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Pneumoperitoneum
April 1951
T U BE R C L E Pneumoperitoneum
The Editor - 'Tubercle'. SiR,- O n reading Dr E. Llewelyn Williams' paper on Pneunmperitoneum Treatment in the February issue of TUBERCLE I realized that once again tile first and, I think, one of tile most important reports on pneumoperitoneum treatment in this country had not been quoted. I am referring to E. Clifford Jones' and N. Macdonald's paper which was published in TUBERCLE in June I9.t3. Tim authors had started pneumoperitoneum treatment at Clare Hall Sanatorium in 1941 and reported on over 60 cases. I believe that this paper has done more for the introduction of pneumoperitoneum treatment in this country than any subsequent report. Yours faithfidly, Itounslow, 21liddlesex. R. HELLER. _
M o r t a l i t y Decline "File E d i t o r - 'Tul)ercle'. S i n , - I trust that the optimism to which you have given your official blessing in youi" editorial of the March number, is going to turn out to be fill!)"justified. It seems to me that there are two possible lallacies in your remarks: the first is that tile dramatic drop in the tuherculous mortality for
Annual
93
tile first six months of 195o may be due to the wide use of streptomycin and para-aminosalicylic acid in the treatment of advanced cases, which seems to postpone death rather than reduce mortality. There are certainly patients of mine treated thus, who Would have died ill 1950 , but are going to die in 195i. The second possible fallacy is that the reduction in the waiting list indicates a fall in the severity and incidence oftuberculosis. During the past few )ears, chest physicians have been becoming conscious of the value of domiciliary treatment, and are using it on a larger scale in suitable cases in contrast to the normally accepted practice of fifteen )-ears ago, when most patients diagnosed as suffering from tuberculosis were immediately sent either to a hospital or sanatorium. " For the sake of the population as a whole, I would like to be proved wrong in m v contentions, but I will venture to forecast that the figures for 1951 will not show any continued improvement. We can only look forward to the time when increasingly efficient earl)" diagnosis will lead to the successfill performance ofprophylactie resection, while the preventive measures that you so rightly stress m'e pursued more vigorously in the clinics. Yours faithftdly, DAVID L. CAI,DIVELL,
Liverpool, I.
Reports
A N N U A I , R E P O R T OF T H E M E I ) I C A L and was lower than in the years immediately OFFICER OF HEAI:I'H FOR KENT preceding the last war. 1)uring the year ',,25o C O U N T Y C O U N C I L . 1949. September n e w cases of pulmonary tuberculosis and 279 I95O. cases of non-pulmonary tuberculosis were The Annual. Report of the Medichl Officer of notified. The total notifications in i9.t8 amounted Health for the County of Kent for 1949 covers to 2,245. On December 3 t, 1949, there were a population of approximately one and a half 14,738 cases remaining on the registers of the medical officers of health. Statistics of health million. The birth-rate at 16. 5 compares with I6- 7 for visiting in general are quoted, hut there is no England and Wales and 16. 7 for the County of special note of the number of visits paid to tuberculous households. These figures would I,ondon (wrongly quoted in the Report as I8.5). The infant mortality at 26. 3 deaths under l l)e of interest in view of the increasing quantity )'ear per thousand live hirths is a little higher of domiciliary treatment. Out of 2,489 households assisted by tile than in 1948 when it was 25. 7. Tim death-rate from all causes was ix-6 per thousand living domestic lmlp service in a typical week in compared with 1o- 7 in x948 and I-..I in 1947. December, 21l contained tuberculous persons. Tile upward fluctuation in I9.t9 probably I)r Elliot's general comments are of interest. reflects a higher mortality from respiratory He begins hy underlining the unsatisfactory disease after a very light year in 1948. The position in relation to tuberculosis saying that general dowmvard trend in mortality neverthe- an important contributory factor is tile shortage less continues.. of beds for institutional treatment. 'Whilst the The cancer death-rate was I-9t per thousand primary cause of tile shortage of beds is the 'compared with 1.92 in 1948 , indicating some lack of nursing staff, a secondary factor is the stability despite the .ageing of the population. economic difficulties of the times that preven! Tile death-rate fi'om pulmonary tuberculosis an extensive progrannne of aherations and rewas o-39 per I,OOO compared with o.4I in 1948 building in respect of residential institutions. It
T U BE R C L E Pneumoperitoneum
The Editor - 'Tubercle'. SiR,- O n reading Dr E. Llewelyn Williams' paper on Pneunmperitoneum Treatment in the February issue of TUBERCLE I realized that once again tile first and, I think, one of tile most important reports on pneumoperitoneum treatment in this country had not been quoted. I am referring to E. Clifford Jones' and N. Macdonald's paper which was published in TUBERCLE in June I9.t3. Tim authors had started pneumoperitoneum treatment at Clare Hall Sanatorium in 1941 and reported on over 60 cases. I believe that this paper has done more for the introduction of pneumoperitoneum treatment in this country than any subsequent report. Yours faithfidly, Itounslow, 21liddlesex. R. HELLER. _
M o r t a l i t y Decline "File E d i t o r - 'Tul)ercle'. S i n , - I trust that the optimism to which you have given your official blessing in youi" editorial of the March number, is going to turn out to be fill!)"justified. It seems to me that there are two possible lallacies in your remarks: the first is that tile dramatic drop in the tuherculous mortality for
Annual
93
tile first six months of 195o may be due to the wide use of streptomycin and para-aminosalicylic acid in the treatment of advanced cases, which seems to postpone death rather than reduce mortality. There are certainly patients of mine treated thus, who Would have died ill 1950 , but are going to die in 195i. The second possible fallacy is that the reduction in the waiting list indicates a fall in the severity and incidence oftuberculosis. During the past few )ears, chest physicians have been becoming conscious of the value of domiciliary treatment, and are using it on a larger scale in suitable cases in contrast to the normally accepted practice of fifteen )-ears ago, when most patients diagnosed as suffering from tuberculosis were immediately sent either to a hospital or sanatorium. " For the sake of the population as a whole, I would like to be proved wrong in m v contentions, but I will venture to forecast that the figures for 1951 will not show any continued improvement. We can only look forward to the time when increasingly efficient earl)" diagnosis will lead to the successfill performance ofprophylactie resection, while the preventive measures that you so rightly stress m'e pursued more vigorously in the clinics. Yours faithftdly, DAVID L. CAI,DIVELL,
Liverpool, I.
Reports
A N N U A I , R E P O R T OF T H E M E I ) I C A L and was lower than in the years immediately OFFICER OF HEAI:I'H FOR KENT preceding the last war. 1)uring the year ',,25o C O U N T Y C O U N C I L . 1949. September n e w cases of pulmonary tuberculosis and 279 I95O. cases of non-pulmonary tuberculosis were The Annual. Report of the Medichl Officer of notified. The total notifications in i9.t8 amounted Health for the County of Kent for 1949 covers to 2,245. On December 3 t, 1949, there were a population of approximately one and a half 14,738 cases remaining on the registers of the medical officers of health. Statistics of health million. The birth-rate at 16. 5 compares with I6- 7 for visiting in general are quoted, hut there is no England and Wales and 16. 7 for the County of special note of the number of visits paid to tuberculous households. These figures would I,ondon (wrongly quoted in the Report as I8.5). The infant mortality at 26. 3 deaths under l l)e of interest in view of the increasing quantity )'ear per thousand live hirths is a little higher of domiciliary treatment. Out of 2,489 households assisted by tile than in 1948 when it was 25. 7. Tim death-rate from all causes was ix-6 per thousand living domestic lmlp service in a typical week in compared with 1o- 7 in x948 and I-..I in 1947. December, 21l contained tuberculous persons. Tile upward fluctuation in I9.t9 probably I)r Elliot's general comments are of interest. reflects a higher mortality from respiratory He begins hy underlining the unsatisfactory disease after a very light year in 1948. The position in relation to tuberculosis saying that general dowmvard trend in mortality neverthe- an important contributory factor is tile shortage less continues.. of beds for institutional treatment. 'Whilst the The cancer death-rate was I-9t per thousand primary cause of tile shortage of beds is the 'compared with 1.92 in 1948 , indicating some lack of nursing staff, a secondary factor is the stability despite the .ageing of the population. economic difficulties of the times that preven! Tile death-rate fi'om pulmonary tuberculosis an extensive progrannne of aherations and rewas o-39 per I,OOO compared with o.4I in 1948 building in respect of residential institutions. It