The medical uses of radium

The medical uses of radium

1934. PUBLIC HEALTH, tion.* This Report deserves thorough study by all interested in social conditions prevailing in agricultural areas wherein urba...

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1934.

PUBLIC HEALTH,

tion.* This Report deserves thorough study by all interested in social conditions prevailing in agricultural areas wherein urbanised communities have developed. In regard to these communities, the very high family incidence of tuberculosis, suggesting that infection largely takes place in the home, was discovered. A heavy rainfall and tack of outdoor recreation tended to increase the liability to home infection, as would also the high degree of inter-marriage which is prevalent amongst the inhabitants of these districts. A fatalistic outlook and inherent pride are prominent features amongst the population, and these traits exert a sinister influence in that they tend towards concealment of the disease, and examination by the tuberculosis officer is often refused because his visit is believed to stigmatise the family, thus leaving a large number of cases undetected and uncontrolled. The housing conditions were found to be very unsatisfactory ; many of the houses had no through ventilation and were inadequately lighted by unopenable and curtained windows, whilst the sanitary arrangements were primitive, the waste matter being dumped on fields, waste ground or on the banks of a stream. Tuberculosis was found to occur with greater frequency in dwellings constructed of the somewhat porous slate shale, with absence of damp-proof Courses, on an impervious subsoil, whilst striking examples age quoted of low tubercular mortalities in neighbouring hamlets where the subsoil is more pervious and the houses are built of non-porous stone. The diet of the people in these districts appeared to be deficient in such foods as milk, fresh meat, fruit and vegetables, the body resistance to infection being thereby lowered ; tinned foodstuffs and bacon, together with an excessive consumption of tea, figured prominently in the dietary. The occupation of slate quarrying is undoubtedly associated with the maintenance of a high death-rate from tuberculosis, especially 'late in life, as apart from the exposure to silica dust, the conditions under which the men are employed enhance the opportunities for infection. At the end of his report, Dr. Chalke has furnished valuable recommendations which deserve the serious consideration of the local authorities and social bodies. Some of the most *Report on an Investigation into the Causes of the continued High Death-Rates from Tuberculosis in certain parts of North Wales. By HERBERTD. CHALKE, M.A., M.R.C.S., D.P.H. Cardiff: King Edward v i i Welsh National ~Memorial Association. 1933.

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important of these, relate to the need of replacement of damp cottages by modern structures on dry sites capable of receiving the maximum amount of sunshine, the intensification of existing schemes for teaching the people the supreme importance of suitable diet, the provision of means for healthy indoor and outdoor recreation to counteract the tendency to overcrowding in the home, the establishment of quarry canteens where the workmen may obtain a cheap, nourishing mid-day meal, increased attention to dust preventive measures in quarries and, finally but by no means least important, the obliteration of the old fears and prejudices which have been rooted by tradition in these communities, and the creation of a confidence that tuberculosis in its early stages is a curable disease which can be rendered non-infective by suitable measures. It is impossible in a short space to do justice to the abundance of statistics and descriptive detail presented in this report, which invites the attention of those concerned in the epidemiology of tuberculosis ; and Dr. Chalke is to be congratulated on the tremendous amount of work which was carried out within the limited period of six months.

The Medical Uses of Radium. N a report recently issued under this title,* I the Medical Research Council summarises the results of research work done during 1932 in the treatment of cancer by means of radium tent by them to selected centres throughout the country. The information provided supplements the account given in ten similar reports already published of the scheme of work carried out under the direction of the Council's Radiology Committee, which has bcen responsible also for the preparation of these reports. The original stock of radium salt entrusted to the Council for this purpose by the Government is supplemented by further quantities provided by the British Empire Cancer Campaign and by the National Radium Commission. The report, in addition to dealing with the actual work of the past year, also gives statistical data relating to the after-histories of patients treated in earlier years. Apart from summarising the reports from the research centres on the results obtained in connection with the treatment of cancers in various situations--the ~Special Report Series, No. 186. H.M. Stationery Office, 1933. Price Is. net.

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breast, uterus, rectum, brain, etc.--the reports include a section in which some account of purely experimental investigations is presented.

The Welsh National Memorial Association. HE twenty-first annual report of the King Edward VII Welsh National Memorial Association for the Prevention, Treatment and Abolition of Tuberculosis covers the twelve months ended March 31st, 1933, and contains a compendium of information which is of interest both to the clinician and the public health officer. The Association provides a tuberculosis service for a population of over twoand-a-half million persons, and has under its control 17 institutions, whilst the diagnosis and domiciliary supervision of cases are undertaken by 14 area tuberculosis physicians, most of whom are assisted by one or more assistant physicians. Dr. D. A . Powell (the Principal Medical Officer), in his report, provides tables which show a steady increase in the work of the Association generally, the large amount of work carried out relatively to England as a whole, the close association maintained between the medical staff of the Association and general practitioners, and, in comparison with previous years, the relatively small number of sputum examinations arid a much greater number of X-ray examinations. It has been found that whilst patients are unable or unwilling to provide specimens for bacteriological examination, they gladly seize the opportunity for radiologieal examination, and the provision of these facilities has done an enormous amount of good in popularising the work of the Association. A table given in Dr. Powell's report also shows that the mortality from tuberculosis in Wales has fallen from 1,730 per million in 1901 to 977 i n 1932, and • that .though the non-pulmonary death-rate has fallen from 47/1 to 172 per million inthis period, the pulmonary mortality has not shown an equal decline, the figures for 1901 and 1932 being. 1,256 and 804 respectively. In addition to the institutional and area reports, which contain a wealth of detailed information presented by the physicians in charge thereof, four formal " studies " are included. Dr. Brownlee (Glanely Hospital) describes a number of cases of clinical interest which presented medical or surgical symptoms simulating tuberculosis, and which were diagnosed as a result of the application of methods

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which are available or at the disposal of a wellequipped institution. Dr. C. W. Burns describes the results of an investigation into the afterresults of treatment of 143 surgical patients discharged from the St. Bride's Hospital between 1923 and 1927. Seventy per cent. of these cases were found to be fit after six or more years, and six out of a total of eight deaths which had occurred after discharge were of patients who had been removed from hospital against advice. Dr. T. W. Davies presents a study of the association of pulmonary and non-pulmonary conditions in the same patients; and Dr. W. Davies describes a case of tuberculous pericarditis with effusion, which was treated with some success by aspiration followed by air replacement of the fluid withdrawn. Over 3,000 contacts, were examined during the year by the medical staff of the Association, and an interesting table giving the results of contact examinations in Wales, compared with similar figures obtained from Lancashire, quoted from Dr. MacNalty's Report on Tuberculosis, shows that tuberculosis is found twice as often amongst contacts in Wales as in Lancashire, and taking adults alone it is found two-and-a-half times as often. The area physicians do n o t unanimously approve contact examination as a method of discovering cases of tuberculosis, but Dr. Howell Williams describes some striking results in this direction, obtained by the examination of contacts of seven cases in his area. In conjunction with the research department of the Association, work has been carried out in connection with " contacts," into certain " curious " bodies found in the lungs of colliers, coal trimmers and others, and in regard to tuberculin tests in a mental hospital ; whilst Prof. Cummins has pursued his study of the value of gold salts in the treatment of pulmonary tuberculosis, and his search for methods to evaluate their effects. In t h e Association?s central laboratory, under the direction of Dr. W. H. Tytler; an increased amount of routine work has been done, and it is interesting to note that from a study of the bacillary types cultured from 450 cases treated by the staff of the Association, not more than 8 per cent. were found to be of bovine origin. T h o u g h t h e amount of bovine infection amongst human cases appears to be comparatively low in Wales, the Association has taken active measures to encourage the establishment of tubercle-free herds and improve the quality of milk generally, and a joint committee representing the Royal Welsh Agricultural Society