- Email: [email protected]
PSITTACOSIS
182 With the help of a local firm of corsetiers, a satisfactory "breast form has now been developed. This is made of ’ Fibrofil ’ and filled with ’Kodel ’. A large (36 in. C cup) prosthesis weighs onlyoz. and is completely wash.able. It could be cheap to produce and is intended to be - sewn into the patient’s original brassiere. It can then be hand or machine washed. Patients are later reassessed by the clinic, and many are .also supplied with oil-filled prostheses. Many prefer oil:filled prostheses for social occasions and the lighter model for working and with bathing costumes and other sports-wear.
Samples
of this
prosthesis are being sent to surgeons at throughout Britain, and it is hoped that sufficient support will be received for a contract for supply
-various -to
centres
the National Health Service.
I thank Messrs. S. Leffman Ltd., of Bridgwater, Somerset, who have provided the material and have helped with the design of this prosthesis, and Mrs. Irene Boyce, who has spent a large amount of her time in helping with the clinics and with the development of the prosthesis itself. Taunton &
Somerset Hospital, Musgrove Park Branch, Taunton, Somerset.
A. C. AKEHURST.
and the proper disposal of their bodies. Fortunately in this instance the owner of the other birds was cooperative and had premises where the birds could be isolated. No further human cases seem to have occurred. Health Department, Borough of Camden,
PAUL BHANDARI.
London WC1H 9DB.
THE D.T.C.H.
SIR,-Your critical comments on the D.T.C.H. course have been answered by our Liverpool colleagues, whose views I endorse. But your second editorial of July 1, repeating some of the previous arguments (June 17), calls for a comment, since it throws doubt on the value of British postgraduate education relevant to tropical conditions. This country accumulated an unsurpassed experience overseas and I see no reason why it should not be transmitted by direct teaching to those of our colleagues from abroad who appreciate its value. Academic institutions in tropical countries capable of organising such comprehensive teaching can be counted on the fingers of one hand, and the applications vastly exceed the number of available places.
PSITTACOSIS
SIR,-Iread your editorial (July 8, p. 72) with particular ’interest, since a confirmed case of this disease recently in Camden. The patient was a 17-year-old girl
,employed by a pet shop specialising in the importation of exotic birds, situated in another borough. She and an -older man occupied a small furnished room containing a sink and hot-water supply in a house in multiple occupa- tion, sharing a water-closet with other residents. At the time of her admission to hospital she had no less than 7 tropical birds in four cages in her room. One bird, a .couney, was ailing, and the room also contained a freerange tortoise and
large black rat in another cage. During 1the six weeks previous to her illness 4 tropical birds that a
she had also kept in this room had sickened and died. .2 of these were disposed of in the dustbin, the others
being refrigerated by a local taxidermist to await his ,attention. The bird which was ill was slaughtered with her consent, and examination at the Royal Veterinary College confirmed that it had psittacosis. I was concerned about the remaining birds, since it seemed possible that their excreta might well be highly infectious. Her partner, who remained in the room, developed - symptoms similar to those of the patient in hospital, and was successfully treated by a course of oxytetracycline. Although no laboratory investigations were undertaken, it -seems probable that he too had psittacosis. He continued 1o live in the room, and was not willing for the birds to be slaughtered. A compromise solution was reached whereby he moved the birds to his office in a block where there were no residents, and the room was fumigated with formaldehyde gas for a period of six hours. The cages in which the birds had been kept were disinfected by exposure to high-pressure steam and by washing with formaldehyde. Although our disinfectors wore masks we have decided, for the future, that the cages of birds suspected of having psittacosis should be treated by superheated steam and then discarded, the owners being suitably compensated. This measure appears reasonable to avoid the risk of infection spreading to our staff and others. In this case the potentially infected birds presented a -problem. It would seem that no powers exist to enforce their isolation, and indeed no pet shops or boarding establishments will accept them for fear of infecting their stock. No powers appear to exist to enforce their slaughter
In the case of the London School of Hygiene and Tropical Medicine, as in the case of Liverpool, only mature candidates requiring special training in their chosen subjects are accepted for the courses leading to diplomas in tropical public health, clinical medicine of the tropics, or for the The fact that the selected postgraduate conjoint D.T.M.&H. students come from many countries gives the curriculum a truly international aspect-surely an important advantage in today’s world. This multinational character of our courses has been fully recognised by the World Health Organisation sponsoring 75% of our students, whose experiences are exchanged at seminars in which they are active participants. At the time when postgraduate teaching of doctors shows a striking increase in Germany,
overseas
France,
Belgium, Holland, Switzerland, Czechoslovakia, Poland, Hungary, Yugoslavia, why should this country with its unique store of basic and applied medical and biological knowledge opt out of its historic role ? The time will certainly come when the main training-centres will shift to overseas countries, but that day has not yet arrived. Last year’s Conference on Medical Education, Research and Medical Care in Developing Countriesdiscussed this problem at length, and I am sure that you will recognise that the two schools of tropical medicine are responding to the felt need and fulfilling their obligations to
this country and to the developing world. Ross Institute of Tropical Hygiene, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
L.
J. BRUCE-CHWATT.
SIR,-My colleague Professor Bruce-Chwatt has shown the letter he is sending to you and I wish to associate myself with everything he says. Your attack on the diploma of tropical child health (Liverpool) was, I believe, ill-chosen, me
and your further attack on the conduction overseas of examinations for the diplomas granted by the Royal Colleges is also unfortunate. You glibly state that the latter has " nothing to do with education: it is certification ", but in saying this you close your eyes to the point that it is certification of the result of an educational process. Without the certification and the effort required to obtain it there is little doubt that the majority would find the urge to cover the particular educational field less impelling. As one who personally took the Membership examination when it was 1. Trans. R. Soc. trop. Med. Hyg. 1972,
65, 709.
Samples
of this
prosthesis are being sent to surgeons at throughout Britain, and it is hoped that sufficient support will be received for a contract for supply
-various -to
centres
the National Health Service.
I thank Messrs. S. Leffman Ltd., of Bridgwater, Somerset, who have provided the material and have helped with the design of this prosthesis, and Mrs. Irene Boyce, who has spent a large amount of her time in helping with the clinics and with the development of the prosthesis itself. Taunton &
Somerset Hospital, Musgrove Park Branch, Taunton, Somerset.
A. C. AKEHURST.
and the proper disposal of their bodies. Fortunately in this instance the owner of the other birds was cooperative and had premises where the birds could be isolated. No further human cases seem to have occurred. Health Department, Borough of Camden,
PAUL BHANDARI.
London WC1H 9DB.
THE D.T.C.H.
SIR,-Your critical comments on the D.T.C.H. course have been answered by our Liverpool colleagues, whose views I endorse. But your second editorial of July 1, repeating some of the previous arguments (June 17), calls for a comment, since it throws doubt on the value of British postgraduate education relevant to tropical conditions. This country accumulated an unsurpassed experience overseas and I see no reason why it should not be transmitted by direct teaching to those of our colleagues from abroad who appreciate its value. Academic institutions in tropical countries capable of organising such comprehensive teaching can be counted on the fingers of one hand, and the applications vastly exceed the number of available places.
PSITTACOSIS
SIR,-Iread your editorial (July 8, p. 72) with particular ’interest, since a confirmed case of this disease recently in Camden. The patient was a 17-year-old girl
,employed by a pet shop specialising in the importation of exotic birds, situated in another borough. She and an -older man occupied a small furnished room containing a sink and hot-water supply in a house in multiple occupa- tion, sharing a water-closet with other residents. At the time of her admission to hospital she had no less than 7 tropical birds in four cages in her room. One bird, a .couney, was ailing, and the room also contained a freerange tortoise and
large black rat in another cage. During 1the six weeks previous to her illness 4 tropical birds that a
she had also kept in this room had sickened and died. .2 of these were disposed of in the dustbin, the others
being refrigerated by a local taxidermist to await his ,attention. The bird which was ill was slaughtered with her consent, and examination at the Royal Veterinary College confirmed that it had psittacosis. I was concerned about the remaining birds, since it seemed possible that their excreta might well be highly infectious. Her partner, who remained in the room, developed - symptoms similar to those of the patient in hospital, and was successfully treated by a course of oxytetracycline. Although no laboratory investigations were undertaken, it -seems probable that he too had psittacosis. He continued 1o live in the room, and was not willing for the birds to be slaughtered. A compromise solution was reached whereby he moved the birds to his office in a block where there were no residents, and the room was fumigated with formaldehyde gas for a period of six hours. The cages in which the birds had been kept were disinfected by exposure to high-pressure steam and by washing with formaldehyde. Although our disinfectors wore masks we have decided, for the future, that the cages of birds suspected of having psittacosis should be treated by superheated steam and then discarded, the owners being suitably compensated. This measure appears reasonable to avoid the risk of infection spreading to our staff and others. In this case the potentially infected birds presented a -problem. It would seem that no powers exist to enforce their isolation, and indeed no pet shops or boarding establishments will accept them for fear of infecting their stock. No powers appear to exist to enforce their slaughter
In the case of the London School of Hygiene and Tropical Medicine, as in the case of Liverpool, only mature candidates requiring special training in their chosen subjects are accepted for the courses leading to diplomas in tropical public health, clinical medicine of the tropics, or for the The fact that the selected postgraduate conjoint D.T.M.&H. students come from many countries gives the curriculum a truly international aspect-surely an important advantage in today’s world. This multinational character of our courses has been fully recognised by the World Health Organisation sponsoring 75% of our students, whose experiences are exchanged at seminars in which they are active participants. At the time when postgraduate teaching of doctors shows a striking increase in Germany,
overseas
France,
Belgium, Holland, Switzerland, Czechoslovakia, Poland, Hungary, Yugoslavia, why should this country with its unique store of basic and applied medical and biological knowledge opt out of its historic role ? The time will certainly come when the main training-centres will shift to overseas countries, but that day has not yet arrived. Last year’s Conference on Medical Education, Research and Medical Care in Developing Countriesdiscussed this problem at length, and I am sure that you will recognise that the two schools of tropical medicine are responding to the felt need and fulfilling their obligations to
this country and to the developing world. Ross Institute of Tropical Hygiene, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
L.
J. BRUCE-CHWATT.
SIR,-My colleague Professor Bruce-Chwatt has shown the letter he is sending to you and I wish to associate myself with everything he says. Your attack on the diploma of tropical child health (Liverpool) was, I believe, ill-chosen, me
and your further attack on the conduction overseas of examinations for the diplomas granted by the Royal Colleges is also unfortunate. You glibly state that the latter has " nothing to do with education: it is certification ", but in saying this you close your eyes to the point that it is certification of the result of an educational process. Without the certification and the effort required to obtain it there is little doubt that the majority would find the urge to cover the particular educational field less impelling. As one who personally took the Membership examination when it was 1. Trans. R. Soc. trop. Med. Hyg. 1972,
65, 709.