- Email: [email protected]
TUBERCULOSIS.
669 Another tuberculosis officer writes
TUBERCULOSIS.
:-
" Many of our old beliefs are being shaken, and even the very infectivity of tuberculosis, as we have up to now underthe cold truth stood the term, is being questioned remains that the medical profession is not yet in possession of the full requisite knowledge either as to the cause, briefly prevention, or cure of tuberculosis." ......
The
the
Ministry of Health. Report of THIS Report, the appearance of which was noted in THE LANCET last week, includes a colourless, but no doubt accurate, review of recent measures for dealing with tuberculosis. It is a tale of committees, recommendations, grants, and schemes. It does not reflect favourably on the wisdom and prescience of the Departmental Committee on Tuberculosis that it should in 1912 have set the tentative standard of one sanatorium bed and one hospital bed per 5000 of the population, but though the insufficiency of this standard is now admitted, the 1 in 1000 standard, as already established in Denmark, has not apparently been accepted by the Ministry. There are, however, interesting facts to be extracted from this Report, serving, as milestones There are now 15,781 on a dull road, to mark progress. beds for the tuberculous under voluntary bodies and local authorities, and 2258 of these beds were provided during the year under review. Up to March, 1920, proposals had been submitted for the provision of 9830 additional beds. Thus it appears that the crying need for beds is> rapidly being made good. The staffing of the tuberculosis machine is also beginning to come up to strength, or nearly so. By the end of March, 1920, county councils had appointed 150 tuberculosis officers, and county borough councils another 108. Tuberculosis dispensaries have also been staffed by 41 tuberculosis officers under the schemes of the metropolitan borough councils. Even the dental welfare of the tuberculous, which has in the past suffered much stepmotherly inattention, is coming to the fore, and by the end of March, 1920, arrangements by 15 county councils and 20 county boroughs for dental treatment of the tuberculous had been sanctioned by the Ministry. In so chronic and subterranean a disease as tuberculosis the latent period between any given measure and the effect it produces on the mortality must necessarily be long and uncertain. But it is encouraging, even if the declining tuberculosis mortality is only in part traced to the activities of the Ministry, to note that whereas the deaths in England and Wales from all forms of tuberculosis in 1918 were 58,073, in 1919 they were only
The remedy is, in his opinion, research work. With regard to the conflicting claims of treatment at home or in a segregation camp, euphemistically termed an industrial colony, Dr. C. C. A. de Villiers, T.O. for district No. 6, advocates the establishment of workshops in each town or area, where men still undergoing treatment can be trained and employed while in receipt of their allowances. " The training colonies are doing excellent work, but the large majority of men are either unable to comply with the conditions of admittance or are unwilling to leave their homes for any considerable period of time." American 1’rudeait
Sanatorum
Reports.
(Thirty-fifth
Report).-The reports published by
Annual Medical this sanatorium
as well as instructive, and show a happy combination of imagination, hustle, and perseverance. To combat the common tendency of sanatorium work to lapse into a. rut of dull routine, all examinations and data found to be uninstructive are ruthlessly " scrapped," and new methods and points of view are constantly being studied. The X rays have been found to stimulate interest in the usual physical examination, and the Monday morning diagnostic clinics, where the entire staff meet to discuss individual cases, have proved a valuable whetstone on which to sharpen wits. Another prominent feature of the Trudeau Sanatorium is the close Coöperation of clinical and laboratory work. Un:ortunately, most sanatoriums provide few or no :acilities for adequate research, although the problems )f tuberculosis are obviously not going to be solved by the casual investigator. Among the papers published n conjunction with this report is one on the adrenalin iest (Goetsch) between pulmonary tuberculosis and lyperthyroidism. It has been employed at the sanatorium for several years and has proved of considerable value. I,oomis Sanatorium, U.S.A. (Twenty-third Annual 46,312. it may be asked, is the chief fnnction Report).—What, The Tuberc2tlosis Becls of the M.A.B. )f a sanatorium report? The authors of this report vould be justified in calling it propaganda,,for they If the number of beds provided for the tuberculous is iave produced a beautifully illustrated work showing an anti-tuberculosis an index to the efficiency of campaign, then the Metropolitan Asylums Board is to be he attractions of the sanatorium surroundings in both congratulated on its annual report for 1919-20. As summer and winter. Sandwiched in among these Appendix C shows, the Board’s existing and prospective )retty pictures is much solid and useful information. accommodation for the tuberculous is one of 2593 beds. Tuberculin, it appears, is given in only a few cases, vhereas treatment by artificial pneumothorax is It is not yet possible to judge whether the needs of )ractised in about 19 per cent. of all the cases. The London have been met by this accommodation, existing and prospective, but the report suggests that the supply ’ gratifying success " achieved by this treatment is ,ttributed to careful selection of cases and to the comwill approximately meet the demand. One of the pression of the lung being gradual, except when severe latest steps to be taken by the Board has been the acquisition of an institution at Lowestoft with accom- haemorrhage calls for rapid compression. Interesting tudies have been carried out on patients suffering from modation for 150 cases of surgical tuberculosis in adults. In the section dealing with finance it is pointed out that Lay fever, and their pollen sensitiveness was " skinested" in some cases with as many as six different the Government originally promised to defray threeollen extracts. fifths of the capital cost of sanatoriums up to X90 per Practically all reacted to ragweed ollen. In addition to routine studies the sanatorium bed. Though this sum was doubled in 1918 the amount is quite inadequate, for it is calculated that three-fifths undertaking : (a) an intensive statistical study of the revious year’s work on complement fixation; (b) a of the capital cost per bed is likely to exceed £500. tudy of the blood in acute cases of tuberculosis to Sanatorium Benefit in Kent. etermine the presence or absence of ferments; and In the seventh annual report on tuberculosis in Kent ’) cooperation with the medical staff in a series of Dr. Alfred Greenwood edits the reports received from nimal experiments on chemo-therapy in tuberculosis. b is evident from various other subjects discussed that the seven tuberculosis officers in charge of various loomis Sanatorium is conducted on progressive and districts in the county. The interest of these sectional reports is enhanced by the divergence of opinion, not to 3ientinc lines. say conflict of opinion, expressed by their authors. Some are dogmatic, others agnostic. Stressing the LITERARY INTELLIGENCE.—Messrs. J. and A. potency of domiciliary infection, one tuberculosis officer hurchill announce a Text-book on Preventive Medicine, calculates that in his area nearly 7 per cent. of his Professor R. T. Hewlett and Dr. A. T. Nankivell, shortly cases of pulmonary disease occurred in "contacts." be and Co. announce published.—Messrs. Hence his plea for the isolation of the advanced and t lat they will shortly publishWitherby a book entitled "A Naturalist i Himalaya," by Captain R. W. G. Hingston, 1I1.G., 1.M,8. hopeless cases. are
always stimulating
Trudeau’s
successors
TUBERCULOSIS.
:-
" Many of our old beliefs are being shaken, and even the very infectivity of tuberculosis, as we have up to now underthe cold truth stood the term, is being questioned remains that the medical profession is not yet in possession of the full requisite knowledge either as to the cause, briefly prevention, or cure of tuberculosis." ......
The
the
Ministry of Health. Report of THIS Report, the appearance of which was noted in THE LANCET last week, includes a colourless, but no doubt accurate, review of recent measures for dealing with tuberculosis. It is a tale of committees, recommendations, grants, and schemes. It does not reflect favourably on the wisdom and prescience of the Departmental Committee on Tuberculosis that it should in 1912 have set the tentative standard of one sanatorium bed and one hospital bed per 5000 of the population, but though the insufficiency of this standard is now admitted, the 1 in 1000 standard, as already established in Denmark, has not apparently been accepted by the Ministry. There are, however, interesting facts to be extracted from this Report, serving, as milestones There are now 15,781 on a dull road, to mark progress. beds for the tuberculous under voluntary bodies and local authorities, and 2258 of these beds were provided during the year under review. Up to March, 1920, proposals had been submitted for the provision of 9830 additional beds. Thus it appears that the crying need for beds is> rapidly being made good. The staffing of the tuberculosis machine is also beginning to come up to strength, or nearly so. By the end of March, 1920, county councils had appointed 150 tuberculosis officers, and county borough councils another 108. Tuberculosis dispensaries have also been staffed by 41 tuberculosis officers under the schemes of the metropolitan borough councils. Even the dental welfare of the tuberculous, which has in the past suffered much stepmotherly inattention, is coming to the fore, and by the end of March, 1920, arrangements by 15 county councils and 20 county boroughs for dental treatment of the tuberculous had been sanctioned by the Ministry. In so chronic and subterranean a disease as tuberculosis the latent period between any given measure and the effect it produces on the mortality must necessarily be long and uncertain. But it is encouraging, even if the declining tuberculosis mortality is only in part traced to the activities of the Ministry, to note that whereas the deaths in England and Wales from all forms of tuberculosis in 1918 were 58,073, in 1919 they were only
The remedy is, in his opinion, research work. With regard to the conflicting claims of treatment at home or in a segregation camp, euphemistically termed an industrial colony, Dr. C. C. A. de Villiers, T.O. for district No. 6, advocates the establishment of workshops in each town or area, where men still undergoing treatment can be trained and employed while in receipt of their allowances. " The training colonies are doing excellent work, but the large majority of men are either unable to comply with the conditions of admittance or are unwilling to leave their homes for any considerable period of time." American 1’rudeait
Sanatorum
Reports.
(Thirty-fifth
Report).-The reports published by
Annual Medical this sanatorium
as well as instructive, and show a happy combination of imagination, hustle, and perseverance. To combat the common tendency of sanatorium work to lapse into a. rut of dull routine, all examinations and data found to be uninstructive are ruthlessly " scrapped," and new methods and points of view are constantly being studied. The X rays have been found to stimulate interest in the usual physical examination, and the Monday morning diagnostic clinics, where the entire staff meet to discuss individual cases, have proved a valuable whetstone on which to sharpen wits. Another prominent feature of the Trudeau Sanatorium is the close Coöperation of clinical and laboratory work. Un:ortunately, most sanatoriums provide few or no :acilities for adequate research, although the problems )f tuberculosis are obviously not going to be solved by the casual investigator. Among the papers published n conjunction with this report is one on the adrenalin iest (Goetsch) between pulmonary tuberculosis and lyperthyroidism. It has been employed at the sanatorium for several years and has proved of considerable value. I,oomis Sanatorium, U.S.A. (Twenty-third Annual 46,312. it may be asked, is the chief fnnction Report).—What, The Tuberc2tlosis Becls of the M.A.B. )f a sanatorium report? The authors of this report vould be justified in calling it propaganda,,for they If the number of beds provided for the tuberculous is iave produced a beautifully illustrated work showing an anti-tuberculosis an index to the efficiency of campaign, then the Metropolitan Asylums Board is to be he attractions of the sanatorium surroundings in both congratulated on its annual report for 1919-20. As summer and winter. Sandwiched in among these Appendix C shows, the Board’s existing and prospective )retty pictures is much solid and useful information. accommodation for the tuberculous is one of 2593 beds. Tuberculin, it appears, is given in only a few cases, vhereas treatment by artificial pneumothorax is It is not yet possible to judge whether the needs of )ractised in about 19 per cent. of all the cases. The London have been met by this accommodation, existing and prospective, but the report suggests that the supply ’ gratifying success " achieved by this treatment is ,ttributed to careful selection of cases and to the comwill approximately meet the demand. One of the pression of the lung being gradual, except when severe latest steps to be taken by the Board has been the acquisition of an institution at Lowestoft with accom- haemorrhage calls for rapid compression. Interesting tudies have been carried out on patients suffering from modation for 150 cases of surgical tuberculosis in adults. In the section dealing with finance it is pointed out that Lay fever, and their pollen sensitiveness was " skinested" in some cases with as many as six different the Government originally promised to defray threeollen extracts. fifths of the capital cost of sanatoriums up to X90 per Practically all reacted to ragweed ollen. In addition to routine studies the sanatorium bed. Though this sum was doubled in 1918 the amount is quite inadequate, for it is calculated that three-fifths undertaking : (a) an intensive statistical study of the revious year’s work on complement fixation; (b) a of the capital cost per bed is likely to exceed £500. tudy of the blood in acute cases of tuberculosis to Sanatorium Benefit in Kent. etermine the presence or absence of ferments; and In the seventh annual report on tuberculosis in Kent ’) cooperation with the medical staff in a series of Dr. Alfred Greenwood edits the reports received from nimal experiments on chemo-therapy in tuberculosis. b is evident from various other subjects discussed that the seven tuberculosis officers in charge of various loomis Sanatorium is conducted on progressive and districts in the county. The interest of these sectional reports is enhanced by the divergence of opinion, not to 3ientinc lines. say conflict of opinion, expressed by their authors. Some are dogmatic, others agnostic. Stressing the LITERARY INTELLIGENCE.—Messrs. J. and A. potency of domiciliary infection, one tuberculosis officer hurchill announce a Text-book on Preventive Medicine, calculates that in his area nearly 7 per cent. of his Professor R. T. Hewlett and Dr. A. T. Nankivell, shortly cases of pulmonary disease occurred in "contacts." be and Co. announce published.—Messrs. Hence his plea for the isolation of the advanced and t lat they will shortly publishWitherby a book entitled "A Naturalist i Himalaya," by Captain R. W. G. Hingston, 1I1.G., 1.M,8. hopeless cases. are
always stimulating
Trudeau’s
successors