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The royal sanitary institute congress
PUBLIC HEALTH,
247
September, 1949
h i g h l y decalcified b u t t h e t e e t h are still n o r m a l . If t h e r e is a n y increase i n caries in p r e g n a n c y it is m o s t likely d u e to t h e lack of oral h y g i e n e because of t h e m o t h e r b e i n g u n d u l y b u s y a t this t i m e ; it m a y just possibly b e due to some c h a n g e in the organic c o n t e n t of the t o o t h - b u t n o t t h e inorganic content.
Dental Fistula A n o t h e r e x a m p l e of t h e n e e d of d e n t a l a n d medical coo p e r a t i o n is seen in t h o s e cases w h e r e t h e p a t i e n t is suffering from a c o n d i t i o n w h i c h is p a r t l y d e n t a l a n d p a r t l y surgical. Children often p r e s e n t w i t h a fistula of t h e face, or u n d e r t h e chin. T h i s is s o m e t i m e s of d e n t a l origin a n d due to a d e a d t o o t h b u t I h a v e seen such p a t i e n t s t r e a t e d for l o n g periods b y medical p r a c t i t i o n e r s w i t h o u t a n y d e n t a l advice or d e n t a I t r e a t m e n t b e i n g sought, w i t h t h e result t h a t t h e sinus h a s persisted in spite of c u r e t t i n g a n d s h o r t - w a v e t h e r a p y .
Fractures Yet a n o t h e r sphere of d e n t a l / s u r g i c a l co-operation is to be • f o u n d in f r a c t u r e s of t h e jaw. Good results in t h e t r e a t m e n t of these d e p e n d on d e n t a l a n d surgical specialists w o r k i n g together. T h e s e r e q u i r e m e n t s existed d u r i n g t h e w a r in t h e maxillo-faciaI t e a m s b u t n o s u c h t e a m exists at t h e m o m e n t in N o r t h e r n I r e l a n d . S u c h a t e a m m a y b e considered as a n u r g e n t r e q u i r e m e n t for a n y f u t u r e .development of this t y p e of work in t h e P r o v i n c e . T h e d e n t a l surgeon c a n also help w i t h plastic s u r g e r y w h e r e his skill in m a k i n g appliances of all types c a n be utilised for s u c h t h i n g s as c r a n i a l plates in b r a i n surgery or artificiM noses a n d ears i n t h e p o s t - o p e r a t i v e t r e a t m e n t of l u p u s a n d cancer. Artificial eyes m a y also b e m a d e for p a r t i c u l a r p a t i e n t s a n d are f a r s u p e r i o r to t h e stock v a r i e t y supplied b y t h e wholesale producers. T h e r e is p a r t i c u l a r need for this k i n d of co-operation b e t w e e n t h e hospitals a n d t h e i r specialist services a n d t h e P u b l i c D e n t a l Service, a n d I h o p e t h a t h a r m o n i o u s w o r k i n g b e t w e e n these two bodies m a y b e a c h i e v e d u n d e r t h e new H e a l t h Act.
THE
ROYAL
SANITARY
INSTITUTE
CONGRESS
(Continued from P.H., August, page 229) Rehabilitation and Resettlemer~t in Industry Professor Thomas Ferguson, Professor of Public Health in Glasgow University, presided over the section of Hygiene in Industry and gave his address under the above title. H e said that before the war there were no official schemes in this country and no legal definition of " d i s a b i l i t y " as in Germany or Denmark, although some of the more advanced hospitals, notably tuberculosis sanatoria, were undertaking courses of occupational therapy and training suitable patients in carpentry, basketry and agricultural pursuits. Some of the larger mental hospitals and voluntary organisations were also doing some work in aftercare and occupational therapy. The big general hospitals took very little real interest with notable exceptions such as the Seamen's Hospital, Greenwich, and the L.M.S. Hospital at Crewe. Some of the indemnity insurance companies operating in the coalfields had, however, found that planned rehabilitation could be effective in reducing compensation costs, e.g., the centre at Berryhill, near Mansfield, could return more than 85% of the men treated through working in the coalmines; it served an area of about 18,000 accidents a year in respect of which compensations were paid, of which 6,000 caused total incapacity for more than a month and 800 for more than six months. The B.M.A. had reported in 1935 on the undue delay in securing the employment of injured work people and had concerned itself primarily with fractures. As a result of the B.M.A. report the Government set up an inter-departmental committee which in its turn presented a report which was essentially surgical and mainly fracture in its outlook. During the war the Services early recognised the importance of rehabilitation and all set up " convalescent depots" whose results were strikingly good. Meanwhile the Tomlinson Committee w a s set up for the civil field in 1941 and in its report (1943) recommended that the central health departments should stimulate provision by hospital authorities of special rehabilitation treatment for a special surgical group (other than fracture and injuries) and medical cases. He made special mention of the opening of the Birmingham accident hospital and rehabilitation centre and the Ministry of Labour and National Service interim scheme for resettlement introduced in late 1941.
Experience of these schemes showed that men from some clinical groups did better than others and those that did badly were sufferers from heart disease and tuberculosis. Recent social legislation had made further provision, e.,,~., the Disabled Persons (Employment) Act, the N.H.S. Act and the National Assistance Act. The first of these had e
The Inspiration of Home Professor \ ¥ . S. Craig, Professor of Paediatrics and Child Health, Leeds University, was the president of the section of Maternal and Child Health. In his address he said that he felt that the administrators of child health schemes had reached a crucial stage in their journeyings, but he would urge that they should not stray from the path which led hy the shortest route to child health in the home. Maternity and child welfare had pioneered visits to the homes of children and out of its efforts in disease prevention in childhood had grown the conception of the promotion of health in infancy. This work had compelled recognition of the social, economic and environmental factors contributing to ill-health in the early months and years of life. The nursery conception also had helped the family while at the same time furthering the interests of the child. Lastly, the service had tried to watch over the child who had been received for reward or who was a candidate for adoption. Professor Craig urged that further measures for the care of child health should not be deprived of the home factor. They could not but be alarmed at the effects of housing conditions on the physical and emotional health of children. There seemed to be an endless stream of children sent to hospital for reasons directly or indirectly related to home or housing conditions• Many of these children did not need hospital treatment and radical treatment of these cases should be concerned with remedying home conditions. Instead the hospital was expected to patch things up. This attitude was not condoned now with the aged and should not be complacently expected for children. The hospital was no place to send a child on a forced or small pretext. To many people hospitals constituted the foundation of the national health service. This might be desirable with adult patients but with the ailing child the aim should be to reduce to the minimum need for reference of children to hospital• It could only be achieved if experimental and domiciliary services concerned with the child were given the place of first importance in plans for the future. Also if the punic were educated into the understanding of the part the home had to play in the care of both the ailing and healthy child. T h e disadvantage of the preventive services was that they were largely taken for granted; falling infantile mortality rates had less news value than ambitious hospital schemes. T h e maternity and child welfare service in co-operation with the family doctor should ensure that home was the better alternative compared with the hospital, by expanding home help and home nursing services and improving conditions of housing. Mothers and fathers must then be convinced of the special value of home treatment for their
248 children. He thought family doctors would co-operate; certainly the universities were trying to see that the next generation at least of general practitioners would have the right ideas. He urged the service to take full advantage of the vast potential represented by the family doctor and secondly to educate the hospitals into a true understanding of child health.
Publie Health Research Dr. C. Metcalfe Brown opened a discussion on May 25th in the Conference of Medical Officers of Health on public health research. H e thought that from 1930-48 the health departments had been too much occupied in hospital administration at the expense of their true work. Now came the opportunity of exploring the field of research on which depended the expansion of preventive medicine. T h e r e were statutory powers for the pursuit of such research in Section 47 of the Handicapped Pupils and School Health Service Regulations~ 1945, made under the Education Act, 1944, and in Section 16(i) of the National Health Service Act, 1946. On choice of subject he quoted Alstead's dictum that a large number of discoveries in medicine had resulted from accidents and that we should all try to be accident-prone. Stimulation for subjects would come from many quarters, as a result 6f reading or listening, by chance in the course of daily work, by spontaneous ideas arising from speculation or by direct approach of a colleague or of the Medical Research Cotmcil. It was frequently complained that we were too busy to think, but the inveterate speculator made time to think or pursued his philosophic way in spite of routine duties or general distractions. Most of the daily problems set for solution in the medical department were matters of routine administration but the frequent appearance of the unusual added variety and led to investigation well beyond the immediate needs. As an example, he quoted a piece of research in Manchester which followed investigations of cases of food poisoning involving examination of samples of meat and fat d6bris taken from slicing machines in kitchens. This had revealed heavy growths of organisms such as S. pyogenes, aureus and albus, B. typhimurlum, B. sonne and coliform organisms. As a result a survey of such machines had commenced in Manchester for which the bacteriological work was being carried out in the recently created Public Health Laboratory. This was certainly an aspect of food handling worthy of attention and might lead to raising the standard of hygiene in one respect. T h e ever-increasing collaboration between the M.R.C.'s laboratory service and health departments was most encouraging. The P.H.L.S..provided a pyramid of laboratories which gave an epidemiological and bacteriological service for health departments throughout the country. Referring to whooping-cough immunisation Dr. Brown said that Oxford, Wembley, Tottenham and Manchester had been cooperating since 1946 in controlled investigations for the M.R.C. O t h e r areas had since joined in this work. W h e n Manchester was invited to take part he had had serious doubts about the reactions of the public to the proposal that young babies should be the subject of experiment. He had sought the advice of the health visitors and had been assured that he need have no fear about the attitude of Manchester mothers. There had indeed been a good response and the young mothers of Manchester and the other areas were to be congratulated on their public spirit and sense of responsibility in volunteering their babies for whooping-cough vaccine trials. The early results of the trials were deemed to justify further trials and the fourth trial in the series had begun in Manchester on November 1st, 1948. Procedure was similar to that of earlier ones but the aim was to ascertain whether vaccines of different antigenic potency in laboratory tests would give the same order of protection when inoculated into children. Four thousand children grouped in sexes in the age groups 6-8 months, 9-I1 months, 12.-14 months and 15- 17 months had volunteered for trial IV. In Manchester and other areas there were also trials in collaboration with the M.R.C. with a British gamma globulin for the prevention and modification of measles in young children. These again were heing carried out in strictly controlled conditions in day and residential nurseries. Soon an investigation into the safety of new diptheria prophylaxis was to be undertaken in which 12 county boroughs were to take part. These trials were all examples of what .could be done with collaboration between the laboratory service and the public health service. Turning to possible fields of future research Dr. Brown referred to meteorology and its influence on health statistics and to forecasting the number of future births such as attempted by the Registrar-General for the first time in the weekly returns in February, 1949. This new source of information opened up an interesting field of speculation about attempts at forecasting the incidence of infectious disease which, if successful, would be an important step towards prevention. The field of mental health
P U B L I C H E A L T H , September, 1949 presented numerous opportunities for research, especially of the long term type, in order to follow up the ultimate value of various forms of treatment, the study of psychopathic personalities and the possibility of staving off senile dementia. In most health departments there was careful compilation and scrutiny of information as it came in and the preparation of annual reports gave further opportunity of review of such statistics. He gave as an example a table showing incidence and deaths in conventional age groups for tuberculosis, which under scrutiny showed signs of a relative increase of pulmonary tuberculosis in children aged one to three. A possible explanation was the failing to secure early admission to sanatorium treatment of many cases of tuberculosis which were left at home in an infective state and possibly in the presence of children. H e concluded by impressing that it was the duty of all engaged in preventive medicine to seize every opportunity for research. T h e successful discoveries of the past should encourage those who were prepared in addition to their routine work to look and to see, to search and to discover, In the ensuing discussion Dr. Cockburn (Public Health Laboratory Service) pointed out that at all ages one death in 14 could be ascribed to one of the infections and one death in 20 to a known bacterial infection. W i t h children under 10 one death in seven was ascribable to the former and one in 10 to the latter. He suggested that food poisoning presented a great scope for research. There were nearly 1,000 outbreaks last year and in many the cause was unknown. Tuberculosis was still the world's greatest health problem. Comparison of the toss of working hours from tuberculosis and other diseases showed tuberculosis as much the most important cause. T h e medical officer of health was the only medical man to look into the position throughout the contmunity. Dr. J. L. Burn (Salford) urged that there should be more scope and more encouragement for local legislation for purposes of experimentation. Dr. J. V. Walker (Darlington) asked for more research into techniques, for example, in maternity and child welfare. Dr. F. A. Belam (Guildford) expressed his concern at the rise in mortality from tuberculosis amongst the very young. He was convinced that the infective cases which had to remain at home were exposing children to risks they should not have to face. Dr. C. M. Smith (Northamptonshire) described an interesting study into the prevalence of tuberculosis in the boot and shoe industry in his county over the past two years. The investigation had been a combined effort of the county council, the employers and employees carried out under whole-time workers of the Oxford Institute of Social Medicine.* Winding up, Dr. Metcalfe Brown said he hoped that the virus of research would spread throughout the health departments from the top downwards.
THE
TUBERCULOSIS
CONFERENCE
Over 1,100 representatives from more than 50 countries attended the N A P T Second Commonwealth and Empire Health and Tuberculosis Conference, at the Central Hall, from July 4th to 8th last. The Conference was a Commonwealth Conference ; but tuberculosis, like other infectious diseases, cannot be isolated and wust therefore be considered from a world aspect. This point was emphasised by Dr. J'. E. Perkins (National Tuberculosis Association of the U.S.A.), when he said at the first session of the Conference that, owing to modern means of communication, if tuberculosis was rampant in one country, no other country was safe. This first session dealt with tuberculosis as a world problem, and Dr. Perkins said that tuberculosis was still the leading cause of death in the younger age-groups in America, while in India the mortality-rate was five times as great, and in China as bad or worse. H e said that the first W o r l d Health Assembly had given tuberculosis top priority for action by the Secretariat which might cause some people to ask why voluntary anti-tuberculosis work was necessary. But it was only through the pressure of public opinion that things got done quickly--" It was necessary for the people to demand that Governments should take steps." Dr. Perkins referred to the educational work of the anti-tuberculosis associations, and emphasised the part which could be played by the International Union Against Tuberculosis. Dr. C. J. Beckwith (Canadian Tuberculosis Association) gave a summary of the measures of control in Canada, i.e., case-finding with mass radiography as its sheet anchor; treatment, including streptomycin, and measures for rehabilitation. Dr. Beckwith emphasised the importance of prevention. Dr. R. C. Adhikari (Bengal Tuberculosis Association) spoke of the wide increase of tuberculosis in India where there were half a million deaths and two and a half million open cases per year. Mass * " Tuberculosis in Industry. An Epidemiological Study." (May 28th, 1949.) Brit. Med. J., 1,926.
247
September, 1949
h i g h l y decalcified b u t t h e t e e t h are still n o r m a l . If t h e r e is a n y increase i n caries in p r e g n a n c y it is m o s t likely d u e to t h e lack of oral h y g i e n e because of t h e m o t h e r b e i n g u n d u l y b u s y a t this t i m e ; it m a y just possibly b e due to some c h a n g e in the organic c o n t e n t of the t o o t h - b u t n o t t h e inorganic content.
Dental Fistula A n o t h e r e x a m p l e of t h e n e e d of d e n t a l a n d medical coo p e r a t i o n is seen in t h o s e cases w h e r e t h e p a t i e n t is suffering from a c o n d i t i o n w h i c h is p a r t l y d e n t a l a n d p a r t l y surgical. Children often p r e s e n t w i t h a fistula of t h e face, or u n d e r t h e chin. T h i s is s o m e t i m e s of d e n t a l origin a n d due to a d e a d t o o t h b u t I h a v e seen such p a t i e n t s t r e a t e d for l o n g periods b y medical p r a c t i t i o n e r s w i t h o u t a n y d e n t a l advice or d e n t a I t r e a t m e n t b e i n g sought, w i t h t h e result t h a t t h e sinus h a s persisted in spite of c u r e t t i n g a n d s h o r t - w a v e t h e r a p y .
Fractures Yet a n o t h e r sphere of d e n t a l / s u r g i c a l co-operation is to be • f o u n d in f r a c t u r e s of t h e jaw. Good results in t h e t r e a t m e n t of these d e p e n d on d e n t a l a n d surgical specialists w o r k i n g together. T h e s e r e q u i r e m e n t s existed d u r i n g t h e w a r in t h e maxillo-faciaI t e a m s b u t n o s u c h t e a m exists at t h e m o m e n t in N o r t h e r n I r e l a n d . S u c h a t e a m m a y b e considered as a n u r g e n t r e q u i r e m e n t for a n y f u t u r e .development of this t y p e of work in t h e P r o v i n c e . T h e d e n t a l surgeon c a n also help w i t h plastic s u r g e r y w h e r e his skill in m a k i n g appliances of all types c a n be utilised for s u c h t h i n g s as c r a n i a l plates in b r a i n surgery or artificiM noses a n d ears i n t h e p o s t - o p e r a t i v e t r e a t m e n t of l u p u s a n d cancer. Artificial eyes m a y also b e m a d e for p a r t i c u l a r p a t i e n t s a n d are f a r s u p e r i o r to t h e stock v a r i e t y supplied b y t h e wholesale producers. T h e r e is p a r t i c u l a r need for this k i n d of co-operation b e t w e e n t h e hospitals a n d t h e i r specialist services a n d t h e P u b l i c D e n t a l Service, a n d I h o p e t h a t h a r m o n i o u s w o r k i n g b e t w e e n these two bodies m a y b e a c h i e v e d u n d e r t h e new H e a l t h Act.
THE
ROYAL
SANITARY
INSTITUTE
CONGRESS
(Continued from P.H., August, page 229) Rehabilitation and Resettlemer~t in Industry Professor Thomas Ferguson, Professor of Public Health in Glasgow University, presided over the section of Hygiene in Industry and gave his address under the above title. H e said that before the war there were no official schemes in this country and no legal definition of " d i s a b i l i t y " as in Germany or Denmark, although some of the more advanced hospitals, notably tuberculosis sanatoria, were undertaking courses of occupational therapy and training suitable patients in carpentry, basketry and agricultural pursuits. Some of the larger mental hospitals and voluntary organisations were also doing some work in aftercare and occupational therapy. The big general hospitals took very little real interest with notable exceptions such as the Seamen's Hospital, Greenwich, and the L.M.S. Hospital at Crewe. Some of the indemnity insurance companies operating in the coalfields had, however, found that planned rehabilitation could be effective in reducing compensation costs, e.g., the centre at Berryhill, near Mansfield, could return more than 85% of the men treated through working in the coalmines; it served an area of about 18,000 accidents a year in respect of which compensations were paid, of which 6,000 caused total incapacity for more than a month and 800 for more than six months. The B.M.A. had reported in 1935 on the undue delay in securing the employment of injured work people and had concerned itself primarily with fractures. As a result of the B.M.A. report the Government set up an inter-departmental committee which in its turn presented a report which was essentially surgical and mainly fracture in its outlook. During the war the Services early recognised the importance of rehabilitation and all set up " convalescent depots" whose results were strikingly good. Meanwhile the Tomlinson Committee w a s set up for the civil field in 1941 and in its report (1943) recommended that the central health departments should stimulate provision by hospital authorities of special rehabilitation treatment for a special surgical group (other than fracture and injuries) and medical cases. He made special mention of the opening of the Birmingham accident hospital and rehabilitation centre and the Ministry of Labour and National Service interim scheme for resettlement introduced in late 1941.
Experience of these schemes showed that men from some clinical groups did better than others and those that did badly were sufferers from heart disease and tuberculosis. Recent social legislation had made further provision, e.,,~., the Disabled Persons (Employment) Act, the N.H.S. Act and the National Assistance Act. The first of these had e
The Inspiration of Home Professor \ ¥ . S. Craig, Professor of Paediatrics and Child Health, Leeds University, was the president of the section of Maternal and Child Health. In his address he said that he felt that the administrators of child health schemes had reached a crucial stage in their journeyings, but he would urge that they should not stray from the path which led hy the shortest route to child health in the home. Maternity and child welfare had pioneered visits to the homes of children and out of its efforts in disease prevention in childhood had grown the conception of the promotion of health in infancy. This work had compelled recognition of the social, economic and environmental factors contributing to ill-health in the early months and years of life. The nursery conception also had helped the family while at the same time furthering the interests of the child. Lastly, the service had tried to watch over the child who had been received for reward or who was a candidate for adoption. Professor Craig urged that further measures for the care of child health should not be deprived of the home factor. They could not but be alarmed at the effects of housing conditions on the physical and emotional health of children. There seemed to be an endless stream of children sent to hospital for reasons directly or indirectly related to home or housing conditions• Many of these children did not need hospital treatment and radical treatment of these cases should be concerned with remedying home conditions. Instead the hospital was expected to patch things up. This attitude was not condoned now with the aged and should not be complacently expected for children. The hospital was no place to send a child on a forced or small pretext. To many people hospitals constituted the foundation of the national health service. This might be desirable with adult patients but with the ailing child the aim should be to reduce to the minimum need for reference of children to hospital• It could only be achieved if experimental and domiciliary services concerned with the child were given the place of first importance in plans for the future. Also if the punic were educated into the understanding of the part the home had to play in the care of both the ailing and healthy child. T h e disadvantage of the preventive services was that they were largely taken for granted; falling infantile mortality rates had less news value than ambitious hospital schemes. T h e maternity and child welfare service in co-operation with the family doctor should ensure that home was the better alternative compared with the hospital, by expanding home help and home nursing services and improving conditions of housing. Mothers and fathers must then be convinced of the special value of home treatment for their
248 children. He thought family doctors would co-operate; certainly the universities were trying to see that the next generation at least of general practitioners would have the right ideas. He urged the service to take full advantage of the vast potential represented by the family doctor and secondly to educate the hospitals into a true understanding of child health.
Publie Health Research Dr. C. Metcalfe Brown opened a discussion on May 25th in the Conference of Medical Officers of Health on public health research. H e thought that from 1930-48 the health departments had been too much occupied in hospital administration at the expense of their true work. Now came the opportunity of exploring the field of research on which depended the expansion of preventive medicine. T h e r e were statutory powers for the pursuit of such research in Section 47 of the Handicapped Pupils and School Health Service Regulations~ 1945, made under the Education Act, 1944, and in Section 16(i) of the National Health Service Act, 1946. On choice of subject he quoted Alstead's dictum that a large number of discoveries in medicine had resulted from accidents and that we should all try to be accident-prone. Stimulation for subjects would come from many quarters, as a result 6f reading or listening, by chance in the course of daily work, by spontaneous ideas arising from speculation or by direct approach of a colleague or of the Medical Research Cotmcil. It was frequently complained that we were too busy to think, but the inveterate speculator made time to think or pursued his philosophic way in spite of routine duties or general distractions. Most of the daily problems set for solution in the medical department were matters of routine administration but the frequent appearance of the unusual added variety and led to investigation well beyond the immediate needs. As an example, he quoted a piece of research in Manchester which followed investigations of cases of food poisoning involving examination of samples of meat and fat d6bris taken from slicing machines in kitchens. This had revealed heavy growths of organisms such as S. pyogenes, aureus and albus, B. typhimurlum, B. sonne and coliform organisms. As a result a survey of such machines had commenced in Manchester for which the bacteriological work was being carried out in the recently created Public Health Laboratory. This was certainly an aspect of food handling worthy of attention and might lead to raising the standard of hygiene in one respect. T h e ever-increasing collaboration between the M.R.C.'s laboratory service and health departments was most encouraging. The P.H.L.S..provided a pyramid of laboratories which gave an epidemiological and bacteriological service for health departments throughout the country. Referring to whooping-cough immunisation Dr. Brown said that Oxford, Wembley, Tottenham and Manchester had been cooperating since 1946 in controlled investigations for the M.R.C. O t h e r areas had since joined in this work. W h e n Manchester was invited to take part he had had serious doubts about the reactions of the public to the proposal that young babies should be the subject of experiment. He had sought the advice of the health visitors and had been assured that he need have no fear about the attitude of Manchester mothers. There had indeed been a good response and the young mothers of Manchester and the other areas were to be congratulated on their public spirit and sense of responsibility in volunteering their babies for whooping-cough vaccine trials. The early results of the trials were deemed to justify further trials and the fourth trial in the series had begun in Manchester on November 1st, 1948. Procedure was similar to that of earlier ones but the aim was to ascertain whether vaccines of different antigenic potency in laboratory tests would give the same order of protection when inoculated into children. Four thousand children grouped in sexes in the age groups 6-8 months, 9-I1 months, 12.-14 months and 15- 17 months had volunteered for trial IV. In Manchester and other areas there were also trials in collaboration with the M.R.C. with a British gamma globulin for the prevention and modification of measles in young children. These again were heing carried out in strictly controlled conditions in day and residential nurseries. Soon an investigation into the safety of new diptheria prophylaxis was to be undertaken in which 12 county boroughs were to take part. These trials were all examples of what .could be done with collaboration between the laboratory service and the public health service. Turning to possible fields of future research Dr. Brown referred to meteorology and its influence on health statistics and to forecasting the number of future births such as attempted by the Registrar-General for the first time in the weekly returns in February, 1949. This new source of information opened up an interesting field of speculation about attempts at forecasting the incidence of infectious disease which, if successful, would be an important step towards prevention. The field of mental health
P U B L I C H E A L T H , September, 1949 presented numerous opportunities for research, especially of the long term type, in order to follow up the ultimate value of various forms of treatment, the study of psychopathic personalities and the possibility of staving off senile dementia. In most health departments there was careful compilation and scrutiny of information as it came in and the preparation of annual reports gave further opportunity of review of such statistics. He gave as an example a table showing incidence and deaths in conventional age groups for tuberculosis, which under scrutiny showed signs of a relative increase of pulmonary tuberculosis in children aged one to three. A possible explanation was the failing to secure early admission to sanatorium treatment of many cases of tuberculosis which were left at home in an infective state and possibly in the presence of children. H e concluded by impressing that it was the duty of all engaged in preventive medicine to seize every opportunity for research. T h e successful discoveries of the past should encourage those who were prepared in addition to their routine work to look and to see, to search and to discover, In the ensuing discussion Dr. Cockburn (Public Health Laboratory Service) pointed out that at all ages one death in 14 could be ascribed to one of the infections and one death in 20 to a known bacterial infection. W i t h children under 10 one death in seven was ascribable to the former and one in 10 to the latter. He suggested that food poisoning presented a great scope for research. There were nearly 1,000 outbreaks last year and in many the cause was unknown. Tuberculosis was still the world's greatest health problem. Comparison of the toss of working hours from tuberculosis and other diseases showed tuberculosis as much the most important cause. T h e medical officer of health was the only medical man to look into the position throughout the contmunity. Dr. J. L. Burn (Salford) urged that there should be more scope and more encouragement for local legislation for purposes of experimentation. Dr. J. V. Walker (Darlington) asked for more research into techniques, for example, in maternity and child welfare. Dr. F. A. Belam (Guildford) expressed his concern at the rise in mortality from tuberculosis amongst the very young. He was convinced that the infective cases which had to remain at home were exposing children to risks they should not have to face. Dr. C. M. Smith (Northamptonshire) described an interesting study into the prevalence of tuberculosis in the boot and shoe industry in his county over the past two years. The investigation had been a combined effort of the county council, the employers and employees carried out under whole-time workers of the Oxford Institute of Social Medicine.* Winding up, Dr. Metcalfe Brown said he hoped that the virus of research would spread throughout the health departments from the top downwards.
THE
TUBERCULOSIS
CONFERENCE
Over 1,100 representatives from more than 50 countries attended the N A P T Second Commonwealth and Empire Health and Tuberculosis Conference, at the Central Hall, from July 4th to 8th last. The Conference was a Commonwealth Conference ; but tuberculosis, like other infectious diseases, cannot be isolated and wust therefore be considered from a world aspect. This point was emphasised by Dr. J'. E. Perkins (National Tuberculosis Association of the U.S.A.), when he said at the first session of the Conference that, owing to modern means of communication, if tuberculosis was rampant in one country, no other country was safe. This first session dealt with tuberculosis as a world problem, and Dr. Perkins said that tuberculosis was still the leading cause of death in the younger age-groups in America, while in India the mortality-rate was five times as great, and in China as bad or worse. H e said that the first W o r l d Health Assembly had given tuberculosis top priority for action by the Secretariat which might cause some people to ask why voluntary anti-tuberculosis work was necessary. But it was only through the pressure of public opinion that things got done quickly--" It was necessary for the people to demand that Governments should take steps." Dr. Perkins referred to the educational work of the anti-tuberculosis associations, and emphasised the part which could be played by the International Union Against Tuberculosis. Dr. C. J. Beckwith (Canadian Tuberculosis Association) gave a summary of the measures of control in Canada, i.e., case-finding with mass radiography as its sheet anchor; treatment, including streptomycin, and measures for rehabilitation. Dr. Beckwith emphasised the importance of prevention. Dr. R. C. Adhikari (Bengal Tuberculosis Association) spoke of the wide increase of tuberculosis in India where there were half a million deaths and two and a half million open cases per year. Mass * " Tuberculosis in Industry. An Epidemiological Study." (May 28th, 1949.) Brit. Med. J., 1,926.