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TUBERCLE THE
T H E J O U R N A L OF BRITISH T U B E R C U L O S I S A S S O C I A T I O N
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Search for an Index In this and the preceding issue of TUBERCLE we have printed articles from Birmingham and Oxford on the results of the treatment of tuberculous meningitis. It is clear that we still have much to learn and that not only is the mortality still high but also that of those who survive many are grossly crippled in one way or another. Nevertheless great progress has been made in dealing with this once uniformly fatal form of tuberculosis: the total number of deaths h a s fallen steeply particularly in the first few years of life. No doubt this is largely due to treatment but to some extent it may be due to a decline in the number of new cases. In former times the new cases were equated with the deaths but now of course it is not so. From certain centres of treatment we know the survival rates but we do not know that all the cases in those districts go to those centres for treatment and there must be m a n y areas where survival rates are less than say in Oxford, Manchester or Birmingh a m and the survival rate for the whole country is probably considerably less than in the reported series. Tuberculous meningitis is often a manifestation of fairly recent infection and therefore if we knew the total number of new cases it would be possible to use meningitis as an index of the efficacy of the epidemiological control of tuberculous infection. But unhappily, while we know the
number of deaths and have done so for many years, yet now that the disease is often cured we do not know the incidence. New cases are irregularly notified and tile notifications are not specifically published but are placed in the large group of nonrespiratory cases. A strong plea could be made for the accurate notification of tuberculous meningitis and separate publication of the figures. This would provide us with a valuable index. We might find that the age of incidence was rising or even that the total number was not falling off. I f this were so then it" would justify those less optimistic people who say that we are increasing the amount of infection by keeping alive m a n y chronic pulmonary cases. On the other hand if the numbers were falling such a position would be less tenable. This search for an index is a teasing problem. Undiminished by death the registers continue to increase, the number of sputum positive cases at any one time seems only to reflect the intensive care of the advanced case and the loss of working time is vitiated by inadequate certification of the cause of illness. We must fall back on notifications with all their weaknesses. These weaknesses are well known to anyone working in the field but are not fully appreciated elsewhere. A keen man can rapidly swell tile figures for his district.
T H E J O U R N A L OF BRITISH T U B E R C U L O S I S A S S O C I A T I O N
A STAPLES
Single Copy U.K. 3s. 6d. ; (:~s. 7½d. post free) Single Copy U.S.A. (7S cents post free)
PUBLICATION
Annual Subscription U°K. 40s. post free Annual Subscription U.S.A. $6. po~t free
Search for an Index In this and the preceding issue of TUBERCLE we have printed articles from Birmingham and Oxford on the results of the treatment of tuberculous meningitis. It is clear that we still have much to learn and that not only is the mortality still high but also that of those who survive many are grossly crippled in one way or another. Nevertheless great progress has been made in dealing with this once uniformly fatal form of tuberculosis: the total number of deaths h a s fallen steeply particularly in the first few years of life. No doubt this is largely due to treatment but to some extent it may be due to a decline in the number of new cases. In former times the new cases were equated with the deaths but now of course it is not so. From certain centres of treatment we know the survival rates but we do not know that all the cases in those districts go to those centres for treatment and there must be m a n y areas where survival rates are less than say in Oxford, Manchester or Birmingh a m and the survival rate for the whole country is probably considerably less than in the reported series. Tuberculous meningitis is often a manifestation of fairly recent infection and therefore if we knew the total number of new cases it would be possible to use meningitis as an index of the efficacy of the epidemiological control of tuberculous infection. But unhappily, while we know the
number of deaths and have done so for many years, yet now that the disease is often cured we do not know the incidence. New cases are irregularly notified and tile notifications are not specifically published but are placed in the large group of nonrespiratory cases. A strong plea could be made for the accurate notification of tuberculous meningitis and separate publication of the figures. This would provide us with a valuable index. We might find that the age of incidence was rising or even that the total number was not falling off. I f this were so then it" would justify those less optimistic people who say that we are increasing the amount of infection by keeping alive m a n y chronic pulmonary cases. On the other hand if the numbers were falling such a position would be less tenable. This search for an index is a teasing problem. Undiminished by death the registers continue to increase, the number of sputum positive cases at any one time seems only to reflect the intensive care of the advanced case and the loss of working time is vitiated by inadequate certification of the cause of illness. We must fall back on notifications with all their weaknesses. These weaknesses are well known to anyone working in the field but are not fully appreciated elsewhere. A keen man can rapidly swell tile figures for his district.