- Email: [email protected]
Society
£10
TUBEHCLE
year 4G1 remained under observation. Twenty. three cases were removed to hospital. The death-rate from all forms of tuberculosis was 1'22, which was slightly less than the average figure for recent years. The age i ncidence of pulmonary cases notified during 1923 was as follows i-> Under 1 year 3 1 to 5 years 8 5 " 15 10 15 " 25 33 25 .. 45 53 15 4" " 65 Over 65 2 Age incidence of non-pulmonary cases notified during 1923 :Under 1 year 4 1 to 5 years 31 5 15 26 15 25 19 25 45 11 45 .. 65
2
The notifications of non-pulmonary tubercn· losis arc classified as follows, according to the localisation of the principal lesion at the time of notification: glands 22; abdomen ~2 ; meninges 15; generalised 10; !(enito-urinary 9; joints 7; bones 5; skin 3. A table is given snowing the relation of housing and other economic factors to the incidence of the 217 cases notified duri ng the year, emphasising the fact that tuberculosis is essentially a disease of under-nutrition and faulty environment. DisJl~1tsary '1'1·eatm~nt.-The Municipal Dis. pensary is open on two afternoons weekly, each session lasting about two hours. The sub-
[September, 1924
joined table gives the principal figures relating to the work done there during 1923 : Total attendances •. A vcrngo monthly attendances First consultations .•
2,440
203 148
Thc two most important funetion« of the Dispensary are that -it forms the best centre for observation and diagnosis of early cases, and also enables regular medical supervision of ex-sanatorium pa-tients to be maintained. Early cases of tuberculosis frequently require observation for several weeks before a definite diagnosis can be arrived at, and the necessary observation could only be maintained through a centre like the Dispensary. Institutional Trcatment.-Dr. l't1'11ichael emphasises the fact that institutional treatment still offers the only hope of arresting the disease to the great majority of tuberculous patients. Unti! the root causal factors of tuberculosis are seriously tackled public opinion will not tolerate a purely passiva attitude toward. the md ividualjpatient, a.nd at present he considers tbat there is no alternative to institutional treatment. A table is subjoined showing the interval which elapsed between notification and death in some of the seventy-one cases of pulmonary tuberculosis who died during the year:Notifieation first received from the Registrar of Deaths . . 5 Number of deaths occurring-Within 1 montb of notification G Between 1 and 3 months of notification 12 Between 3 and 6 months of notification 11 Between 6 and 9 months of notification. 9
SOCIETIES. SOClBTY OF SUPEHINTENDBNTS OF TUBERCULOSIS INSTITUTIONS. A general meeting of the Society was held at 3.0. p.m., on the 30th June, 1924, at 122, Harley Street, London, Dr. James Watt in the chair. The minutes were read and approved. Letters regretting absence were read from the following :-Drs. E. L. Carling, W. G. Kinton, H. Sharpe, Claude Lillingston and Colin Milne. Dr. C. E.. Redman, Winsley Sanatorium, Bath, was unsnimously elected to Ordinary Member. ship. Dr, JHIES WATT presented a report on the first Examination of the Society of Buperin tendents of Tuberculosis Institutions for the Training of Nurses in Institutions for cases of Pulmonary Tuberculosis, showing that fifteen people had obtained the Certificate. It was resolved that the Constitution be altered to permit of honorary memhership being conferred hy the Society on distinguished workers in tuberculosis, the numbers not to exceed twenty at anyone time.
A discussion 011 the relations between Tuberculosis Officers and Medical Superinten. dents showed that where common ethics and courtesy exist no quarrels were likely to take place, but that unfortunately these attributes were occasionally absen t. It was resolved to have a provincial meeting next year in the summer, in addition to the quarterly meeting, arrangements for conveyance to be made by the secretary. Dr. SAUIOND gave an interesting paper OD. "The X-ray Appearancesof Tuberculous Joints" which will be published later on in Tubercle. In the discussion which followed, Dr. WEST who brough t some plates for diagnosis said that he believed X-rays would indicate whether it were safe to get a case up. Dr, .GORnoN 1:'UOB was 01 the same opinion, and thought that postmortem findings showed that many so-called cured cases were still active. He asked whether there was subluxation In pseudo-coxalgta. In a tuberculous knee-joint, the bone felt larger than in the healthy knee, but X.ra.ys showed
September, 1924]
BIB L IOGRA P H Y
them to be tbc same size. In t he hi p.joi nt, t he synovial form of th e disease was not com mon in h is experien ce . The d iseuse if t rea t ed con. st itut iona lly at an ea rly stage would not sp read in to th e syn ovia l me m bra ne. Dr. SALMOND in reply sa id that the pathology of pseud c -coxal gia was hazy ; h e did not find s ublu xa tion . T he swell ing of the knee- join t was duo t o cedema and thicken in g of th o peri. a rti cul ar t issues . Dr. F OWLF.R sho wed som e pr ints. He tho ugh . t hat chest rad iograp hy was over-ra ted by pen sions people and by en tbusiast s wh o h ad no co nst ent : it was useless in diag nosis, but very
611
useful in pneumotborax, especia lly wi th t h e /loppiug, bulging media.sti nu m, in t he pr esen ce of ad hesi ons and in t he case of extension in the opposite lung. T he X .ray was merely an ad ju nct and the screen was of m ore value than t he plate. Other plates" ore sho wn hy Drs. Ni ven Robertson and W at t . It was re solved th80t the ne xt meet in g sho uld t ak e place in Oc tob~r, th e subjec.ts fur di s. cu ssion to be .. D uration of Sa nato ri um Treat . ment " and" Diet in T ubercul osis." It was decided tha t Tu bercul osis Officers be invited to attend ,
BIBLIOGRAPHY. O IU GI ~ A L
AR'fICLES PUBLISHIi:l>
MAY - ..AUGUST, 1924. (See also previous Numbers.) American Journal of Diseases of Children. JL'LY.
Iteapira tory Diseases iu Child ren .
A Review of t he L itera ture from J ul y 1921 to J uly I()23. O. FOUCAR-p . 79.
Amerlc..n Journal of Medical Sciences. J ULY. The Surgery of Pulmonar y Tubercul osis. J. ALI!:XAIWER-p. 1. AmerioanJournal of Public Heahh .-JuLY . Improved Method of Examinati on of Spu t um for Tubercle Bac illi . P. CAS'ILEMA li-p. 61O. American Review of Tuberculosis.-J L"IH;. Th e Relation of the National Tu borcu losis Association to Medi cal Re sear ch in Tu berculosis. E . R . BALDWIN-p. 285. End R esults of 600 Cases 01 Pulmonary Tuber. culo sis Tr eated by Ad ificial Pneumothorax . R . W. II1ATSON, R C. Muse!> a nd N . BI8AlLLe!>--p. 294. Artifi cial P ne um oth ora x with Ne cropsy. J. WALSH-po337. Spontaneous Pneumothorax during the Cou rse cif Art ificial Pneumothorax. 1. D. BRONFlN -p.346. Complete Loft Hemiplegia, with Re cover y, after Attempted Artificial Pneumothorax. S. SU40N-p. 364. A Plea Aga.lnst the Indiscriminate Use of Artl. ficial Pneumothorax in the Trea.tment of Pulmonar y Tubercul osis. H. GOLEIlfBE- p .
370. Controlled Diaphragmutic Breathing in th e Treatment of Pulmonary Tuberculosis . S. A. KNoPt'-p. 377. IJlDtJes de Dermatologie et de Syphlll. graphle.-JuLY. Uechercbcs s ur I·.,tiologie de I'eczema des nourrisecns, E czema et tubercu lose ; eczema et syph ili s. A. BOUTELLIER-p. 425.
Annale. de lIedecine.-J cLY. de l'anergie bepatique dans la tuber. culose, N. FIEBBINGEn lind P. Bao ons-cp, 4G. Archive. de lIedecine et de PhaI'lllacie IIl11tairea.-M AY. L ~ t ub erculose dana qu elqu es oasi s d u 7. i b~ n . SABRIK- p . 478.
Apropos
ArchlYes d 'Ophta lm ologie. -J ULY. De Is. cboeio-refi nite tuberc ule use afolf iculaire . F. LAORANOt;-p. 385.
Arcbives of Pedlabic8.-J uNE. T Uber culosis of the Mesen ter ic Lymph Node s with Report of a n U nusua l Case. H. R . MIXSELL and C. Eo FAlla -p. 402. Beltrage ZUI' KlInlk der TuberkuloBe. Bd. lix, H ef t 1-2. en do pleu ralo U eber 'I'h orakoskop ie u na Eing rifle mit Hilfe des 'I'ho rakoskop s. G. Sc HRODER- p . 1. . B eitrag zur Riintgentiefentheraple der Tuberkulose. B . BAituCHLll:N-p. 7. L eber Behandlung der Lungentuberkulose mit Tebeprotin und Ektebin, F . BAUMANlII). 13. Ueber erworbene Anl age sur Sp itzllntuber. kulose, Kesuistieche Be itrage, C. T. ZEIT8CHEL-p. 26. Kurze Mitteilung uber unsere Erfahrungen mit der Erythrooyt6n-Sodimentierung in Kombination mit der Injektion kleiner, untarschwelliger'I'uberkulindosen . F. GRUBE - p . S5 . Ueber die Bedeutung der BlutkorperchenBenkungsreaktion, der Fiillungsrolloktion usch M,tttlfy und der Komplementbindungsreaktion mit Wassermann· Ant igen fiir di e Dtagnose der aktiven Lungentuberkulose. Zum 25 jiihrigen Beateben der Heilstatte . W. U.U:R'l'GENS and llL GOCKP:L-p. 86. Ueber ak ttve und beha.ndlungsbedUrUige Tuberkulose. Bemerkungen 2U dor vorstehenden Arbeit von Ga ehtgens und Gockel. J . RITTER-p.57.
TUBEHCLE
year 4G1 remained under observation. Twenty. three cases were removed to hospital. The death-rate from all forms of tuberculosis was 1'22, which was slightly less than the average figure for recent years. The age i ncidence of pulmonary cases notified during 1923 was as follows i-> Under 1 year 3 1 to 5 years 8 5 " 15 10 15 " 25 33 25 .. 45 53 15 4" " 65 Over 65 2 Age incidence of non-pulmonary cases notified during 1923 :Under 1 year 4 1 to 5 years 31 5 15 26 15 25 19 25 45 11 45 .. 65
2
The notifications of non-pulmonary tubercn· losis arc classified as follows, according to the localisation of the principal lesion at the time of notification: glands 22; abdomen ~2 ; meninges 15; generalised 10; !(enito-urinary 9; joints 7; bones 5; skin 3. A table is given snowing the relation of housing and other economic factors to the incidence of the 217 cases notified duri ng the year, emphasising the fact that tuberculosis is essentially a disease of under-nutrition and faulty environment. DisJl~1tsary '1'1·eatm~nt.-The Municipal Dis. pensary is open on two afternoons weekly, each session lasting about two hours. The sub-
[September, 1924
joined table gives the principal figures relating to the work done there during 1923 : Total attendances •. A vcrngo monthly attendances First consultations .•
2,440
203 148
Thc two most important funetion« of the Dispensary are that -it forms the best centre for observation and diagnosis of early cases, and also enables regular medical supervision of ex-sanatorium pa-tients to be maintained. Early cases of tuberculosis frequently require observation for several weeks before a definite diagnosis can be arrived at, and the necessary observation could only be maintained through a centre like the Dispensary. Institutional Trcatment.-Dr. l't1'11ichael emphasises the fact that institutional treatment still offers the only hope of arresting the disease to the great majority of tuberculous patients. Unti! the root causal factors of tuberculosis are seriously tackled public opinion will not tolerate a purely passiva attitude toward. the md ividualjpatient, a.nd at present he considers tbat there is no alternative to institutional treatment. A table is subjoined showing the interval which elapsed between notification and death in some of the seventy-one cases of pulmonary tuberculosis who died during the year:Notifieation first received from the Registrar of Deaths . . 5 Number of deaths occurring-Within 1 montb of notification G Between 1 and 3 months of notification 12 Between 3 and 6 months of notification 11 Between 6 and 9 months of notification. 9
SOCIETIES. SOClBTY OF SUPEHINTENDBNTS OF TUBERCULOSIS INSTITUTIONS. A general meeting of the Society was held at 3.0. p.m., on the 30th June, 1924, at 122, Harley Street, London, Dr. James Watt in the chair. The minutes were read and approved. Letters regretting absence were read from the following :-Drs. E. L. Carling, W. G. Kinton, H. Sharpe, Claude Lillingston and Colin Milne. Dr. C. E.. Redman, Winsley Sanatorium, Bath, was unsnimously elected to Ordinary Member. ship. Dr, JHIES WATT presented a report on the first Examination of the Society of Buperin tendents of Tuberculosis Institutions for the Training of Nurses in Institutions for cases of Pulmonary Tuberculosis, showing that fifteen people had obtained the Certificate. It was resolved that the Constitution be altered to permit of honorary memhership being conferred hy the Society on distinguished workers in tuberculosis, the numbers not to exceed twenty at anyone time.
A discussion 011 the relations between Tuberculosis Officers and Medical Superinten. dents showed that where common ethics and courtesy exist no quarrels were likely to take place, but that unfortunately these attributes were occasionally absen t. It was resolved to have a provincial meeting next year in the summer, in addition to the quarterly meeting, arrangements for conveyance to be made by the secretary. Dr. SAUIOND gave an interesting paper OD. "The X-ray Appearancesof Tuberculous Joints" which will be published later on in Tubercle. In the discussion which followed, Dr. WEST who brough t some plates for diagnosis said that he believed X-rays would indicate whether it were safe to get a case up. Dr, .GORnoN 1:'UOB was 01 the same opinion, and thought that postmortem findings showed that many so-called cured cases were still active. He asked whether there was subluxation In pseudo-coxalgta. In a tuberculous knee-joint, the bone felt larger than in the healthy knee, but X.ra.ys showed
September, 1924]
BIB L IOGRA P H Y
them to be tbc same size. In t he hi p.joi nt, t he synovial form of th e disease was not com mon in h is experien ce . The d iseuse if t rea t ed con. st itut iona lly at an ea rly stage would not sp read in to th e syn ovia l me m bra ne. Dr. SALMOND in reply sa id that the pathology of pseud c -coxal gia was hazy ; h e did not find s ublu xa tion . T he swell ing of the knee- join t was duo t o cedema and thicken in g of th o peri. a rti cul ar t issues . Dr. F OWLF.R sho wed som e pr ints. He tho ugh . t hat chest rad iograp hy was over-ra ted by pen sions people and by en tbusiast s wh o h ad no co nst ent : it was useless in diag nosis, but very
611
useful in pneumotborax, especia lly wi th t h e /loppiug, bulging media.sti nu m, in t he pr esen ce of ad hesi ons and in t he case of extension in the opposite lung. T he X .ray was merely an ad ju nct and the screen was of m ore value than t he plate. Other plates" ore sho wn hy Drs. Ni ven Robertson and W at t . It was re solved th80t the ne xt meet in g sho uld t ak e place in Oc tob~r, th e subjec.ts fur di s. cu ssion to be .. D uration of Sa nato ri um Treat . ment " and" Diet in T ubercul osis." It was decided tha t Tu bercul osis Officers be invited to attend ,
BIBLIOGRAPHY. O IU GI ~ A L
AR'fICLES PUBLISHIi:l>
MAY - ..AUGUST, 1924. (See also previous Numbers.) American Journal of Diseases of Children. JL'LY.
Iteapira tory Diseases iu Child ren .
A Review of t he L itera ture from J ul y 1921 to J uly I()23. O. FOUCAR-p . 79.
Amerlc..n Journal of Medical Sciences. J ULY. The Surgery of Pulmonar y Tubercul osis. J. ALI!:XAIWER-p. 1. AmerioanJournal of Public Heahh .-JuLY . Improved Method of Examinati on of Spu t um for Tubercle Bac illi . P. CAS'ILEMA li-p. 61O. American Review of Tuberculosis.-J L"IH;. Th e Relation of the National Tu borcu losis Association to Medi cal Re sear ch in Tu berculosis. E . R . BALDWIN-p. 285. End R esults of 600 Cases 01 Pulmonary Tuber. culo sis Tr eated by Ad ificial Pneumothorax . R . W. II1ATSON, R C. Muse!> a nd N . BI8AlLLe!>--p. 294. Artifi cial P ne um oth ora x with Ne cropsy. J. WALSH-po337. Spontaneous Pneumothorax during the Cou rse cif Art ificial Pneumothorax. 1. D. BRONFlN -p.346. Complete Loft Hemiplegia, with Re cover y, after Attempted Artificial Pneumothorax. S. SU40N-p. 364. A Plea Aga.lnst the Indiscriminate Use of Artl. ficial Pneumothorax in the Trea.tment of Pulmonar y Tubercul osis. H. GOLEIlfBE- p .
370. Controlled Diaphragmutic Breathing in th e Treatment of Pulmonary Tuberculosis . S. A. KNoPt'-p. 377. IJlDtJes de Dermatologie et de Syphlll. graphle.-JuLY. Uechercbcs s ur I·.,tiologie de I'eczema des nourrisecns, E czema et tubercu lose ; eczema et syph ili s. A. BOUTELLIER-p. 425.
Annale. de lIedecine.-J cLY. de l'anergie bepatique dans la tuber. culose, N. FIEBBINGEn lind P. Bao ons-cp, 4G. Archive. de lIedecine et de PhaI'lllacie IIl11tairea.-M AY. L ~ t ub erculose dana qu elqu es oasi s d u 7. i b~ n . SABRIK- p . 478.
Apropos
ArchlYes d 'Ophta lm ologie. -J ULY. De Is. cboeio-refi nite tuberc ule use afolf iculaire . F. LAORANOt;-p. 385.
Arcbives of Pedlabic8.-J uNE. T Uber culosis of the Mesen ter ic Lymph Node s with Report of a n U nusua l Case. H. R . MIXSELL and C. Eo FAlla -p. 402. Beltrage ZUI' KlInlk der TuberkuloBe. Bd. lix, H ef t 1-2. en do pleu ralo U eber 'I'h orakoskop ie u na Eing rifle mit Hilfe des 'I'ho rakoskop s. G. Sc HRODER- p . 1. . B eitrag zur Riintgentiefentheraple der Tuberkulose. B . BAituCHLll:N-p. 7. L eber Behandlung der Lungentuberkulose mit Tebeprotin und Ektebin, F . BAUMANlII). 13. Ueber erworbene Anl age sur Sp itzllntuber. kulose, Kesuistieche Be itrage, C. T. ZEIT8CHEL-p. 26. Kurze Mitteilung uber unsere Erfahrungen mit der Erythrooyt6n-Sodimentierung in Kombination mit der Injektion kleiner, untarschwelliger'I'uberkulindosen . F. GRUBE - p . S5 . Ueber die Bedeutung der BlutkorperchenBenkungsreaktion, der Fiillungsrolloktion usch M,tttlfy und der Komplementbindungsreaktion mit Wassermann· Ant igen fiir di e Dtagnose der aktiven Lungentuberkulose. Zum 25 jiihrigen Beateben der Heilstatte . W. U.U:R'l'GENS and llL GOCKP:L-p. 86. Ueber ak ttve und beha.ndlungsbedUrUige Tuberkulose. Bemerkungen 2U dor vorstehenden Arbeit von Ga ehtgens und Gockel. J . RITTER-p.57.