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OSTRACISM OF THE TUBERCULOUS
261 I consider that the basic procedure in the treatment of acute malaria in Africa consists in : (1) overwhelming the infection and so gaining rapid control of the attack with quinine either orally or, in special circumstances, parenterally (quinine acts promptly on the parasite in
OSTRACISM OF THE TUBERCULOUS SrB,—Many of us working in the field of tuberculosis share the concern of Dr. Edelston (July 16) lest ostracism of the tuberculous should cause patients to conceal their disease and thus disseminate it. But one of his remarks, unless qualified, is in my view misleading and contrary to general experience. He writes " it is time that it was realised that active cases of pulmonary tuberculosis can be nursed in general wards of general hospitals without the smallest danger to nursing staff or to the nonHad he added " if adequate tuberculous patients." precautions are taken " one might be inclined to agree. However, where cases of active pulmonary tuberculosis are admitted sporadically to general wards it is unlikely that junior nurses or even ward sisters are aware of what precautions should be taken ; nor are facilities for the adequate disinfection and disposal of sputum and soiled linen usually available. Again, one wonders how often tuberculous patients in general wards are supplied with individual crockery, whether they are taught safe coughing, and whether nurses tending them are urged to wear masks. My own feeling is that there is probably less risk to staff in a well-run sanatorium than in a general hospital where positive-sputum cases are admitted to the general wards. frequently Your issue of July 16 also contained reports of papers given by various distinguished authorities on tuberculosis in nurses and students. Dr. Marc Daniels, in his able summing-up, stated that it is now generally agreed that there is a higher tuberculosis morbidity among hospital workers than in the general population, and drew attention to the casual attitude towards tuberculous infection in many hospitals. is not to exaggerate such risks My purpose in as exist, which in my view are almost negligible in Mantoux-positive subjects where adequate precautions are taken. I feel, however, that the proposal in Dr. Edelston’s letter which I have criticised might, if acted upon, lead to a perpetuation of the casual methods deplored by the above-mentioned authorities, which could only tend to maintain a higher incidence of tuberculous disease in hospital workers. W. E. SNELL. Colindale Hospital, London, N.W.9.
the early stages of schizogony) ; and (2) following through with a full course of one of the newer plasmocidal drugs. Dosage varies with the strain or species of the causal plasmodium. Salisbury,
Southern Rhodesia.
WILLIAM KERR BLACKIE.
SHOE LACES FOR THE STIFF-JOINTED
SiR,-Mr. Dundas Irvine’s patients (July 30, p. 199)
give up their search for an instrument " to draw tight and tie shoe laces " if they use elastic shoe laces. These are supplied by the Soesi Co., 78, Upper Richmond Road, London, S.W.15, in various colours and sizes. can
G. K. ROSE.
Birmingham.
Parliament QUESTION TIME Grading of Venereologists Sir ERNEST GrRAHAM-LiTTLE asked the Minister of Health if, in view of the fact that by reason of the downgrading of venereologists the total of accredited -specialists would be reduced to a number wholly insufficient to deal with the increasingly anxious problem of venereal disease, he would review the position.-Mr. ANEURiN BEVAN replied : Boards are. at present reviewing their medical establishments in the light of the needs of the service. It would not be proper for the grading of existing individuals to be influenced by considerations of staffing requirements.
,
writing
Ambulance Services Mr. BAKER WHITE asked the Minister what was the total strength of the ambulance services coming within the scope of the National Health Service in terms of personnel and vehicles ; and what were the corresponding figures for public ambulance services on June 30, 1946.-Mr. BEVAN replied : The figures for the National Health Service (England and Wales) are whole-time drivers and attendants 7000 (approx.) ; ambulances 3321 ; sitting-case cars 824. The corresponding figures for public ambulance services before July, 1948, were obtained somewhat later than the date mentioned in the question. They are 4275 ; 3925 (including a large number of works and colliery ambulances still operating outside the National Health Service) ; and 366.
QUININE IN ACUTE MALARIA
SiR,-The prevailing tendency amongst writers on the treatment of malaria is to stress the virtues of the newer plasmocidal drugs while showing remarkable indifference to the established properties of quinine. This attitude is also prevalent amongst newcomers to medical practice in the tropics-so much so that one is obliged to conclude that the present-day teaching in tropical medicine fails to stress the salient fact that quinine is still our sheet anchor in the treatment of acute malaria. Those of us who through years of practice in the tropics havelearned to respect the unpredictable vagaries .and viciousness of malignant malaria in the nonimmune, continue to regard quinine as the most reliable and most effective of all-the plasmocidal drugs in gaining speedy control of an acute attack ; and this still holds good after giving fair trial to all the newer plasmocidal drugs. Furthermore, the prejudice expressed in some authoritative quarters against the use of parenteral quinine therapy-more especially against intramuscular injection-is wholly unjustified. With the patient prostrated by the persistent and intractable vomiting and the profound toxaemia that so often accompany attacks of acute malignant malaria, oral therapy is wholly unreasonable : in such circumstances the parenteral administration of quinine will not only save life but will spare the patient hours-even days-of distress and suffering.
.
Hearing-aids
Mr. GERALD WILLIAMS asked the Minister what percentage ofMedresco’ hearing-aids have been found to be faulty.Mr. ARTHUR BLENKINSOP replied : About 3% of the aids delivered to distribution centres are now returned as faulty. Of the aids issued to patients in the first year about 24% have come in for servicing or repair in England and Wales, but it is difficult to know how much of this represents original faults in the instruments. Mr. WILLIAM : Has the Minister any idea how long it takes to repair these hearing-aids, because there is a great deal of complaint about this matter ?‘? - Mr. BLENKiNSor : Very often the repairs are minor servicing repairs. We regard the proportion of sets which come back for minor repairs and servicing as extremely small.
_
Spectacles, Dentures, and Wigs Mr. WILLIAM TEELHSTG asked the Minister how many pairs of glasses and how many sets of false teeth and how many wigs have been provided in the last 12 months ; and how many demands are still outstanding.-Mr. BLENKINSOP replied : At a very rough estimate, about 41/2 million pairs of spectacles have been supplied under the supplementary eye service and between three and four million pairs are on order. No information is available as to the number of dentures. Up to May 20, 8000 wigs were ordered and 2600 supplied through the Ministry of Pensions, on the advice of specialists. Birth-control Advice in the Colonies Mr. R. W. SORENSEN asked the Secretary of State for the Colonies in which Colonies was appropriate birth-control
OSTRACISM OF THE TUBERCULOUS SrB,—Many of us working in the field of tuberculosis share the concern of Dr. Edelston (July 16) lest ostracism of the tuberculous should cause patients to conceal their disease and thus disseminate it. But one of his remarks, unless qualified, is in my view misleading and contrary to general experience. He writes " it is time that it was realised that active cases of pulmonary tuberculosis can be nursed in general wards of general hospitals without the smallest danger to nursing staff or to the nonHad he added " if adequate tuberculous patients." precautions are taken " one might be inclined to agree. However, where cases of active pulmonary tuberculosis are admitted sporadically to general wards it is unlikely that junior nurses or even ward sisters are aware of what precautions should be taken ; nor are facilities for the adequate disinfection and disposal of sputum and soiled linen usually available. Again, one wonders how often tuberculous patients in general wards are supplied with individual crockery, whether they are taught safe coughing, and whether nurses tending them are urged to wear masks. My own feeling is that there is probably less risk to staff in a well-run sanatorium than in a general hospital where positive-sputum cases are admitted to the general wards. frequently Your issue of July 16 also contained reports of papers given by various distinguished authorities on tuberculosis in nurses and students. Dr. Marc Daniels, in his able summing-up, stated that it is now generally agreed that there is a higher tuberculosis morbidity among hospital workers than in the general population, and drew attention to the casual attitude towards tuberculous infection in many hospitals. is not to exaggerate such risks My purpose in as exist, which in my view are almost negligible in Mantoux-positive subjects where adequate precautions are taken. I feel, however, that the proposal in Dr. Edelston’s letter which I have criticised might, if acted upon, lead to a perpetuation of the casual methods deplored by the above-mentioned authorities, which could only tend to maintain a higher incidence of tuberculous disease in hospital workers. W. E. SNELL. Colindale Hospital, London, N.W.9.
the early stages of schizogony) ; and (2) following through with a full course of one of the newer plasmocidal drugs. Dosage varies with the strain or species of the causal plasmodium. Salisbury,
Southern Rhodesia.
WILLIAM KERR BLACKIE.
SHOE LACES FOR THE STIFF-JOINTED
SiR,-Mr. Dundas Irvine’s patients (July 30, p. 199)
give up their search for an instrument " to draw tight and tie shoe laces " if they use elastic shoe laces. These are supplied by the Soesi Co., 78, Upper Richmond Road, London, S.W.15, in various colours and sizes. can
G. K. ROSE.
Birmingham.
Parliament QUESTION TIME Grading of Venereologists Sir ERNEST GrRAHAM-LiTTLE asked the Minister of Health if, in view of the fact that by reason of the downgrading of venereologists the total of accredited -specialists would be reduced to a number wholly insufficient to deal with the increasingly anxious problem of venereal disease, he would review the position.-Mr. ANEURiN BEVAN replied : Boards are. at present reviewing their medical establishments in the light of the needs of the service. It would not be proper for the grading of existing individuals to be influenced by considerations of staffing requirements.
,
writing
Ambulance Services Mr. BAKER WHITE asked the Minister what was the total strength of the ambulance services coming within the scope of the National Health Service in terms of personnel and vehicles ; and what were the corresponding figures for public ambulance services on June 30, 1946.-Mr. BEVAN replied : The figures for the National Health Service (England and Wales) are whole-time drivers and attendants 7000 (approx.) ; ambulances 3321 ; sitting-case cars 824. The corresponding figures for public ambulance services before July, 1948, were obtained somewhat later than the date mentioned in the question. They are 4275 ; 3925 (including a large number of works and colliery ambulances still operating outside the National Health Service) ; and 366.
QUININE IN ACUTE MALARIA
SiR,-The prevailing tendency amongst writers on the treatment of malaria is to stress the virtues of the newer plasmocidal drugs while showing remarkable indifference to the established properties of quinine. This attitude is also prevalent amongst newcomers to medical practice in the tropics-so much so that one is obliged to conclude that the present-day teaching in tropical medicine fails to stress the salient fact that quinine is still our sheet anchor in the treatment of acute malaria. Those of us who through years of practice in the tropics havelearned to respect the unpredictable vagaries .and viciousness of malignant malaria in the nonimmune, continue to regard quinine as the most reliable and most effective of all-the plasmocidal drugs in gaining speedy control of an acute attack ; and this still holds good after giving fair trial to all the newer plasmocidal drugs. Furthermore, the prejudice expressed in some authoritative quarters against the use of parenteral quinine therapy-more especially against intramuscular injection-is wholly unjustified. With the patient prostrated by the persistent and intractable vomiting and the profound toxaemia that so often accompany attacks of acute malignant malaria, oral therapy is wholly unreasonable : in such circumstances the parenteral administration of quinine will not only save life but will spare the patient hours-even days-of distress and suffering.
.
Hearing-aids
Mr. GERALD WILLIAMS asked the Minister what percentage ofMedresco’ hearing-aids have been found to be faulty.Mr. ARTHUR BLENKINSOP replied : About 3% of the aids delivered to distribution centres are now returned as faulty. Of the aids issued to patients in the first year about 24% have come in for servicing or repair in England and Wales, but it is difficult to know how much of this represents original faults in the instruments. Mr. WILLIAM : Has the Minister any idea how long it takes to repair these hearing-aids, because there is a great deal of complaint about this matter ?‘? - Mr. BLENKiNSor : Very often the repairs are minor servicing repairs. We regard the proportion of sets which come back for minor repairs and servicing as extremely small.
_
Spectacles, Dentures, and Wigs Mr. WILLIAM TEELHSTG asked the Minister how many pairs of glasses and how many sets of false teeth and how many wigs have been provided in the last 12 months ; and how many demands are still outstanding.-Mr. BLENKINSOP replied : At a very rough estimate, about 41/2 million pairs of spectacles have been supplied under the supplementary eye service and between three and four million pairs are on order. No information is available as to the number of dentures. Up to May 20, 8000 wigs were ordered and 2600 supplied through the Ministry of Pensions, on the advice of specialists. Birth-control Advice in the Colonies Mr. R. W. SORENSEN asked the Secretary of State for the Colonies in which Colonies was appropriate birth-control