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Spread of tuberculosis from house to house
32
T U B ERC L E
Spread of Tuberculosis from House to House
January 1955
Thirty Years Ago
(Extract from " ] . ' U B E R C L E , J a n u a r y , i925. T o the E d i t o r - 'Tubercle'. Obliterative Pneumothorax, by L. S. T. Burrell, S i n , - F r o m our N o r t h a m p t o n Survey (B. J . M.D., F.R.C.P.) Soc. Med., I95I, v, 13) we concluded that neighbourly contact with tuberculosis increases These cases have been described to illustrate the risk to a healthy family by about one-fifth. w h a t m a y be done by artificial p n e u m o t h o r a x A n u m b e r o f suggestions have now been made by in cases where for some reason it is not possible Drs Grenville-Mathers, T r e n c h a r d and Wheeler to continue the treatment for m o r e than a few (TUBERCLE, December I954) to explain an montbs or even weeks. O f course all eases do alleged discrepancy between this conclusion a n d not show improvement. Sometimes one sees the findings of a comparable survey of two a case where the disease continues to progress housing estates in Middlesex. But no such dis- after the p n e u m o t h o r a x has been induced and c r e p a n c y has b e e n d e m o n s t r a t e d . W e estimated and it is impossible to tell from the course of the the excess of tuberculosis notifications from disease where the treatment was started or houses next door to a previously notified case as stopped. I n such cases it is usually found post19 per cent. T h e corresponding figures at m o r t e m that there is m u c h active disease in the E d g w a r e a n d H a r r o w are: for Estate E, 24 per other lung, or that dense patches of adherent cent; for Estate H, 15 per cent; and for the two pleura are preventing the collapse o f that estates together, 21 per cent. It would be hard to p o r t i o n of the hlng where the disease is most imagine a closer measure ofagreement. active, or t h a t there is a general iniliary W h e r e the two surveys do differ is in the fact tuberculosis. that the result at N o r t h a m p t o n was statistically I n artificial p n e u m o t h o r a x treatment the significant, while that at Edgavare and H a r r o w ideal is to keep the diseased lung collapsed and was not. W e suggest that this is because the cases at rest until the disease is completely arrested. available in the earlie.r survey were about five T h u s only can one hope for p e r m a n e n t good times as numerous as those available in the later results in a large n u m b e r of cases. I f the lung survey. is collapsed for a short time only there is danger Priority rehousing u n d o u b t e d l y confers great o f the symptoms returning w h e n the lung rebenefits on tuberculous families, for which some expands, as shown in Cases 7 and 8. I f the increase in risk to their new neighbours m a y be a symptoms do not return and the case is conreasonable price to pay. I t would, however, be a verted into one of chronic fibroid disease life m a y serious mistake to conclude, from any .evidence be prolonged considerably and in some cases the yet available, that this policy can be carried out disease m a y be completely arrested, but there is w i t h o u t social cost, or t h a t the risks associated not the same chance of a lasting arrest as there with neighbourly contact are smaller in Middleis after a full time pneumothorax. Moreover, sex t h a n in N o r t h a m p t o n . the chronic fibrotic cases are very liable to Yours faithfully, attacks of haemoptysis. At the same time great Social Medicine Unit, J. xIV. XVEBB, M.B. improvement m a y follow a collapse of lung o f 9, South Parks Road, A . M . STmVagT, .Xt.D., very short duration and the gradual obliteration Oaford. V.R.C.V. o f the p n e u m o t h o r a x cavity does not o f necessity indicate a bad prognosis, for some of (Continued from p. 25) these patients do extremely well. W e are g r a t e f u l to D r G w y n e t h H a m i l t o n f o r m u c h h e l p w i t h this w o r k . T h e cortisone a c e t a t e was s u p p l i e d t h r o u g h the M e d i c a l CLASSIFIED ADVERTISEMENTS R e s e a r c h Council. Official and Legal Notices, Appointments, 5s. oer line. (.Minimum References
Birkhaug, K. 0950 Am. Rev. Tuberc., LXm, 85. Birkhaug, K. 0954) Am. Rev. Tuberc., l.XXX,5It. Gezmuth, F. G., Oyarna, J., and Ottingeri B. (i95~) Bull. 07. IIopk. Hosp., xci, 22. Haudttroy, P. 0950 Bull. Schweiz. Akad. reed. Wiss., wr, 37 I. Houghton, L. E., and Davies, D. 0954) Tubercle,.,axxv, ~. Long, D. A. (I954) Lancet, i, 529 . Mogabgab, W.J., and Thomas, L. (I952) 07. Lab. Clln., Med., xxxax, ~,7I. Vorwald, A.J., Dworskl, M., Platt, P. CI., and Delahant, A. B. (t95o) Am. Rev. Tuberc., LXn, 455-
lSs.) Trade Advertisements and Situations Wanted 25 words or less 12s. 6d. (13s. 6d. ~sith Box lN'o.). Each additional 6 words or less 2s. 6d. All small advertisements must he prel~id before Insertion. All orders and rentiltanees for advertisements should be addressed to "Tubercle', 14, Great Smith Street, London, S.W.1. Replies to Box Nambers should be addressed to Box I N n . - - , c / o 'Tubercle') 14, Great Smith Street, London, S.W.I. t I U L L (B) H.M.C.---CASTLE h I L L HOSPITAL. CO'I~flNGHAM J U N I O R HOSPITAL MEDICAL O F F I C E R to work in Major Thoracic Surgery Unit. Excellent flat available, suitable for married man with family, or accommodation for single man. The Unit has 50 beds for all tylxs o f thorazie surgery, including tuberculous and non-tuberculous, ¢¢sophageal and cardiac. Aoplications with names of referees to Grouo Secretary. De la Pole n o s l f t a l . ~,Villerby. E. Yorkshire.
T U B ERC L E
Spread of Tuberculosis from House to House
January 1955
Thirty Years Ago
(Extract from " ] . ' U B E R C L E , J a n u a r y , i925. T o the E d i t o r - 'Tubercle'. Obliterative Pneumothorax, by L. S. T. Burrell, S i n , - F r o m our N o r t h a m p t o n Survey (B. J . M.D., F.R.C.P.) Soc. Med., I95I, v, 13) we concluded that neighbourly contact with tuberculosis increases These cases have been described to illustrate the risk to a healthy family by about one-fifth. w h a t m a y be done by artificial p n e u m o t h o r a x A n u m b e r o f suggestions have now been made by in cases where for some reason it is not possible Drs Grenville-Mathers, T r e n c h a r d and Wheeler to continue the treatment for m o r e than a few (TUBERCLE, December I954) to explain an montbs or even weeks. O f course all eases do alleged discrepancy between this conclusion a n d not show improvement. Sometimes one sees the findings of a comparable survey of two a case where the disease continues to progress housing estates in Middlesex. But no such dis- after the p n e u m o t h o r a x has been induced and c r e p a n c y has b e e n d e m o n s t r a t e d . W e estimated and it is impossible to tell from the course of the the excess of tuberculosis notifications from disease where the treatment was started or houses next door to a previously notified case as stopped. I n such cases it is usually found post19 per cent. T h e corresponding figures at m o r t e m that there is m u c h active disease in the E d g w a r e a n d H a r r o w are: for Estate E, 24 per other lung, or that dense patches of adherent cent; for Estate H, 15 per cent; and for the two pleura are preventing the collapse o f that estates together, 21 per cent. It would be hard to p o r t i o n of the hlng where the disease is most imagine a closer measure ofagreement. active, or t h a t there is a general iniliary W h e r e the two surveys do differ is in the fact tuberculosis. that the result at N o r t h a m p t o n was statistically I n artificial p n e u m o t h o r a x treatment the significant, while that at Edgavare and H a r r o w ideal is to keep the diseased lung collapsed and was not. W e suggest that this is because the cases at rest until the disease is completely arrested. available in the earlie.r survey were about five T h u s only can one hope for p e r m a n e n t good times as numerous as those available in the later results in a large n u m b e r of cases. I f the lung survey. is collapsed for a short time only there is danger Priority rehousing u n d o u b t e d l y confers great o f the symptoms returning w h e n the lung rebenefits on tuberculous families, for which some expands, as shown in Cases 7 and 8. I f the increase in risk to their new neighbours m a y be a symptoms do not return and the case is conreasonable price to pay. I t would, however, be a verted into one of chronic fibroid disease life m a y serious mistake to conclude, from any .evidence be prolonged considerably and in some cases the yet available, that this policy can be carried out disease m a y be completely arrested, but there is w i t h o u t social cost, or t h a t the risks associated not the same chance of a lasting arrest as there with neighbourly contact are smaller in Middleis after a full time pneumothorax. Moreover, sex t h a n in N o r t h a m p t o n . the chronic fibrotic cases are very liable to Yours faithfully, attacks of haemoptysis. At the same time great Social Medicine Unit, J. xIV. XVEBB, M.B. improvement m a y follow a collapse of lung o f 9, South Parks Road, A . M . STmVagT, .Xt.D., very short duration and the gradual obliteration Oaford. V.R.C.V. o f the p n e u m o t h o r a x cavity does not o f necessity indicate a bad prognosis, for some of (Continued from p. 25) these patients do extremely well. W e are g r a t e f u l to D r G w y n e t h H a m i l t o n f o r m u c h h e l p w i t h this w o r k . T h e cortisone a c e t a t e was s u p p l i e d t h r o u g h the M e d i c a l CLASSIFIED ADVERTISEMENTS R e s e a r c h Council. Official and Legal Notices, Appointments, 5s. oer line. (.Minimum References
Birkhaug, K. 0950 Am. Rev. Tuberc., LXm, 85. Birkhaug, K. 0954) Am. Rev. Tuberc., l.XXX,5It. Gezmuth, F. G., Oyarna, J., and Ottingeri B. (i95~) Bull. 07. IIopk. Hosp., xci, 22. Haudttroy, P. 0950 Bull. Schweiz. Akad. reed. Wiss., wr, 37 I. Houghton, L. E., and Davies, D. 0954) Tubercle,.,axxv, ~. Long, D. A. (I954) Lancet, i, 529 . Mogabgab, W.J., and Thomas, L. (I952) 07. Lab. Clln., Med., xxxax, ~,7I. Vorwald, A.J., Dworskl, M., Platt, P. CI., and Delahant, A. B. (t95o) Am. Rev. Tuberc., LXn, 455-
lSs.) Trade Advertisements and Situations Wanted 25 words or less 12s. 6d. (13s. 6d. ~sith Box lN'o.). Each additional 6 words or less 2s. 6d. All small advertisements must he prel~id before Insertion. All orders and rentiltanees for advertisements should be addressed to "Tubercle', 14, Great Smith Street, London, S.W.1. Replies to Box Nambers should be addressed to Box I N n . - - , c / o 'Tubercle') 14, Great Smith Street, London, S.W.I. t I U L L (B) H.M.C.---CASTLE h I L L HOSPITAL. CO'I~flNGHAM J U N I O R HOSPITAL MEDICAL O F F I C E R to work in Major Thoracic Surgery Unit. Excellent flat available, suitable for married man with family, or accommodation for single man. The Unit has 50 beds for all tylxs o f thorazie surgery, including tuberculous and non-tuberculous, ¢¢sophageal and cardiac. Aoplications with names of referees to Grouo Secretary. De la Pole n o s l f t a l . ~,Villerby. E. Yorkshire.