Medical Societies TUBERCULOSIS ASSOCIATION A meeting of the Association was held in London on November 2i, with Mr J. E. H. Roberts, the President, in the chair, to discuss 'Immunity Producing Measures in Tuberculosis'. The opening paper, prepared by Dr O. GALTUNO HANSEN, of Oslo, is published in full on page I of this issue. The second paper was read by COL. C. F. BENNETT who gave an account of the evolution of the Tuberculosis Service of Saskatchewan and of the success of vaccination with B.C.G. in Canada. [It was hoped, but it has not been possible owing to the demands of military service, to publish Col. Bennett's paper in full.] In the general discussion which ensued the following took part : LmuT.-Cot. MUCKENFUSS(U.S. Army) alluded to Park's work with B.C.G. in New York. The results did not appear conclusive aItd differed in degree in white and coloured population. The only complication was abscess formation-local or in regional lymph nodes--in a small number. On the whole he did not feel that B.C.G. vaccination was justified in a population (like New York) where the incidence of tuberculosis in children was low. COL. HOLST remarked that of a contingent of 3,5oo members of the Norwegian forces, all who were Pirquet negative (about '25~ were vaccinated. None of them suffered any more harm than a subcutaneous abscess. Vaccination of probationary nurses and medical students was done in Norway, if possible two to three months before thevwere admitted to wards of tubercular cases. Infants t'rom tuberculous homes should be vaccinated during temporary removal from contact. Perhaps the greatest value lay in inoculation of young people (i5-25)about to be exposed to infection, e.g. in hospital wards. PROFESSORT. DALLINO (M. of Agriculture and Fisheries) described the large-scale experiments on cattle which would continue for some years. Inoculation with B.C.G., followed later by feeding with bovine T.B., had shown that immunity remained high for six months, and revaccination could be repeated a number of times. The tuberculin test became positive. In an experiment at Cambrittge 5~ cattle were vaccinated, then placed among known tuberculous herds for several years. In the 2o-3o killed, only 3 showed any evidence or infection (obvious in none and microscopic in 2). The present large field trial involved Ioo farms. The speaker said that Vole bacillus inoculation produces a degree of resistance, possibly better than did B.C.G. DR A. Q . WELLS mentioned that the Vote bacillus was
not harmful when injected. Three volunteers had become tuberculin positive after inoculation and remained so for eighteen months. DR M. E. WILKINSONshowed data to support his belief that glandular tuberculosis in childhood was a beneficent disease and raised resistance of the patient against subsequent tuberculosis. Children who had manifest glandular tuberculosis did not usually have other tuberculous lesions then--nor later if the former was successfully treated. Moreover previous glandular infection seemed favourably to affect the severity of a subsequent tuberculous lesion if it did occur. Primary infection should be brought about in childhood when the natural resistance was at its maximum and to be effective it appeared that a specific stimulus of the reticulo-endothelial system was required. PROV~SSOR S. LYLE CUMMINS thought that a certain amount of resistance may be developed even in the period between infection and the tuberculin test becoming positive. PROFESSOR W. H. TYTLER stressing the importance of the individual who reaches adult life without becoming tuberculin positive thought that B.C.G. immunity might not last long enough in such if he were to be exposed--for example, the probationer nurse. He agreed with Col. Bennett that improved housing conditions were not the answer to the tuberculosis problem. DR E. NASSAUargued that B.C.G. merely created an artificial primary infection which did not prevent further adult infection. DR A. L. JACOBSthought there was an increasing amount of evidence in favour of B.C.G. The tuberculin-negative individual in the t5-2 5 age-group might develop tuberculosis within two years of becoming exposed, e.g. nurses in a hospital. The limited immunity of B.C.G. (perhaps repeated) would be useful for such. DR W. E. SNELL queried whether Mantoux-negative nurses should be employed in a hospital. DR P. W. EDWARDSmentioned the herd of cattle which he had vaccinated with B.C.G. for past eighteen years. He thought the results favourable, but felt that still more work on cattle should precede trial on human beings. Of several resolutions which the meeting put forward, it finally agreed to one--that 'The T.A. Council be instructed to approach the councils of the N.A.P.T. and J.T.C. with a view to a joint request to the Minister of Health to make B.C.G. available for trial in this country'. A further resolution empowered the T.A. Council alone to approach the Minister of Health if the other bodies declined to accompany them.
Book Review TUBERCULOSIS Price.
IN
CHILDHOOD.
By Dorothy
This book is an excellent summary and has evidently been written primarily for students and public health workers. The classification of all stages in tuberculosis has been well described and stress laid upon the importance of routine tuberculin testing of infants and children of all ages, whether there is a contact history or not. Applying this principle and treating positive reactors, Dr Price has been able to achieve a significant reduction in infantile mortality from tuberculosis in Dublin. The book has added interest on account of the amount of original work incorporated in addition to a large bibliography. The first part is devoted to pulmonary disease and the
second part more briefly describes tuberculosis in other organs. The text is very readable apart from a few grammatical errors and ambiguous statements which have arisen mainly from too sweeping generalizations. The physician might well hesitate to remove blood from the anterior fontanelle for the purposes of a sedimentation rate while the child still has fingers. Some of the radiographs lack detail and one has yet to see a book which lays sufficient stress on the importance of lateral x-rays although a complete chapter has been devoted to radiology. Our minds are naturally drifting these days towards the prevention of tuberculosis, and it is both interesting and gratifying to see an entire chapter devoted to epidemiology.