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The health and social services of Dorset
March 1953
TUBERCLE
m e that he has seen two cases of fractures of femoral necks in therapeutically induced fits. I t is possible that the fractures sustained b y our patient o c c u r r e d because o f decalcification of the bones associated with prolonged r e c u m b e n c y . I wish to t h a n k D r J. B. Morrison, the Medical S u p e r i n t e n d e n t , for permission to r e p o r t this case.
Bibliography [i] Meduna, L., and Friedman, E. 0939) J.A.M.A., cxH, 5m, February z L [~] Zelfert, M. (1939) Psychiatry Quarterly, xm, 3o3, April. [3] Caplan, G. (t9.~6) Journal of Mental Science, 784, October. [4] Caplan, G. 09i6) Journal of Mental Sciel~ce, 766, Ocotber. [5] Blair, D. 094o) Lancet, 3"25,September x4.
British Tuberculosis Association At a meeting of the Association on Friday, February 20 the following candidates were admitted to membership: Robert J. Cuthbert, George Gerrard, J . S. B. Greenfield, W. S. Hamilton, George Hurrell, .John R. Lauckner, J. S. G. P. Stapleford, P. S. Thorne and William F. Wheeler. A whole day meeting will be held at L E I C E S T E R on Friday, April I7, when the following subjects will be discussed: Bronchiectasis in the Community, by Dr J. C. H. Mackenzie; Mantoux Testing and Clinical Progress, by Dr Midgley Turner; Aberrant Pulmonary Tissue, by Mr Gordon Cruickshank, and the Results of Training and Emplo)a'nent at Papworth, by Dr Owen Clarke. T h e A N N U A L C O N F E R E N C E will he held at E D I N B U R G H in conjunction with the meeting of the Tuberculosis Society of Scotland. The dates are July I to 4 and the subjects for discussion include Field Surveys, Chemotherapy, Tuberculosis in I n f a n c y - certain aspects of immunity and pathologT, Tuberculous Endometrifis, Renal Tuberculosis, Pulmonary Disease of Industrial Origin, Diagnostic Bronchoscopy in Chest Clinics, Pulmonary Function in Plcural Effusions /rod there will also be demonstrations at various clinics in the City. Further information about the Association and its activities may be obtained from the Secretary, Dr Hugh Ramsay, at the Association's offices, x6, Grosvenor Place, London, S.'~V.I. Telephone: SLOane 2r ~5.
97
Joint Tuberculosis Council At a meeting of the Council on February ")i the following officers were elected: Chairman, Dr J. E. Geddes; Vice-Chairmen, Professor XV. F. Gaisford and Dr J. V. Hurford; Hon. Treasurer, Dr Norman England; Hon. Scoretaw, Dr R. L. Midgley, and Hon. Auditor, Dr F. L. XVollaston. The chief business before the Council was the discussion on the report of the Children's Committee on the safeguarding of infants and children against tuberculosis. The recommendations which were approved by the Council included the examination and" annual x-raying of all people whose employment brings them in close contact with infants and young children together with rigid standards of quiescence before people who have had tuberculosis shall be permitted to return to such work. The council also approved a plan for the repeated tuberculin testing of all persons at various intervals up t o t h e l r fifteenth year. Conversion at any age should lead to clinical examination and a search for the source case in the child's environment while a child who remains negatlve until the age of 15 shall be offered vaccination against tuberculosis. Implementation of such a plan would undoubtedly diminish the prevalence of childhood tuberculosis and lead to the discovery of a number of hitherto u n suspected cases. The Council was aware that it would involve a considerable amount of work and that it would not be immediately practicable in all areas but nevertheless accorded the report its approval.
Annual Reports T H E H E A L T H AND S O C I A L SERVICES OF D O R S E T . Annual Report of the County Medical Officer of Health, A. A. Lisney, for the,Year 195I. Health Department, County Hall, Dorchester. September i952. Dorset is a nlral, well-wooded county with a mild, healthy climate; it has a rural population of II2,8oo and an urban one of I83,5oo. Its birth-rate was low at t4.8. T h e death-rate was 13 . And infant mortality was 26"4. Pneumonia with I6O deaths stood fourth in the great causes of death, contributing 4.I per cent of all deaths; bronchitis with 145 deaths came fifth and contributed 3"7 per c e n t ; pulmonary tubcrculosls claimed 47 deaths and stood seventh with 1"2 per cent. The death-rate per ioo,ooo from all forms of tuberculosis fell from 27 in i95o to I9, a striking reduction. But notifications have not yetstarted upon a definite fall;
98
TUBERCLE
here, mass radiography and the follow-up of contacts must be allowed for. A forecast is hazarded that tuberculosis in ten )'ears' time will cease to be a major health problem; certainly, it seems to be losing some of its virulence. Domiciliary cases m a y get shelters and free milk; health visitors watch them; their contacts, when suitable, receive BCG vaccination. During the year mass radiography was applied to 2o,4I 5 persons, disclosing 35 cases of active tuberculosis. There were 71 deaths due to cancer of hmg and bronchus, of which 58 were males; these deaths seem to be supplanting the deaths saved among males from pulmonary tuberculosis which occurred at similar age periods. Two M.B.s, L y m e Regis and Wareham, a n d two R.D.s, Beaminster and Bridport, had no death ascribed to tuberculosis; otherwise the infection seems to be fairly evenly distributed over the county; certainly, there is no 'specified area' for humans. But one is shortly expected in the coun W for milk. T o d a y milk is closely supervised with improvements in production and sale. T h e milk supply to --07 schools was pasteurized, to 48 it was tuberculin tested, and to only one was accredited. Lack of enough guinea-pigs interfered with biological tests of samples for part of the year. GLOUCESTERSHIRE COUNTY COUNCIL. Annual Report of the Count)" Medical Officer of Health, G. F. Bramley, for the Year I95I. Health Department, Berkeley Honse, Berkeley Street, Gloucester. Augnst 7, I952. T h e population of the county of Gloucester has increased by 3 ~ per cent since I931 to reach 429,o69, of whom two-thirds live in rural districts. T h e yearly health record is good; the death-rate was I-',; the birth-rate 15.3; the infant mortality was 26.6, the lowest yet recorded; and tuberculosis with 12I deaths, giving a rate per IO%OOOof~8, was down again, while it only claimed 2. 3 per cent of all deaths. Bronchitis claimed 4"4 per cent and pneumonia 3"4 per cent. Deaths due to tuberculosis which numbered 2I 5 in I948, fell to I65 in I949, to i24 in I95O , and 121 in 1951 ; but there were 60 more new cases notified than in i95o. Useful reports appear froin the consultant chest physicians of the North Gloucestersbire Clinical Area and the Bristol Clinical Area. The for.rnef holds that more can be done to make milk safe; t h a t i f B C G vaccine is good, it should be widely used; and that mass radiography is a valuable agent to discover new cases of which the value is limited by lack of compulsory removal to -ensure isolation. Effective prevention requires some loss of individual liberty which other
March 1953
countries think well worth while. ~,Ve call it liberty to l e a v e t h e healtl W free to.be infected. There has been a fidl in the early minimal cases and in the advanced cases coming under notice, with a surprising rise in moderately advanced cases. 5 ~ extra beds lightened the embarrassment of waiting lists; there were 375 beds to z21 deaths. T h e examination of contacts is being carefully and closely pursued. But complete and compulsory community surveys are needed. Tubercle bacilli were found in 5 batik samples of milk and in 18 killed calves. O f the cattle population 30 per cent arc in attested herds.
Thirty Years Ago (Extract from TUBERCLE, March 1923 'Industrialism and the Incidence of Phthisis' by Edgar L. Collis, .~I.A., M.D., .M.R.C.P.) First, there are primitive communities with no death-rate from the disease; such communities when infected quickly succumb, and probably more or less equally at all ages. W h a t happens in such a community during the time that the disease, from being a new infection, becomes endemic, has not been traced. In a European non-industrialized community where in tile disease is endemic, the age of m a x i m u m incidence is found late in life. When the habits and customs of such a community are disturbed by industrialization, the age of m a x i m u m incidence moves to early adult life. As such a community settles down to the new conditions, the age of m a x i m u m incidence steadily recedes again to late life. This process m a y be retarded by such influences as indoor sedentary life, or the alcoholic habit, or m a y even be i-eversed by such social upheavals as occurred d u r i n g the war; it i s essentially associated with the industries and is found taking place most rapidly in those occupations which have been least distflrbed in recent years. T h e process appears to occur irrespective of tim total phthisis death-rate in the population; it has been slow among agricultural labourers with a low mortality, and among inn-servants with a high mortality; it has proceeded quickly for tailors with a high mortality, and extended furthest among clergy with the lowest mortality of all. In other words, resistance to phthisis in early life seems to depend upon the extent to which the race has suited itself to its environment, while the degree of mortality experienced appears to depend rather on aggregation of population which probably means opportunities for infection. .
.
.
TUBERCLE
m e that he has seen two cases of fractures of femoral necks in therapeutically induced fits. I t is possible that the fractures sustained b y our patient o c c u r r e d because o f decalcification of the bones associated with prolonged r e c u m b e n c y . I wish to t h a n k D r J. B. Morrison, the Medical S u p e r i n t e n d e n t , for permission to r e p o r t this case.
Bibliography [i] Meduna, L., and Friedman, E. 0939) J.A.M.A., cxH, 5m, February z L [~] Zelfert, M. (1939) Psychiatry Quarterly, xm, 3o3, April. [3] Caplan, G. (t9.~6) Journal of Mental Science, 784, October. [4] Caplan, G. 09i6) Journal of Mental Sciel~ce, 766, Ocotber. [5] Blair, D. 094o) Lancet, 3"25,September x4.
British Tuberculosis Association At a meeting of the Association on Friday, February 20 the following candidates were admitted to membership: Robert J. Cuthbert, George Gerrard, J . S. B. Greenfield, W. S. Hamilton, George Hurrell, .John R. Lauckner, J. S. G. P. Stapleford, P. S. Thorne and William F. Wheeler. A whole day meeting will be held at L E I C E S T E R on Friday, April I7, when the following subjects will be discussed: Bronchiectasis in the Community, by Dr J. C. H. Mackenzie; Mantoux Testing and Clinical Progress, by Dr Midgley Turner; Aberrant Pulmonary Tissue, by Mr Gordon Cruickshank, and the Results of Training and Emplo)a'nent at Papworth, by Dr Owen Clarke. T h e A N N U A L C O N F E R E N C E will he held at E D I N B U R G H in conjunction with the meeting of the Tuberculosis Society of Scotland. The dates are July I to 4 and the subjects for discussion include Field Surveys, Chemotherapy, Tuberculosis in I n f a n c y - certain aspects of immunity and pathologT, Tuberculous Endometrifis, Renal Tuberculosis, Pulmonary Disease of Industrial Origin, Diagnostic Bronchoscopy in Chest Clinics, Pulmonary Function in Plcural Effusions /rod there will also be demonstrations at various clinics in the City. Further information about the Association and its activities may be obtained from the Secretary, Dr Hugh Ramsay, at the Association's offices, x6, Grosvenor Place, London, S.'~V.I. Telephone: SLOane 2r ~5.
97
Joint Tuberculosis Council At a meeting of the Council on February ")i the following officers were elected: Chairman, Dr J. E. Geddes; Vice-Chairmen, Professor XV. F. Gaisford and Dr J. V. Hurford; Hon. Treasurer, Dr Norman England; Hon. Scoretaw, Dr R. L. Midgley, and Hon. Auditor, Dr F. L. XVollaston. The chief business before the Council was the discussion on the report of the Children's Committee on the safeguarding of infants and children against tuberculosis. The recommendations which were approved by the Council included the examination and" annual x-raying of all people whose employment brings them in close contact with infants and young children together with rigid standards of quiescence before people who have had tuberculosis shall be permitted to return to such work. The council also approved a plan for the repeated tuberculin testing of all persons at various intervals up t o t h e l r fifteenth year. Conversion at any age should lead to clinical examination and a search for the source case in the child's environment while a child who remains negatlve until the age of 15 shall be offered vaccination against tuberculosis. Implementation of such a plan would undoubtedly diminish the prevalence of childhood tuberculosis and lead to the discovery of a number of hitherto u n suspected cases. The Council was aware that it would involve a considerable amount of work and that it would not be immediately practicable in all areas but nevertheless accorded the report its approval.
Annual Reports T H E H E A L T H AND S O C I A L SERVICES OF D O R S E T . Annual Report of the County Medical Officer of Health, A. A. Lisney, for the,Year 195I. Health Department, County Hall, Dorchester. September i952. Dorset is a nlral, well-wooded county with a mild, healthy climate; it has a rural population of II2,8oo and an urban one of I83,5oo. Its birth-rate was low at t4.8. T h e death-rate was 13 . And infant mortality was 26"4. Pneumonia with I6O deaths stood fourth in the great causes of death, contributing 4.I per cent of all deaths; bronchitis with 145 deaths came fifth and contributed 3"7 per c e n t ; pulmonary tubcrculosls claimed 47 deaths and stood seventh with 1"2 per cent. The death-rate per ioo,ooo from all forms of tuberculosis fell from 27 in i95o to I9, a striking reduction. But notifications have not yetstarted upon a definite fall;
98
TUBERCLE
here, mass radiography and the follow-up of contacts must be allowed for. A forecast is hazarded that tuberculosis in ten )'ears' time will cease to be a major health problem; certainly, it seems to be losing some of its virulence. Domiciliary cases m a y get shelters and free milk; health visitors watch them; their contacts, when suitable, receive BCG vaccination. During the year mass radiography was applied to 2o,4I 5 persons, disclosing 35 cases of active tuberculosis. There were 71 deaths due to cancer of hmg and bronchus, of which 58 were males; these deaths seem to be supplanting the deaths saved among males from pulmonary tuberculosis which occurred at similar age periods. Two M.B.s, L y m e Regis and Wareham, a n d two R.D.s, Beaminster and Bridport, had no death ascribed to tuberculosis; otherwise the infection seems to be fairly evenly distributed over the county; certainly, there is no 'specified area' for humans. But one is shortly expected in the coun W for milk. T o d a y milk is closely supervised with improvements in production and sale. T h e milk supply to --07 schools was pasteurized, to 48 it was tuberculin tested, and to only one was accredited. Lack of enough guinea-pigs interfered with biological tests of samples for part of the year. GLOUCESTERSHIRE COUNTY COUNCIL. Annual Report of the Count)" Medical Officer of Health, G. F. Bramley, for the Year I95I. Health Department, Berkeley Honse, Berkeley Street, Gloucester. Augnst 7, I952. T h e population of the county of Gloucester has increased by 3 ~ per cent since I931 to reach 429,o69, of whom two-thirds live in rural districts. T h e yearly health record is good; the death-rate was I-',; the birth-rate 15.3; the infant mortality was 26.6, the lowest yet recorded; and tuberculosis with 12I deaths, giving a rate per IO%OOOof~8, was down again, while it only claimed 2. 3 per cent of all deaths. Bronchitis claimed 4"4 per cent and pneumonia 3"4 per cent. Deaths due to tuberculosis which numbered 2I 5 in I948, fell to I65 in I949, to i24 in I95O , and 121 in 1951 ; but there were 60 more new cases notified than in i95o. Useful reports appear froin the consultant chest physicians of the North Gloucestersbire Clinical Area and the Bristol Clinical Area. The for.rnef holds that more can be done to make milk safe; t h a t i f B C G vaccine is good, it should be widely used; and that mass radiography is a valuable agent to discover new cases of which the value is limited by lack of compulsory removal to -ensure isolation. Effective prevention requires some loss of individual liberty which other
March 1953
countries think well worth while. ~,Ve call it liberty to l e a v e t h e healtl W free to.be infected. There has been a fidl in the early minimal cases and in the advanced cases coming under notice, with a surprising rise in moderately advanced cases. 5 ~ extra beds lightened the embarrassment of waiting lists; there were 375 beds to z21 deaths. T h e examination of contacts is being carefully and closely pursued. But complete and compulsory community surveys are needed. Tubercle bacilli were found in 5 batik samples of milk and in 18 killed calves. O f the cattle population 30 per cent arc in attested herds.
Thirty Years Ago (Extract from TUBERCLE, March 1923 'Industrialism and the Incidence of Phthisis' by Edgar L. Collis, .~I.A., M.D., .M.R.C.P.) First, there are primitive communities with no death-rate from the disease; such communities when infected quickly succumb, and probably more or less equally at all ages. W h a t happens in such a community during the time that the disease, from being a new infection, becomes endemic, has not been traced. In a European non-industrialized community where in tile disease is endemic, the age of m a x i m u m incidence is found late in life. When the habits and customs of such a community are disturbed by industrialization, the age of m a x i m u m incidence moves to early adult life. As such a community settles down to the new conditions, the age of m a x i m u m incidence steadily recedes again to late life. This process m a y be retarded by such influences as indoor sedentary life, or the alcoholic habit, or m a y even be i-eversed by such social upheavals as occurred d u r i n g the war; it i s essentially associated with the industries and is found taking place most rapidly in those occupations which have been least distflrbed in recent years. T h e process appears to occur irrespective of tim total phthisis death-rate in the population; it has been slow among agricultural labourers with a low mortality, and among inn-servants with a high mortality; it has proceeded quickly for tailors with a high mortality, and extended furthest among clergy with the lowest mortality of all. In other words, resistance to phthisis in early life seems to depend upon the extent to which the race has suited itself to its environment, while the degree of mortality experienced appears to depend rather on aggregation of population which probably means opportunities for infection. .
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