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THE PROPOSED TUBERCULOSIS RESEARCH UNIT
659 in fact inhaled as small particles by the mice. Campbellhas shown also that road dust with a content of only 2 per cent. of tar is capable of raising the lung-tumour rate from 8 to 80 per cent. when mice are subjected for long periods to an atmosphere containing it. The active agent in such a dust would probably be very dilute. It thus appears that by whatever route the carcinogenic agent reaches the lungs, whether directly with air or indirectly by the blood-stream, the effective dose may be extremely
small. COST OF MINIATURE RADIOGRAPHY
THE miniature radiogram as an adjunct to routine physical examination was mentioned in one of our leading articles a fortnight ago, in discussing the death of a militiaman from pulmonary tuberculosis a few weeks after being passed as fit. Now A. Robinson Thomas4 has described in detail a simple set-up prepared for him by Watson and Sons of Parker Street, W.C.I. If ordinary 12 x 15 in. direct films were used, the outlay on examining 1000 men would be JE100. since these films cost about 2s. each. Using 35 mm. film, nine photographs can be taken on 1 foot of film, and 16 feet of this film cost 6s. 10d. at ordinary prices. Using miniature photography, therefore, the cost for 1000 men would be about 2 8s. The cost of the apparatus used by Mr. Thomas, including
special developing tanks, screening stand, lightproof cone, miniature camera and lens, and also a special projector and screen, is about 1:650. As soon therefore as 7000 pictures have been taken, the capital expenditure on the new apparatus has been covered, and the enormous saving in running cost starts to show itself. The method is extremely rapid, and Holfelder in his clinic at Frankfurt A.M. claims to be able to examine 400 cases an hour. In Rio de Janeiro, de Abreu5 its satisfied with 120 an hour. Berner6 has already examined 55,666 patients of whom 32,360were soldiers and 10,532 picked storm-troopers. Among the latter, 0-8 per cent. was found to have active tuberculosis, while among the German police, 1.68 per cent were found by the same method to be infected. In spite of mechanisation, personnel is still the most important thing in an army, and miniature radiography can scarcely be excluded from making its contribution to the health of our newly recruited forces on the grounds of expense. THE SOUTH AFRICAN DOCTOR
ACCORDING to Dr. Dru Drurythere are three defects in the South African medical profession. Firstly there are too few doctors. There is one practising doctor for every thousand of the European population, but if coloured and native population are included, the ratio becomes one doctor for every five thousand. Secondly the distribution is faulty. One-fifth of the Union population live in nine large cities, but this fraction has attracted half of the available doctors. Cape Town has one doctor for every four hundred people, while the Transkei has one for thirty .thousand natives. Lastly medical care is too expensive. White doctors fail to settle in native areas, yet Dr. Drury says that when the Rockefeller Foundation offered to found a medical 3. Campbell, Ibid, 1937, 18, 215. 4. Thomas, A. R., Public Health, Sept. 1939, p. 347. 5. de Abreu, M., Amer. J. Roentgenol. 1939, 41, 662. 6. Berner, F.. Röntgenpraxis, 1939. 7. Dru Drury, E. G., public lecture to the twenty-third South African Medical Congress, July 10, 1939.
school on the Rand for training native doctors the offer was turned down, and natives are not admitted to medical degrees in the existing universities. But of the need for a widening of medical practice the recent annual report of the M.O.H. for Cape Town leaves no doubt. He writes: "
The social and economic conditions of the Cape Coloured the whole unsatisfactory. The principle of compulsory education, which is applied to European children, does not extend to them ; and although certain schooling facilities are available for them, in many cases of an inferior order, there is much illiteracy, and also a lack of discipline in certain classes of adolescents. With a very few exceptions they belong to the working class. A small proportion have skilled trades and receive satisfactory wages, but the majority belong to the unskilled labouring class. These receive very low wages, usually not more than 30s. a week when in full work, and often less. The wages of the head of the household are commonly eked out by the earnings of his wife and children. The City Council pays its labourers a minimum wage of 12a week, but this is much above the local standard of wages. In the building trade the minimum wage for labourers is 9d. an hour. The resulting poverty produces its inevitable result amongst the coloured people. A large section of them suffer from malnutrition and their housing conditions are very bad. Alcoholism is common and there is a high incidence of venereal disease. The effects on their health are shown by the contrast between the vital statistics of Europeans and non-Europeans...." are on
The racial distribution of sixth-year medical students in South Africa is interesting: Jews make up 37 per cent., English 33 per cent. and Afrikaans 26 per cent. THE
PROPOSED TUBERCULOSIS UNIT
RESEARCH
EVER since the discovery of the tubercle bacillus attempts have been made to influence the course of tuberculosis by germicidal drugs-but always without appreciable result. Lately the success of surgical measures in cases proving refractory to regimen and diet has pushed the thought of chemotherapy into the background. The position is now changed by the advent of the sulphonamide group of drugs, although it would be unwise to argue that they must be effective in tuberculosis because they have given such brilliant results in other infections. But if chemotherapy is to find its place in tuberculosis it will surely be as a result of team work, the harmonious cooperation of bacteriologists, pathologists, biochemists and clinicians. For this reason we share the disappointment recently expressed in the Times at the decision of Middlesex county council not to adopt the proposal for a tuberculosis research unit. The council has, it seems, approved the principle, but holds the view that it should be a national rather than a local service. The proposal was to ask the Medical Research Council to second Dr. Leonard Colebrook, who is at present director of the research unit at Queen Charlotte’s Hospital, to direct the new tuberculosis unit, bringing with him his own research team. The salary of the director would have been paid by the council, which would also have provided the raw materials of research from the Mill Hill laboratory. Although no results could be guaranteed, the establishment of a research unit such as that contemplated could hardly fail to yield information of therapeutic as well as of purely scientific value. The record of the unit at Queen Charlotte’s has been remarkably good. We should like to see it made possible to achieve like results in another field. Preoccupation with more obvious foes can be no excuse for wavering in our offensive against Osler’s captain of the men of death.
small. COST OF MINIATURE RADIOGRAPHY
THE miniature radiogram as an adjunct to routine physical examination was mentioned in one of our leading articles a fortnight ago, in discussing the death of a militiaman from pulmonary tuberculosis a few weeks after being passed as fit. Now A. Robinson Thomas4 has described in detail a simple set-up prepared for him by Watson and Sons of Parker Street, W.C.I. If ordinary 12 x 15 in. direct films were used, the outlay on examining 1000 men would be JE100. since these films cost about 2s. each. Using 35 mm. film, nine photographs can be taken on 1 foot of film, and 16 feet of this film cost 6s. 10d. at ordinary prices. Using miniature photography, therefore, the cost for 1000 men would be about 2 8s. The cost of the apparatus used by Mr. Thomas, including
special developing tanks, screening stand, lightproof cone, miniature camera and lens, and also a special projector and screen, is about 1:650. As soon therefore as 7000 pictures have been taken, the capital expenditure on the new apparatus has been covered, and the enormous saving in running cost starts to show itself. The method is extremely rapid, and Holfelder in his clinic at Frankfurt A.M. claims to be able to examine 400 cases an hour. In Rio de Janeiro, de Abreu5 its satisfied with 120 an hour. Berner6 has already examined 55,666 patients of whom 32,360were soldiers and 10,532 picked storm-troopers. Among the latter, 0-8 per cent. was found to have active tuberculosis, while among the German police, 1.68 per cent were found by the same method to be infected. In spite of mechanisation, personnel is still the most important thing in an army, and miniature radiography can scarcely be excluded from making its contribution to the health of our newly recruited forces on the grounds of expense. THE SOUTH AFRICAN DOCTOR
ACCORDING to Dr. Dru Drurythere are three defects in the South African medical profession. Firstly there are too few doctors. There is one practising doctor for every thousand of the European population, but if coloured and native population are included, the ratio becomes one doctor for every five thousand. Secondly the distribution is faulty. One-fifth of the Union population live in nine large cities, but this fraction has attracted half of the available doctors. Cape Town has one doctor for every four hundred people, while the Transkei has one for thirty .thousand natives. Lastly medical care is too expensive. White doctors fail to settle in native areas, yet Dr. Drury says that when the Rockefeller Foundation offered to found a medical 3. Campbell, Ibid, 1937, 18, 215. 4. Thomas, A. R., Public Health, Sept. 1939, p. 347. 5. de Abreu, M., Amer. J. Roentgenol. 1939, 41, 662. 6. Berner, F.. Röntgenpraxis, 1939. 7. Dru Drury, E. G., public lecture to the twenty-third South African Medical Congress, July 10, 1939.
school on the Rand for training native doctors the offer was turned down, and natives are not admitted to medical degrees in the existing universities. But of the need for a widening of medical practice the recent annual report of the M.O.H. for Cape Town leaves no doubt. He writes: "
The social and economic conditions of the Cape Coloured the whole unsatisfactory. The principle of compulsory education, which is applied to European children, does not extend to them ; and although certain schooling facilities are available for them, in many cases of an inferior order, there is much illiteracy, and also a lack of discipline in certain classes of adolescents. With a very few exceptions they belong to the working class. A small proportion have skilled trades and receive satisfactory wages, but the majority belong to the unskilled labouring class. These receive very low wages, usually not more than 30s. a week when in full work, and often less. The wages of the head of the household are commonly eked out by the earnings of his wife and children. The City Council pays its labourers a minimum wage of 12a week, but this is much above the local standard of wages. In the building trade the minimum wage for labourers is 9d. an hour. The resulting poverty produces its inevitable result amongst the coloured people. A large section of them suffer from malnutrition and their housing conditions are very bad. Alcoholism is common and there is a high incidence of venereal disease. The effects on their health are shown by the contrast between the vital statistics of Europeans and non-Europeans...." are on
The racial distribution of sixth-year medical students in South Africa is interesting: Jews make up 37 per cent., English 33 per cent. and Afrikaans 26 per cent. THE
PROPOSED TUBERCULOSIS UNIT
RESEARCH
EVER since the discovery of the tubercle bacillus attempts have been made to influence the course of tuberculosis by germicidal drugs-but always without appreciable result. Lately the success of surgical measures in cases proving refractory to regimen and diet has pushed the thought of chemotherapy into the background. The position is now changed by the advent of the sulphonamide group of drugs, although it would be unwise to argue that they must be effective in tuberculosis because they have given such brilliant results in other infections. But if chemotherapy is to find its place in tuberculosis it will surely be as a result of team work, the harmonious cooperation of bacteriologists, pathologists, biochemists and clinicians. For this reason we share the disappointment recently expressed in the Times at the decision of Middlesex county council not to adopt the proposal for a tuberculosis research unit. The council has, it seems, approved the principle, but holds the view that it should be a national rather than a local service. The proposal was to ask the Medical Research Council to second Dr. Leonard Colebrook, who is at present director of the research unit at Queen Charlotte’s Hospital, to direct the new tuberculosis unit, bringing with him his own research team. The salary of the director would have been paid by the council, which would also have provided the raw materials of research from the Mill Hill laboratory. Although no results could be guaranteed, the establishment of a research unit such as that contemplated could hardly fail to yield information of therapeutic as well as of purely scientific value. The record of the unit at Queen Charlotte’s has been remarkably good. We should like to see it made possible to achieve like results in another field. Preoccupation with more obvious foes can be no excuse for wavering in our offensive against Osler’s captain of the men of death.