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Tubercle
TUBEROLE
.112
TU BERCLE. JUNE. 1930.
The Expeeiation of Survival in Pulmonary Tuberculosis. TilE expectation of life of the tuber· culous person is a subject on which milch has been written, but data which will withstand the criticism of tllC expert statistician are few in number. In the January number of this journal [1] reference was mado to recent work in Canada by Wherrett, and in France by Arna.ud. British figures of exceptional valuo bave now been published by physi. cians of tho Brompton IIospital working in conjunction with an actuary [2]. Tho first investigation from Brompton goes back to 1914, when a record of the after.history of patients treated during tbe years 1905 to 1910 was published. Theso data, however, included a relatively largo number of imtraced cases. and took no account of differences in ago or sex. Moreover, no actuary was associated at that time witil the work. The second investigat.ion came in 192:1, when Bardswell. collaborating with an actuary, J. II. R. Thompson, published the records of the years 19051914. In this record tbe proportion of patients lost sight of was reduced to 10 percent. of the total number included in the investigation. The present inquiry deals not only with the patients of 1905·1914 brought within the purview of the 192,1 report, but also with cases treated during 1915·1931. During the twenty-soven years covered by tho presont investigation thero wore 10,029 admissions· to tho Frimley Sanatorium 'of the Brompton Hospital. Thc method adopted is to group the cases, taken from the period 1905 to 1931, according to whether on admission thoy were (i) incipient, (ii) moderately advanced, or (iii) far advanced, and then to work out, for age· groups and for tho two sexes, the probabilities of surviving five years. It is tho first
[JUDO, 193G
scientific effort to exhibit the results of sanatorium treatment. No similar study has beon made elsewhero of cc.ses either treated differently or left untreated. Henco we have no sure and certain evidence that cases would not progress equally well or equally badly, if left alone. One exception is now provided: the analysis establishes that treatment by artificial pneumothorax mnterially increases the probability of flUrvival; even grado 133 cases so treated . show higher survival rates than the control group; but a fundamental factor in the prognosis of those cases is freedom from disease of the contralateral lung. Two features show forth in tho oxcellent graphs used to demonstrate the trend of tho statistical analysis. One is that the probability of survival improves year by year after the dangerous Rubicon of the initial two years is crossed; here is emphasised the well-known observation that the most perilous year for a. patient suffering from tuberculosis is the year following his discharge from a sanatorium. The o£her is that the probability of survival incroases rapidly for tbe lower grades with the passage of time, until it is equal to that for the higher grades (see Tuberculosis Statistic~, p. 403); hence tho curves tend to coalesco after some years, due, in cases where tho diseaso is most extensive, to more liv~s passing out and leaving tho vitality of the group improved by their elimination. Expressed differentlytho longer anyone lives after contracting tuberculosis, no matter how severely, the less is the likelihood of finally succumbing to tuberculosis; herein a great contrast is presented to the progress of cancer. One argument set forth by the authors is a little hard to follow without further elaboration-the distribution of deaths over the calendar year is examined; then tuberculosis deaths in the general population are found to be more ovenly distributed over the seasons of the year than those among :Frimley p'atients ; hence. the claim is made, "it follows that Frimley patients show more favourable vitality." This evidence is held to demonstrate for tbo first time the value of sanatorium treatment.
June, Ul36]
413
nOOK NOTIOES
As au aCter-history research the report is n.' most valuable document. It has established a. basis for comparison to which future workers in this field will owe n. debt of gratitude.
llEFEItENCES. [11 TlIbercl~, 1!)36, 17. 171. [:l] SmTu,HARTLm', P. II,
WIlwFIEr.D, H. C.• and BURROWS. V. A. "The Ex. pectation of Survival in Pulmonary Tuberculosis." Brompton Hospital Reports, H)35, II, 1.
BOOK NOTICES AND ABSTRACTS. Book Notic~s. Catalogue of British Medical Films of 'Technical Interest to Medical Prac· titioner£! and Students. Published by British Film Institute, 4, Great Hussell :Street, London. W.C.I. H)3G. Pp. ,48. Price Is. This catalogue of British films of technical interest to medical practitioners alld students is a result of tho activities of three bodies, viz. the Intornational Institute of Educational ·Oinematography founded in 1928 at the suggestion of the Italian Government, the Health Organization of the League of Nations to whom the International Institute appealed for collabor· ation and the British Film Institute, 'Counded ill 1933. 'l'hrough the coordinating influence of the Lea~ue a 'Oonvention Cor Facilitating the Intornational Oircuhttion of Films of an Educational Oharacter was held at ·Geneva in 1933, and tho Finance Act of this country in 1935 gave the necessary backing to tho Uonvontion as far as ·Great Britain and Northern Ireland are concerned. The British Film Institute acts as the national body. carrying out the aims of this Oonvention. Its objects ·aro to act as a clearing houso for information, to influence public opinion. to adviso educational institutions and link up tbe film trade with educational interests. to encourago film research, to .establish a national reposit.ory of films of permanent value. to provide a . descriptive and critical catalogue, to adviso Government departments, to certify films as educational, cultural or scientific. and last but not least to undertake similar duties in relation to tho Empire. The present catalogue is the result of a questionnairo issuod to nIl the :Medical
Schools and Uni\'orsities of Great Britain, and is a classified list of films of which inCormation was thus obtained. 'rhe following is a brief summary of films of interest to tuberculosis teachers and lecturers: The Techniquo of Bronchoscopy under Local Anmsthesia by It C. Brock, Phrenic Evulsion and Thoracoplasty by II. l\lorriston Davies, Thoracoplasty in the Treatment of Pulmonary 'l'uberculosis by Newcastle Medical School. Operation' for Unilateral Bronchiectasis by One-stage Lobectomy by A. Tudor Edwards, Prefrontal Tuberculoma by R. E. Kelly and H. Oohen, the Trendelenburg Operation for Pulmonary Embolectomy by W. H. Ogilvie, the Production of Grade A (T.T.) milk from Bermondsey Borough Oouncil. the Nurse's Part in Tuberculosis Burrow Hill Oolony and Opensir Schools by the N.A.P.T., and tho Production of Oertified l\Iilk by the Edinburgh Tuberculosis Trust. A short description of each film is given with its length and the address from whom it can be obtained. This catalogue is probably tho only work of refereneo of its kind in this country. It is a most helpCul publication and should bo in the hands of all teachers: Report of the Director of the School of Tropical Medicine of the University of Puerto Rico, under the Auspices of Columbia Uni versi ty, for tho Year ending Juno. 1935. !'ublis!lcd by the University of Puerto Hico and Columbia University. !'p.5G. Among the various Dopal"truents of the School, details of which are given in this roport, Dr. George W. Bachman, Director of the School, states that the principal study of the Bacteriological Department during tho year bas been
.112
TU BERCLE. JUNE. 1930.
The Expeeiation of Survival in Pulmonary Tuberculosis. TilE expectation of life of the tuber· culous person is a subject on which milch has been written, but data which will withstand the criticism of tllC expert statistician are few in number. In the January number of this journal [1] reference was mado to recent work in Canada by Wherrett, and in France by Arna.ud. British figures of exceptional valuo bave now been published by physi. cians of tho Brompton IIospital working in conjunction with an actuary [2]. Tho first investigation from Brompton goes back to 1914, when a record of the after.history of patients treated during tbe years 1905 to 1910 was published. Theso data, however, included a relatively largo number of imtraced cases. and took no account of differences in ago or sex. Moreover, no actuary was associated at that time witil the work. The second investigat.ion came in 192:1, when Bardswell. collaborating with an actuary, J. II. R. Thompson, published the records of the years 19051914. In this record tbe proportion of patients lost sight of was reduced to 10 percent. of the total number included in the investigation. The present inquiry deals not only with the patients of 1905·1914 brought within the purview of the 192,1 report, but also with cases treated during 1915·1931. During the twenty-soven years covered by tho presont investigation thero wore 10,029 admissions· to tho Frimley Sanatorium 'of the Brompton Hospital. Thc method adopted is to group the cases, taken from the period 1905 to 1931, according to whether on admission thoy were (i) incipient, (ii) moderately advanced, or (iii) far advanced, and then to work out, for age· groups and for tho two sexes, the probabilities of surviving five years. It is tho first
[JUDO, 193G
scientific effort to exhibit the results of sanatorium treatment. No similar study has beon made elsewhero of cc.ses either treated differently or left untreated. Henco we have no sure and certain evidence that cases would not progress equally well or equally badly, if left alone. One exception is now provided: the analysis establishes that treatment by artificial pneumothorax mnterially increases the probability of flUrvival; even grado 133 cases so treated . show higher survival rates than the control group; but a fundamental factor in the prognosis of those cases is freedom from disease of the contralateral lung. Two features show forth in tho oxcellent graphs used to demonstrate the trend of tho statistical analysis. One is that the probability of survival improves year by year after the dangerous Rubicon of the initial two years is crossed; here is emphasised the well-known observation that the most perilous year for a. patient suffering from tuberculosis is the year following his discharge from a sanatorium. The o£her is that the probability of survival incroases rapidly for tbe lower grades with the passage of time, until it is equal to that for the higher grades (see Tuberculosis Statistic~, p. 403); hence tho curves tend to coalesco after some years, due, in cases where tho diseaso is most extensive, to more liv~s passing out and leaving tho vitality of the group improved by their elimination. Expressed differentlytho longer anyone lives after contracting tuberculosis, no matter how severely, the less is the likelihood of finally succumbing to tuberculosis; herein a great contrast is presented to the progress of cancer. One argument set forth by the authors is a little hard to follow without further elaboration-the distribution of deaths over the calendar year is examined; then tuberculosis deaths in the general population are found to be more ovenly distributed over the seasons of the year than those among :Frimley p'atients ; hence. the claim is made, "it follows that Frimley patients show more favourable vitality." This evidence is held to demonstrate for tbo first time the value of sanatorium treatment.
June, Ul36]
413
nOOK NOTIOES
As au aCter-history research the report is n.' most valuable document. It has established a. basis for comparison to which future workers in this field will owe n. debt of gratitude.
llEFEItENCES. [11 TlIbercl~, 1!)36, 17. 171. [:l] SmTu,HARTLm', P. II,
WIlwFIEr.D, H. C.• and BURROWS. V. A. "The Ex. pectation of Survival in Pulmonary Tuberculosis." Brompton Hospital Reports, H)35, II, 1.
BOOK NOTICES AND ABSTRACTS. Book Notic~s. Catalogue of British Medical Films of 'Technical Interest to Medical Prac· titioner£! and Students. Published by British Film Institute, 4, Great Hussell :Street, London. W.C.I. H)3G. Pp. ,48. Price Is. This catalogue of British films of technical interest to medical practitioners alld students is a result of tho activities of three bodies, viz. the Intornational Institute of Educational ·Oinematography founded in 1928 at the suggestion of the Italian Government, the Health Organization of the League of Nations to whom the International Institute appealed for collabor· ation and the British Film Institute, 'Counded ill 1933. 'l'hrough the coordinating influence of the Lea~ue a 'Oonvention Cor Facilitating the Intornational Oircuhttion of Films of an Educational Oharacter was held at ·Geneva in 1933, and tho Finance Act of this country in 1935 gave the necessary backing to tho Uonvontion as far as ·Great Britain and Northern Ireland are concerned. The British Film Institute acts as the national body. carrying out the aims of this Oonvention. Its objects ·aro to act as a clearing houso for information, to influence public opinion. to adviso educational institutions and link up tbe film trade with educational interests. to encourago film research, to .establish a national reposit.ory of films of permanent value. to provide a . descriptive and critical catalogue, to adviso Government departments, to certify films as educational, cultural or scientific. and last but not least to undertake similar duties in relation to tho Empire. The present catalogue is the result of a questionnairo issuod to nIl the :Medical
Schools and Uni\'orsities of Great Britain, and is a classified list of films of which inCormation was thus obtained. 'rhe following is a brief summary of films of interest to tuberculosis teachers and lecturers: The Techniquo of Bronchoscopy under Local Anmsthesia by It C. Brock, Phrenic Evulsion and Thoracoplasty by II. l\lorriston Davies, Thoracoplasty in the Treatment of Pulmonary 'l'uberculosis by Newcastle Medical School. Operation' for Unilateral Bronchiectasis by One-stage Lobectomy by A. Tudor Edwards, Prefrontal Tuberculoma by R. E. Kelly and H. Oohen, the Trendelenburg Operation for Pulmonary Embolectomy by W. H. Ogilvie, the Production of Grade A (T.T.) milk from Bermondsey Borough Oouncil. the Nurse's Part in Tuberculosis Burrow Hill Oolony and Opensir Schools by the N.A.P.T., and tho Production of Oertified l\Iilk by the Edinburgh Tuberculosis Trust. A short description of each film is given with its length and the address from whom it can be obtained. This catalogue is probably tho only work of refereneo of its kind in this country. It is a most helpCul publication and should bo in the hands of all teachers: Report of the Director of the School of Tropical Medicine of the University of Puerto Rico, under the Auspices of Columbia Uni versi ty, for tho Year ending Juno. 1935. !'ublis!lcd by the University of Puerto Hico and Columbia University. !'p.5G. Among the various Dopal"truents of the School, details of which are given in this roport, Dr. George W. Bachman, Director of the School, states that the principal study of the Bacteriological Department during tho year bas been