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TRENDS IN TUBERCULOSIS
836 MEDICINE IN RUSSIA SiR,-Your note of Aug. 18 may, I fear, mislead those who are not familiar with life in the Soviet Union. TRENDS IN TUBERCULOSIS The Russian cities visited by the delegation are not SiR,-The interesting annotation in your last issue of the entire country : Moscow and _representative ends with the important statement : Leningrad are, and always have been, exhibition cities Complacency about the falling mortality would be for foreign visitors. I would like, therefore, to add a wrong; the tuberculosis problem must be measured in few facts which may be of interest. terms of sick people, since- the fact that many more The article states that " known cases of tuberculosis patients are now treatable means that better and more are treated both in sanatoria and in general hospitals... extensive treatment facilities are needed than ever there is now no waiting-list for tuberculosis beds in before." general hospitals, though there is a waiting-list for It might seem to some that it is unnecessary to stress sanatorium treatment." Yes, patients are treated in this point, but examples could be given both in this and sanatoria ;’ but some patients with tubercuhospitals country and others where future policy is being basedlosis have to work even if their temperature is as high on the assumption that tuberculosis is no longer a as 38°C. They are called " chronic cases." To get a problem of national importance. bed in a sanatorium one must have luck or be a Party There is no doubt that great progress has been made member. And what is the use of a chest radiograph if a in the fight against tuberculosis, but we are not sure tuberculous person eats only 1500-2000 calories daily that the present decrease in the mortality will continue (mostly starch and seldom proteins or fats)? Is not during the next decade. Many think that the recent preventive medicine a farce if the whole family, sick rapid fall in mortality is due to streptomycin therapy, person included, occupies only one small room or is but it is not at all improbable that in many cases this housed in Semlianka-a hole dug in the ground ? Dr. therapy only prolongs life and gives no permanent Joules said that " the medical members of the delegation were also impressed by the working of the tuberculosis improvement in the prognosis. such should not But fears prevent us from taking the dispensaries and the night sanatoria." They would be horrified to learn how tuberculous people live and what fullest advantage of the strategic situation in which we tbev eat. have been placed by the introduction of treatment with I was amused at Dr. Gilliland’s comment that the antibiotics and chemotherapeutic agents.
Letters
to
the Editor
"
"
who feel that if a practical and realistic attack on tuberculosis could be launched at this present time, it would reduce the incidence of the disease to insignificant proportions within the next ten or fifteen years. Unfortunately there is evidence that governing authorities are reluctant to grasp the opportunity, and are adopting an attitude of complacency, which is so rightly condemned in your annotation. A greater disservice to the health of youth and elderly males can hardly be imagined than to allow tuberculosis to be dealt with in the National Health Service as an ordinary disease, without special regulations and privileges that will provide a uniform and comprehensive service of prevention, treatment, and rehabilitation throughout the whole country. The fundamental need to establish such a service is money and staff-the money to provide adequate and well-equipped clinics for diagnosis and domiciliary care, institutions offering all forms of modern treatment, and hostels for chronic ambulant infectious cases ; the staff to do the work. The first request is probably easier to meet than the second, but neither doctors nor nurses will be forthcoming in sufficient numbers until more general hospitals adopt a different attitude towards tuberculosis. Both the medical student and the nurse in training must be made to appreciate that tuberculosis work is an interesting and worthy vocation. Too many general hospitals still refuse, or are reluctant to provide, facilities for the modern treatment of tuberculous patients, so that both student and nurse receive only a This hazy and remote impression of the subject. can that one into the idea impression easily develop only does tuberculosis work as a last resort. The time is ripe for an energetic attack-on tuberculosis in the home and in industry. Those already engaged in the work are keen and enthusiastic. They know how the problem should be tackled, and are willing to do the work. Voluntary organisations are well established, and can give valuable assistance when required; but success will not be achieved unless the laissez-faire attitude of the controlling authorities is replaced by a determination to establish a progressive and efficient policy based on
There
are
many of
research and
Cardiff.
us
past experience. FREDERICK HEAF.
Research Institute for Sanitary Instruction... encourages the public to play its part in preventing disease, by means of posters, books, and films." This is typical of the Soviet Union, since this method is less expensive for the government than to improve the living conditions. Health talks given by doctors -to their patients are of no avail when food is not plentiful. When I lived in Russia-I left in 1943-we had only one policlinic for our suburb with a population of 100,000. This policlinic had the following divisions : Internal medicine (2 doctors, 1 nurse). Skin diseases, urology, gynaecology (1 doctor, 1 Throat, ear, nose diseases (1 doctor, 1 nurse).
nurse).
Surgery (2 doctors). Paediatrics (1 doctor, 1 nurse). Eye diseases (1 doctor, 1 nurse). Dentistry (3 doctors, 2 nurses). Home calls (4 doctors).
of medical care seem adequate for I should like to take exception to the statement that one need only telephone for a home visit. It is almost impossible to make an appointment by telephone, since a private or public telephone is a rarity. Actually, a member of the family has to be in the policlinic before 8 A.M., and wait in a long line for registration. Very often the patient has to go himself, because other members of the family are unable to take time off from work. I am informed from various sources that medical care in the policlinic mentioned here is now below pre-war level. I know for a fact that doctors in the Soviet Union are frustrated in their work. They have too many calls to make and must walk from house to house to visit the sick. No car is provided for them. The delegation made one observation that was accurate. The doctor’s remuneration is shamefully low. This, in itself, is a cause for extreme frustration. HÉLÈNE IWASENKO. Hillside, N.J., U.S.A.
Does this
provision
100,000 people ?Q
A COLLEGE OF GENERAL PRACTICE
SIR,—May the voice of a relatively junior general practitioner be raised in support of the plea, by Dr. Hunt and Dr. Rose (Oct. 13), to establish a College of General Practice It is time that the oldest and largest branch of medical practice had its own distinct association and representation. At present general practice is represented by
Letters
to
the Editor
"
"
who feel that if a practical and realistic attack on tuberculosis could be launched at this present time, it would reduce the incidence of the disease to insignificant proportions within the next ten or fifteen years. Unfortunately there is evidence that governing authorities are reluctant to grasp the opportunity, and are adopting an attitude of complacency, which is so rightly condemned in your annotation. A greater disservice to the health of youth and elderly males can hardly be imagined than to allow tuberculosis to be dealt with in the National Health Service as an ordinary disease, without special regulations and privileges that will provide a uniform and comprehensive service of prevention, treatment, and rehabilitation throughout the whole country. The fundamental need to establish such a service is money and staff-the money to provide adequate and well-equipped clinics for diagnosis and domiciliary care, institutions offering all forms of modern treatment, and hostels for chronic ambulant infectious cases ; the staff to do the work. The first request is probably easier to meet than the second, but neither doctors nor nurses will be forthcoming in sufficient numbers until more general hospitals adopt a different attitude towards tuberculosis. Both the medical student and the nurse in training must be made to appreciate that tuberculosis work is an interesting and worthy vocation. Too many general hospitals still refuse, or are reluctant to provide, facilities for the modern treatment of tuberculous patients, so that both student and nurse receive only a This hazy and remote impression of the subject. can that one into the idea impression easily develop only does tuberculosis work as a last resort. The time is ripe for an energetic attack-on tuberculosis in the home and in industry. Those already engaged in the work are keen and enthusiastic. They know how the problem should be tackled, and are willing to do the work. Voluntary organisations are well established, and can give valuable assistance when required; but success will not be achieved unless the laissez-faire attitude of the controlling authorities is replaced by a determination to establish a progressive and efficient policy based on
There
are
many of
research and
Cardiff.
us
past experience. FREDERICK HEAF.
Research Institute for Sanitary Instruction... encourages the public to play its part in preventing disease, by means of posters, books, and films." This is typical of the Soviet Union, since this method is less expensive for the government than to improve the living conditions. Health talks given by doctors -to their patients are of no avail when food is not plentiful. When I lived in Russia-I left in 1943-we had only one policlinic for our suburb with a population of 100,000. This policlinic had the following divisions : Internal medicine (2 doctors, 1 nurse). Skin diseases, urology, gynaecology (1 doctor, 1 Throat, ear, nose diseases (1 doctor, 1 nurse).
nurse).
Surgery (2 doctors). Paediatrics (1 doctor, 1 nurse). Eye diseases (1 doctor, 1 nurse). Dentistry (3 doctors, 2 nurses). Home calls (4 doctors).
of medical care seem adequate for I should like to take exception to the statement that one need only telephone for a home visit. It is almost impossible to make an appointment by telephone, since a private or public telephone is a rarity. Actually, a member of the family has to be in the policlinic before 8 A.M., and wait in a long line for registration. Very often the patient has to go himself, because other members of the family are unable to take time off from work. I am informed from various sources that medical care in the policlinic mentioned here is now below pre-war level. I know for a fact that doctors in the Soviet Union are frustrated in their work. They have too many calls to make and must walk from house to house to visit the sick. No car is provided for them. The delegation made one observation that was accurate. The doctor’s remuneration is shamefully low. This, in itself, is a cause for extreme frustration. HÉLÈNE IWASENKO. Hillside, N.J., U.S.A.
Does this
provision
100,000 people ?Q
A COLLEGE OF GENERAL PRACTICE
SIR,—May the voice of a relatively junior general practitioner be raised in support of the plea, by Dr. Hunt and Dr. Rose (Oct. 13), to establish a College of General Practice It is time that the oldest and largest branch of medical practice had its own distinct association and representation. At present general practice is represented by