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The tuberculosis dispensary
1940 and adjustments have had to be made, on the whole this " vast organisation " has stood the test of experience to a remarkable degree. The real test, however, is still to come. General.--There is much of direct interest to readers which exigencies of space prevent us from mentioning, but reference should be made to valuable contributions by members of the staff appearing as appendices on puerperal mastitis, chick embryo vaccine lymph, an outbreak of toxic polyneuritis probably from tri-ortho-cresyl, and hydatid disease in Wales which seems to be commoner in industrial areas than might have been expected. Throughout the report there are numerous references to original work published elsewhere. These are valuable though not exhaustive. For instance, in the passage on psittacosis no mention is made of the view that this disease is transmitted in the Faroe Islands by fulmar petrels and may be carried by other seabirds*, a suggestion of considerable importance to a race of islanders like ourselves.
PUBLIC HEALTH Dr. Jessel rightly deprecates the sending of patients to general hospitals for diagnosis, for the tuberculosis officer has, or should have, a wider and more useful experience of the interpretation of chest films than the hospital radiologist. Many diseases cast shadows similar to tuberculosis and their discrimination is no easy matter. In X-ray dispensary work Dr. Jessel was one of our pioneers and speaks with authority. The Mantoux test he has found to be a helpful diagnostic in children. It is advocated that the health visitor dealing with tuberculosis should minister to that work alone and not in addition to schools and maternity and child welfare, but such limitation is not universally possible, partly because of expense and partly because of the scattered areas that may have to be covered. Moreover the " o m n i b u s " health visitor, if readers will forgive the word, can sometimes carry out useful tuberculosis detective work and she becomes acquainted with the inter-relationships of our departments. The attention of all our readers should be directed to Dr. Jessel's address.
The Tuberculosis Dispensary A valuable review of twenty-five years' experience. in tuberculosis,. dispensar,y work will be found in Dr. Jesse1 s Presldenual Address to the NorthWestern Branch appearing on page 78 of this number of PUBLICHEALTH. Dr. Jessel has worked, observed and reflected, and his conclusions deserve the close attention and respect of his fellowmembers of the service. Some errors of early dispensary planning are described; small premises were allotted for the work, the arrangements were awkward and unsatisfactory and the sites were generally far from large general hospitals and often also distant from other public health units. Dr. Jessel believes that the most efficient arrangement is to place the dispensary in the out-patient department of a large hospital in close association with other branches of medical work, and he prefers the name " c l i n i c " to " d i s p e n s a r y . " By such association it is thought that the fear of the word tuberculosis may be overcome, and it is pointed out that the majority of patients attending such a clinic are not tuberculous; he might have suggested the figure of 70 per cent., which is a moderately accurate estimate of the proportion. There is no doubt that adequate X-ray facilities, and X-ray reports helpful to practitioners, abolish many of the clinic difficulties and ease the examination of the all-important adult contact. Moreover the expense of installation is counterbalanced, for with X-ray control our institutions are no longer burdened with numerous non-tuberculous patients. *Lancet (1939), 1,708.
Milk and Nutrition The last of the series of reports to be issued by the Milk Nutrition Committee in connection with the researches into the nutritive values of raw and pasteurised milk has now been published. This report* deals with the effects of dietary supplements of pasteurised and raw milk on the growth and health of school children. The report deals with 6,097 children randomly divided into four feeding groups with supplements (a} biscuit, (b) ~-pint milk pasteurised, (c) ~-pint milk raw, (d) ]-pint milk pasteurised. The children were mostly in the age groups 5 to 7, 8 to I0, 11 to 14 years. The tests used were objective measurements, i.e., height, weight, chest circumference and pull (dynamometer test) and subjective assessments, i.e., clinical assessment of state of nutrition, assessment of intellectual capacity, while certain other assessments were tentatively tried. The report itself must be studied for the details, which are discussed fully, but the general conclusions may be mentioned. T h e y confirm the nutritional importance of milk for promoting growth, health and intellectual capacity. The ]-pint supplement gave better results than the ~-pint. No constant differences could be detected between the growth-promoting effects of ~-pint pasteurised and ]-pint raw milk in either height, weight or chest circumference. Thus this investigation, like all the earlier ones, confirms the exceptional value of milk for children. *Published by The National Institute for Research in Dairying, Shinfield, Reading. 1939. 2s.,post free. 73
PUBLIC HEALTH Dr. Jessel rightly deprecates the sending of patients to general hospitals for diagnosis, for the tuberculosis officer has, or should have, a wider and more useful experience of the interpretation of chest films than the hospital radiologist. Many diseases cast shadows similar to tuberculosis and their discrimination is no easy matter. In X-ray dispensary work Dr. Jessel was one of our pioneers and speaks with authority. The Mantoux test he has found to be a helpful diagnostic in children. It is advocated that the health visitor dealing with tuberculosis should minister to that work alone and not in addition to schools and maternity and child welfare, but such limitation is not universally possible, partly because of expense and partly because of the scattered areas that may have to be covered. Moreover the " o m n i b u s " health visitor, if readers will forgive the word, can sometimes carry out useful tuberculosis detective work and she becomes acquainted with the inter-relationships of our departments. The attention of all our readers should be directed to Dr. Jessel's address.
The Tuberculosis Dispensary A valuable review of twenty-five years' experience. in tuberculosis,. dispensar,y work will be found in Dr. Jesse1 s Presldenual Address to the NorthWestern Branch appearing on page 78 of this number of PUBLICHEALTH. Dr. Jessel has worked, observed and reflected, and his conclusions deserve the close attention and respect of his fellowmembers of the service. Some errors of early dispensary planning are described; small premises were allotted for the work, the arrangements were awkward and unsatisfactory and the sites were generally far from large general hospitals and often also distant from other public health units. Dr. Jessel believes that the most efficient arrangement is to place the dispensary in the out-patient department of a large hospital in close association with other branches of medical work, and he prefers the name " c l i n i c " to " d i s p e n s a r y . " By such association it is thought that the fear of the word tuberculosis may be overcome, and it is pointed out that the majority of patients attending such a clinic are not tuberculous; he might have suggested the figure of 70 per cent., which is a moderately accurate estimate of the proportion. There is no doubt that adequate X-ray facilities, and X-ray reports helpful to practitioners, abolish many of the clinic difficulties and ease the examination of the all-important adult contact. Moreover the expense of installation is counterbalanced, for with X-ray control our institutions are no longer burdened with numerous non-tuberculous patients. *Lancet (1939), 1,708.
Milk and Nutrition The last of the series of reports to be issued by the Milk Nutrition Committee in connection with the researches into the nutritive values of raw and pasteurised milk has now been published. This report* deals with the effects of dietary supplements of pasteurised and raw milk on the growth and health of school children. The report deals with 6,097 children randomly divided into four feeding groups with supplements (a} biscuit, (b) ~-pint milk pasteurised, (c) ~-pint milk raw, (d) ]-pint milk pasteurised. The children were mostly in the age groups 5 to 7, 8 to I0, 11 to 14 years. The tests used were objective measurements, i.e., height, weight, chest circumference and pull (dynamometer test) and subjective assessments, i.e., clinical assessment of state of nutrition, assessment of intellectual capacity, while certain other assessments were tentatively tried. The report itself must be studied for the details, which are discussed fully, but the general conclusions may be mentioned. T h e y confirm the nutritional importance of milk for promoting growth, health and intellectual capacity. The ]-pint supplement gave better results than the ~-pint. No constant differences could be detected between the growth-promoting effects of ~-pint pasteurised and ]-pint raw milk in either height, weight or chest circumference. Thus this investigation, like all the earlier ones, confirms the exceptional value of milk for children. *Published by The National Institute for Research in Dairying, Shinfield, Reading. 1939. 2s.,post free. 73