t h e j o u r n e y to work. T h e 42 p h o t o g r a p h s , s h o w i n g examples of h o u s i n g types i n B i r m i n g h a m , are a m o s t a d m i r a b l e b e g i n n i n g to t h e b o o k ; s t r a i g h t away o n e has a lively p i c t u r e t h a t serves as a b a c k g r o u n d to t h e w h o l e a r g u m e n t , w h i c h is actually n o m o r e t h a n a s t a t e m e n t of p l a i n f a c t s - - s o m e of these s t a r t l i n g enough. T h e first public park was not opened in Birmingham until 1846. The first, entirely purchased by the Corporation, was Highgate Park, opened by Joseph Chamberlain in 1876. T h e first provision of playgrounds was in 1877, and it was in ]879 that George Cadbury moved his firm out of the city; the Bournville Village Trust, responsible for an estate of 1,100 acres, was set up in 1893. This was a bright spot in Birmingham housing history, another good feature being that by 1938 one-third of the working-class population were living in houses built since the end of 1918. Except for the newer houses, however, the words of the recent Summary Report by the Ministry of H e a l t h - - " In housing, as in other Public Health services, the nation began this war well equipped "---are hardly applicable to Birmingham. T h e 1935 overcrowding survey, for instance, revealed that the city still contained 38,733 back-to-back houses, 51,794 houses without a separate w.c., and 13,650 houses without even a separate water supply. I t was in 1841 that Lord Normanby, then Home Secretary, moved a Bill in the House of Lords that houses were not to be built back to back, yet they did not become illegal u n t i l 1909; another 30 years later there were still nearly 40,000 of them in one city alone. A survey of housing needs in Birmingham under the 1919 Housing Act estimated that 14,500 new houses would be needed in the ensuing three years: 10,000 were planned, 3,234 were actually built between 1919 and 1923. At their meeting in December, 1938, the City Council adopted a report of a joint committee which proposed building 25,000 houses in the next five-year period. Even this total " was actually 5,000 less than the very conservative estimate of the m i n i m u m actually required..." to abate slums, overcrowding, and to meet the normal need for new municipal houses. T h e problem of housing is not solved by erecting a large n u m b e r of well-planned houses at economic rentals. Two major aims are to clear central slums and to develop outlying parts without creating new problems. Questions of sites, transport, and relation to areas
outside the city have to be considered. Very properly these research workers included a survey of an area round the city totalling 1,000 square miles or so. As they wisely point out, " T h e whole lesson of the modern world is the explosion of the fallacy of isolationism." Finally there are their recommendations, or rather suggestions. There must be a National planning authority, under whose aegis local planning would be carried out, and this authority must control the use of land in the public interest. Birmingham, they think, is big enough, and those industries that must be removed from the centre of the city to ease congestion should be set up in satellite towns 20 or 30 miles outside. A further interesting industrial suggestion for smaller firms is the building of flatted factories, on the same system as blocks o f dwelling fiats. They recommend also t h e adoption of the principle of licensing the life of buildings as a method of facilitating and of synchronising ordered reconstruction. The' remainder of their suggestions follow more standard lines. Throughout the book the facts are simply and plainly stated and frequently illusfrated by charts.
MASS MINIATURE RADIOGRAPHY In June, 1940, the Medical Advisory Committee appointed to advise the Minister of Labour and National Service made a report on the detection of pulmonary tuberculosis in recruits for the armed forces in which it came to the conclusion that the adoption of mass miniature radiography was impracticable at that time. A further report o n the subject was issued two months ago by the same Committee, which met on b o t h occasions under the chairmanship of Lord Horder. T h e concluding paragraph to the 1942 report states : " T h e Committee have accordingly come to the definite conclusion that they must confirm their previous recommendation in this matter." In the evidence leading up to this conclusion, the Committee observe that the carrying out of the recommendations made to Medical Boards in 1940 has reduced to an almost negligible figure the n u m b e r of eases of tuberculosis passed into the armed forces-namely, making available to the Boards information in the possession of tuberculosis authorities ; careful questioning of recruits about previous history of tuberculosis ; reference to tuberculosis officers in any case where a previous history of the disease had been elicited ; and reference by Boards to tuberculosis officers of cases of general ill health to which no specific cause could be assigned. According to sample statistics which have been taken, it is stated, these measures have resulted in the rejection of about 1% of recruits on account of pulmonary tuberculosis. Referring to the experience of mass miniature radiography in the Navy, R.A.F., and Army, the report observes that active pulmonary tuberculosis has been found by this method in about 0.3% of 100,000 naval personnel, and it is stated that naval experience shows it to be more important to examine trained men than recruits " as the majority of non-symptomic carriers of tubercle bacilli are found after they have been some time in the Service rather that at the time of joining." In the R.A.F. an X-ray examination of about 12,000 new entrants for air-crew duties disclosed pulmonary tuberculosis in less than 0-2%. T h e report points out that under their terms of reference the Committee's concern was with the methods employed by the Medical Boards in the examination of persons before entering the Forces, and it believes that a decentralising of examinations at over 200 places throughout the country militates against the use of mass miniature radiography. They therefore consider that the most satisfactory alternative is to undertake radiological examination to the greatest extent practicable after entry of recruits into the Services, and accept the view that the method of mass miniature radiography is the best means of conducting radiological examinations where there are large numbers to be examined. The Committee repeats the observation made in 1940 that there would be delay in acquiring a sufficient n u m b e r of X-ray units, and that a sufficient n u m b e r of experts capable of interpreting the films does not exist.
SCABIES ORDER, 1941 We print below the substance of the first eight paragraphs of a Circular (2645) just issued by the Ministry of Health. 1. In some counties doubts have arisen as to the respective functions of the County Council and District Councils in giving effect to the Scabies Order, 1941, referred to in Circular 2517 of November 14th, 1941. County Councils and District Councils have concurrent powers under the Scabies Order and the proper distribution of functions should therefore be that which is most convenient and effective in the circumstances of each County. It is for the County Council and the District Authorities to decide in collaboration on the most appropriate arrangement and the following general suggestions are made in the hope that they may be of some help in resolving local difficulties. 2. I n general, the Minister considers, the onus for initial action under the Scabies Order should rest with the District Authority, and