Pulmonary Tuberculosis amongst Students and Teachers in France

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237

Pulmonary Tuberculosis amongst Students and Teachers in France We have received from Paris a number of offcial documents on student heaILh which we summarize below. Yearly medical examination of university students was introduced by a decree in April 1946 , and only a minority of students have :failed to comply. T h e y risk being barred from taking their annual final examinations. Attendance varies between 60 per cent and 9 ~ per cent of the undergraduates, being 83 per cent in Paris. The cost of the preventive health services is borne partly by the students (ioo ti'ancs yearly subscription) and partly by the State which contributes 75 fi'ancs per student examined per year. The chief aim of these examinations is the detection of tuberculosis. All universities practise radiographic or radioscopic examinations as well as tuberculin skin tests, and clinical examinations are carried out in addition everywhere except in Paris. I n a good m a n y centres the fitness fbr sports is also tested. The proportion of posidve tuberculin reactors in the various universities and of active cases of pulmonary tuberculosis detected during the academic year i 9 4 6 - I 9 4 7 makes interesting reading.

Proportion of positive reactors.

Preventive Heald~ Service Academic year z 946- r 947 Paris: Law and A r t s . . Medicine, P h a r m a c y and pre - medical studies Science and literature A i x - Marseilles - Nice .. Besancon . . . . Bordeaux.. Caen - Rouen Clermont.. Dijon Grenoble i i Lille - Amiens Lyons . . . . Montpellier .. Nancy . . . . Poitiers-Limoges- Tours Rennes - Nantes - Angers Strasbourg .... Toulouse . . . .

73%

This table gives food for thought, It shows that the incidence of pulmonary tuberculosis, which is known to be on the decrease in the general population on France, is on the increase in some of the Iarge university centres. I t is probable that this rise in the incidence is connected with the bad living conditions of a good m a n y French students. Malnutrition, insufficient funds, overwork and the combination of wage earning occupation with university studies are fi-equent occurrences, and require attention.

Vaccination of Students with BEG Protection of studertts against tuberculosis by means of cutaneous vaccination with BCG was recommended by the Government in a circular dated I5.I 1.46. It was to be particularly applied to those medical students who had remained tuberculin negative up to the time when they were due to commence clinical studies. Vaccination is meant to convert the tuberculin reaction to positive and to prevent the occurrence of serious primary infection as the result of exposure to massive doses of tubercle bacilli on the hospital wards. SeverM universities organized sessions of vaccination with BCG.

Active Pul. Tub. Proportion of Pulmonary Tuberculosis discovered discoveredper i,ooo students examined. in I946-r947 I38

z945-6 -1

t

I946- 7

by r.6.48

z2

")

3"o5

73% 65'3o% 58~ 53'75% 55"64% 58% 52% 54'50% 56% 52.50% 57"30% 48% 5 ~% 46%

65%

7~/o 45 %

83 49 29 6 I4 3 5 I5 r7 38 44 8 3 z I8 IZ 18

4 ~ 3 3 "z 2.8 5 --5 z "5 ---2"5 4"5

7"6 7"9 4"5 I~ 5 4 .8 3 3 7 7 9'4 9"I 2"4 r "5 t "2 7'I 4 "I 4

I3 zo'7 5'7 ro 2"3 I2'2 5'6 7 6. 5 4.I 3"5 6 Io

5"6 6"6

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TUBERCLE

Explanatory leaflets were distributed amongst pre-clinieal students to enlighten them on the ~ubject, and an important proportion of negative reactors have already submitted themselves to vaccination. A start has thus been made, and the measure should soon find more generalized acceptance, It is interesting to note that since I947 the Ministries of Public Health and of National Education have been contemplating a regulation which should prevent negative tuberculin reactors fi'om taking up studies which lead to certain professions sttch as Medicine, Midwifery, General Nursing and Social Work. Only those may become stuclents whose tuberculin reaction has become positive either by natural infection, or as the result of BOG vaccination.

October 1948

On 3 ~. I=.47 such x-ray examinatiou o{" all the teaching personnel combined with clinical examination by the School M'edieaI Officers became compulsory, Certificates of non.infectiousness are issued to all those with negative findings~ and all cases where there is any doubt are referred to their own doctors or to disensaries for thrther investigation. The results ave ah'eady proved the value of the efforts, About ten in every thousand teachers and allied personnel examined in Lille and Paris were discovered to be previously undetected sufferers from tuberculosis. No doubt this hi~;h l~ercentage will /'all in subsequent years, ~u~ me lirst survey always brings to light the 'arrears' of many years, and these will be eliminated before subsequent surveys. Needless to say, every teacher lbund to be Treatment Centres for Students suffering from open pulmonary tuberculosis is T h e number of treatment beds available to male. suspended from duty, and sent oH hmg term and female adult students has been steadily lea.re. All his cifild contacts al'e examined hy growing, By June x9,1.8 it was z,~2c), as cc,)m. x-ray, and I;|"teRfl,ll'(~s t~,l'~ t~Lkell tO r pared wifll ~5o in I939 and 900 in t9,1.7, l;ifty appropriate treatment. hew beds h~ve recently been allocated to students at the Calmette Sanatorium at Charly Relief Measures (Aisne) and a rehabilitation centre has been A Relk:f Committee has been ibrmecl in Paris opened at Sceaux as an annexe to the Paris with the object ol" lzelping young people at University Convalescent Home. In spite of thls school and university. It runs set'vices lhr social good. mtmber, the beds remain full and are and medicat care whose.' scope includes some likely to remain so for many years to come, interesting enterprises. The &tMico-Sodal Restaurant is one of them. Tuberculosis in Secondary School Children Full attention is also paid in France to the Its present premises at the Rue ,%t, .!ac~quc,'s are detection of pulmonary tuberculosis in secondary already too small. The Restaurant Js run with schools. The State con!ributes 25 francs per the help of'the medical adviser, I)r Hazemamh head for the purpose. "I he procedure adopted an Almoner and two students who are in charge has been limited to the radioiogical examination ol" ticket control and other administrative duties. of all tuberculin positive skin reactors. Active Students are admitted m the Restaurant only cases detected m'e sent to appropriate treatment on medical recommendation from the Discentres. There is a special sanatorium for pensary set up by the Relief Committee where secondary school children at Neufmontiers-en- the students are examined clinically and Brie (9~ beds), where a new block is in course of radloscopically. They are expected to attend construction. At the Dreux Sanatorium zoo one meal at noon and another in the evening beds are reserved for this class of chiidren~ and daily except Sundays. On Saturday evenings a rehabilitation centre has recently been only a cold supper is served. At the end of each opened at Vaux-le-Perril (Seine et Marne) for month the students are again medically exthem. 'Preventoria' centres for prophylactic amined, and according to their state of health treatment of children 'threatened with tuber- either kept on at the Restaurant or sent away. Medical circumstances being equal, preference culosis' are urgently needed. is always given to those students who are in Tuberculosis amongst School Teachers material difficulties. The necessity for early detection of active cases Original recruitment takes place on the of pulmonary tuberculosis amongst school recommendation of any of the medical centres teachers who are in prolonged daily contact attached to the university and also at the with numerous children is obvious. Systematic personal request of students interested in the x-ray examinations of all teachers employed scheme. was begun e ~ l y in ~9,1.7, and about 4o,ooo Great attention is paid to quantity and x-ray films were taken during that year, It was bakuw.e of diet, as well as to attractive presentalater decided to use the less costly method of tion of t!ae lbod, IAs on a personal visit we have screen examination or miniature radiography. seen.~Ed.] In addition, milk is distributed either

~

October 1948

239

TUBERCLE

free or against payment, as circumstances permit, a n d vitamin preparations are also given. T h e accepted students m-e m a d e welcome in a kind of familial circle. They are served at a table, they can take their time over t h e food, a n d they like coming. The meal gives good relaxation in between lectures and studies, The medical adviser and the Almoner take their m e a l s with them and are able to make valuable observations during the students' passage through the Restaurant which will be helpful in placing their proteges in conditions best suited to the pursuance of their studies. I t is the definite purpose of the Paris Relief C o m m i t t e e to support the students both morally a n d materially. The meals at the Restaurant m a y be supplemented by food parcels for their m o r n i n g meal at home. Medical advice is always available at the Dispensary which is u n d e r the same management, and the Almoner's office procures such little employment as enables them to make ends meet financiaIly. Thus for a good m a n y young people away f r o m their families, some married themselves a n d maybe fathers, often living in poor housing conditions and in low straits, both materially a n d morally, the medico-social restaurant constitutes a safe and m u c h valued refuge. T h e sad faces of those who, having gained a few pounds in weight, have to m a k e room for new-comers at the end of a m o n t h p a y testimony to its worth. T h e number of students catered for monthly b y J u l y i948 , have been I5o. O f those, 29 were medical, 34 were studying letters, ~4 law, 14 science, 13 sculpture and painting, 05 dentistry, p h a r m a c y and 2 economics. O f the I5o , 56 are classed as tuberculous, and o f these 4 ~ have been in sanatoria, and 16 are affected in various ways but are never infectious. T h e r e is urgent need to offer a steady IOO~I5o places to ex-tuberculous students, and a far greater number of meals must be served if the medico-social restaurant is to play a part as a preventative centre. A new restaurant with a capacity for 4oo meals is now being built near t h e Observatoire. O f the i5o students now catered for I26 are F r e n c h Parisians, 14 are from overseas and IO a r e foreign. The latter were admitted because t h e y were in need of help and also because the restaurant's existence was partly due to gifts f r o m the American aid for France, from the Q u a k e r Service and from Unitarians. T h e students pay 5 ~ francs per meal (Is. 3d.) b u t a certain number are granted a reduction o f 25 or 5 ~ per cent. A few who are employed part-time as helpers in the scheme receive their meals free of charge.

T h e gain in weight in a month varies between 500 grin. and 1,5oo grin. and averages r kilogram. W h e n the second restaurant at the Observatoire is opened, it is planned to devote the restaurant in the Rue St. Jacques entirely to meals for ex-tuberculous students. A Medical Dispensary is available for consultation and out-patient treatment. Various specialist branches are represented. The state of health of French students is alarmingly low and remains so. O f 469 examined, i8i presented general fatigue, loss of weight, muscular weakness and under-development, 63 were general medical cases, 5 ~ general surgical, 25 had pulmonary tuberculosis~ 34 had digestive complaints, 8 cardiac diseases, ~4 had mental troubles, 23 were referred to an E.N.T. Department, 7 had tropical diseases, Io had gynaecological complaints, io h a d diseases of the mouth, 7 consultations were obstetrical, and I4 were suffering from skin or venereal diseases. M o r e than 6oo were eligible for admission to the medico-social restaurant, but only 285 found vacancies.

Summary by Michaela Kohnstamm.

Abstracts HOJA T I S I O L O G I O A T O M O VII D E C E M B E R ~947 No. 4 NATINO, ]~. M." TUBERCULOSIS D E L A

BOCA (Tuberculosis of the Mouth.) Most of the cases of tuberculosis of the m o u t h are chronic, bilateral, excavated and positive sputum patients with an old clinical history. Out of I,OOO eases, most of them very advanced and practically hopeless, i2 had lesions in the mouth (i .2 per cent). All the cases were men, aged between 3o-7 o. Myerson found a 0.75 per cent incidence. Pain was present in all the cases. The ulceration was commonly round, chancrelike. The prognosis is bad. Pain can be treated with pantocaine 2 per cent or cocaine 5 per cent o r b y infiltration of the regional nerve with 2 c.c. of cocaine-alcohoL Electrocoagulation has also been useful although not curative. Silver nitrate, lactic acid, chromic acid, &c. are useless. PURRIEL, P., PIAGGIO, A. A., EPIFANIO, C.:

DIAGNOSTICO, PRONOSTICO Y TERAPEIJTICA D E LA TUBERCULOSIS INAPARENTE INICIAL D E L ADULTO~

Every year, throughout the world, 5,ooo,ooo people die from tuberculosis. U r u g u a y contributes to that figure 3,ooo deaths. I t is estimated that ~o, ooo cases of undetected tuberculous