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Tuberculosis in Young Adults
174 properties of food and of roughage which by stimulating mastication could maintain the health of the teeth and jaws. The dentist would add to the biochemist's essential food factors another essential dietary factor--roughage--and an essential physical property-hardness. These attributes of a healthy diet are grossly deficient in ours. Doctors and dentists agree on many questions of diet, e.g., the value of raw fruits and vegetables and 0f lightly milled flour, but dentists would put much more emphasis on mese points and would especially condemn pure sugar; they regard it as a poison, rather than as a food, though admitting it to be an otherwise excellent condiment. Many biochemists, and most of the lay public are inclined-to favour it as a compact source of energy and " nutritious" as applied to many foods means nothing else but having a low content of roughage; thus biochemists often praise precisely what dentists condemn. The Ministry of Food, e.g., in its Manual of Nutrition ~ prefers cooked vegetables to salads on t h e grounds that more nutriment can thus be included in " a convenient serving," and it suggests that children's stomachs are too small to deal with much more roughage than the present diet contains. Dentists and anthropologists however, realise that the teeth, and therefore presumably the rest of the alimentary canal, are adapted to deal with a diet needing five or ten times as much mastication as modern diet requires. Thus dietary improveme~nt in regard to dental health, in general supplements, but often Conflicts with, purely nutritional improvement. Moreover, the problemS of health education towards a dentally hygienic diet are quite different from those of the nutritionist. The latter is generally assisted by the natural tendency towards greater variety in diet and is hindered mainly by poverty, ignorance and custom. The dental dietary reformer on tile other hand is hindered by two natural tendencies, one towards greater softening and refinement of food and the other towards greater sweetness and therefore greater consumption of extracted sugar. For this reason dentists have mostly given up hope of any significant dietary reform and are even resigned to the worsening which will follow an increase in the sugar ration. They have concentrated on other methods of combating dental disease, but without much success, and it is frequently stated, quite incorrectly, that the causes of dental disease are unknown. What is unknown is how the causes are to be eliminated, or their effects mitigated. Some of these difficulties might be overcome if the scope of dietetics and nutrition was extended to include everything which is eaten and may affect the consumer's health or otherwise please him. The greatest changes in food habits have been produced by technical developments in the food industries and the direction of such changes is dictated by man's natural desires rather than by knowledge of nutrition. The nutrition committee's report speaks of " moulding the common taste," but the food industry changes food habits by exploiting the common taste in new and cheaper ways. A comprehensive science of food and eating might discover ways of exploiting the natural tastes which would b e at the same time healthy and economical and ~6uId thus compete with manufacturers in directing the evolution of food habits. Unless or until this can be done health education must be greatly intensified and there should be no relaxation in the government control of diet. When one considers the immense quantity of milling, extracting and processing machinery which has usurped the function of the teeth, it is obvious that very powerful vested interests would be threatened by a thorough policy of dietary reform aimed at dental health. The Ielafively trivial nature of dental disease and the peculiar problems of its dietary prevention may have justified previous neglect o f the subject, but now that malnutrition is well under control it is surely time that more attention should be ~iven to what is after all a complex of diseases that is painful, d[sngurlng, Undignified, expensive, often more serious than it seems, almost universal, and yet preventable? Medical officers of health and school dental officers probably understand this problem as well as any other group of experts, certainly better than many eminent biochemists; the Society's representatives should therefore be able to persuade the Central Council for Health Education to ask, if it has not done so, for an authoritative report on other aspects of healthy dietary before basing its educational programme on purely nutritional advice. Although the report says that the work of the nutritional scientist is ultimately to improve the human diet it makes it quite clear that nutritional improvement only is under discussion and other qualities of food are only considered in so far as they affect nutrition. It does not, however, state that the dietary prevention of dental disease has been largely excluded from consideration by the nutritional approach to the subject, and it is to draw attention to this fact that this letter has been written, Yours truly, 51, Greencroft Gardens, R . B . D . STOCKER,L.n.s. N.W.6. M a y 19th, 1948.
PUBLIC HEALTH, June, 1948 ~FE~NCES 1 Lancet, 1948, 1, 723. 2 H.M.S.O., 1947.
BOOK REVIEW Tuberculosis in Young Adults.
Report on the Prophit Tuberculosis Survey, 1935-44. By MARC DANIEL, M.D., D.P.H., F. RIDEHALGtI~ M.A., M.B-~ M.R..C.P.~ and V. It. SI)tlINGETT, M.B., R.S. (Pp. xvi. + 228. 58 plates and 22 illustrations. Price 30s. net.). London: H. K. Lewis & Co., 1948. This volume is the fruit of ten years' investigation (1935-.1944) organised under the aegis of the Royal College of Physicians. In the course of this Survey 10,000 presumably healthy young adults were both x-rayed and tuberculin tested at periodic intervals. The human material employed consisted of five groups: (1) Contacts--livlng in a family containing a case of pulmonary tuberculosis. (2) Controls--these comprised mainly of office workers in London who could be regarded as average citizens exposed to the ordinary risks of tuberculous infection. (3) Nurses--one group of whom were employed in institutions admitting ali classes of patients including chronic and advanced tuberculosis and a second who were engaged in hospitals'excluding tuberculous cases. (4) Medical S t u d e n t s - - b o t h in the clinical and pre-clinical stages. (5) Navy Boys.--Unfortunately due to the outbreak of war in 1939 the scope of the Survey had to be radically revised as the Navy Boys were rapidly called up, contacts began to attend less frequently, and many London medical students were " posted " to provincial universities, etc. As a result, the Prophit Research Scholars shifted the emphasis of their work to the investigation of tuberculosis among nurses. Their findings make fascinating reading to the epidemiologist as well as the phthisiologist. In the first place they confirm the general impression that the incidence "of tuberculin sensitivity has fallen 'markedly in this country since the early part of the century. Among young adillts only 85% of males and a slightly lower percentage of females gave a positive Mantoux reading to 1"0 mgm. or less of tuberculin. An interesting feature which emerges is that, whereas 80% of nurses working amongst tuberculosis cases showed a Mantoux conversion after one year of nursing, only 26% of controls became tuberculin positive during the same period. Over 95% of these primary infections in adults developed uneventfully, though about 8% of these revealed the presence of lung lesiofis on radiologleal examination. One of the most instructive features of this Survey was the finding that the morbidity rate among nurses (13'7 per 1,000) was twice as high as among the Control group, and furthermore the incidence of tubercle among nurses in contact with tuberculous cases was one and a half times that noted in nurses where hospital authorities adopted a policy of excluding tuberculous patients. As a proportion of many nursing staffs is Irish or Welsh one might conclude that ethnic factors were responsible for this remarkable difference in morbidity incidence. Yet closer scrutiny reveals that contact is an important factor in the development of adult phthisis which in this instance transcends ethnic differences. All this work is broadly in harmony with the teaching of Heimbeck of Norway about the lower susceptibility of Mantoux positive cases to tuberculosis. Whether a positive tuberculin test means increased resistance or whether it represents a survival group who have been "weeded-out " following infection in early life is a matter for conjecture rather than dogmatism. Perhaps the most striking conclusion of the Prophit Research Scholars is that (excluding Contacts and Navy Boys) the annual tuberculosis morbidity rate was 7"3 per 1,000 in the tuberculinpositive, as compared with 23'1 per 1,000 in those tuberculinnegative on entry to this Survey. T h e seriousness of this evidence becomes even graver when one reflects or~ the numbers of Irish and Welsh nurses from rural areas who commence their new careers with a negative Mantoux reaction. Fortunately however, the mortality rate among nurses does not appear to be higher than that among the equivalent age and sex groups of the general population. There are minor points of criticism with which one must tax the four doctors (Ridehalgh, Daniels, Springett and Hall) who were responsible for this investigation. While the m e d n a g e of the Controls corresponds closely to that of the Nurses group there is a considerable difference in the frequency distribution of the different age classes in both groups. Again, in the early days of the Survey a negative tuberculin reaction to 0"1 mgm. was at~parently not followed up in 260 individuals with an injection of the higher dosage of 1.0 mgm. of tuberculin. While the omission of this number will not substantially affect the comparison between groups, it m u s t alter the Mantoux conversion rate as a proportion of patients classified as showing conversion may well have been tuberculin positive to 1'0 mgm. on admission to this Survey. This volume represents the most thorough, detailed and pains-
175
PUBLIC H E A L T H , June, 1948 taking work o n t h e epidemiology of. tuberculosis that has yet b e e n u n d e r t a k e n in this, or as far as the reviewer is aware, any other c o u n t r y . T h e t y p o g r a p h y is of h i g h quality, t h e x - r a y r e p r o d u c t i o n s are excellent a n d t h e d i a g r a m s a n d h i s t o g r a m s readily c o m p r e h e n s i b l e . T h i s publication m a r k s a n e w h i g h level in the h o n e s t collation o f medical data a n d it reflects t h e h i g h e s t credit on t h e a u t h o r s a n d t h e P r o p h i t T r u s t e e s . OBITUARY ALEXANDER GiBE GLASS, M.A. (ABER.), M.D. (EDIN.), D.P.H. T h e n e w s f r o m G r a n t o w n on Spey of t h e death on April 30th of Dr. A. G. Glass, lately Medical Officer of H e a l t h of F a r n w o r t h a n d Kearsley U r b a n Districts, will be a m a t t e r of regret a m o n g m a n y friends. H e c a m e to F a r n w o r t h a n d K e a r s l e y in 1921, a d m i r a b l y e q u i p p e d to tackle t h e p r o b l e m s in a n u r b a n area in S o u t h L a n c a s h i r e , a n d served his authorities faithfully a n d well u n t i l his r e t i r e m e n t in 1943. G l a s s was t h e e m b o d i m e n t of t h e qualities w h i c h are traditionally associated w i t h t h e b e s t S c o t s m e n . H e h a d first class m e n t a l ability, worked h a r d h i m s e l f a n d expected his staff t o , y o r k h a r d . H e held d e e p - r o o t e d convictions a n d was a generous a n d easy friend. H e was f o r t u n a t e e n o u g h to be able to see t h e results of m u c h of his work in F a r n w o r t h . H e regarded bad h o u s i n g as t h e root cause of m o s t of t h e public h e a l t h evils, saw in t h e H o u s i n g A c t of 1930 t h e powers h e needed, a n d i m m e d i a t e l y c o m m e n c e d to use t h e m zealously. T h e first e n q u i r y in the c o u n t r y into a proposed clearance area was held in F a r n w o r t h . H e persisted in his progt:amme of sl'um clearance until it was possible before t h e war to say t h a t F a r n w o r t h h a d n o insanitary property. His c a m p a i g n for d i p h t h e r i a i m m u n i s a t i o n was a m o d e l in its p l a n n i n g a n d its execution. A. G. Glass was one of a n o t inconsiderable n u m b e r of m e n o f ability in t h e h u n d r e d years' history of Public H e a l t h w h o h a v e given disinterested service o f t h e h i g h e s t quality o u t of all proportion to t h e leeward a n d recognition they received. H e was a Fellow of "the Society f r o m 1920. I n S o u t h L a n c a s h i r e h i s ability a n d good fellowship will l o n g b e r e m e m b e r e d , a n d to his widow, a gracious lady w h o s h a r e d in all his interests a n d friendships," sincere s y m p a t h y is e x t e n d e d . R.M.G.
S O C I E T Y OF M E D I C A L O F F I C E R S OF H E A L T H ORDINARY MEETING A n O r d i n a r y M e e t i n g of t h e Society was h e l d at t h e H a s t i n g s Hall, Tavistock House, London, W.C.1, on F r i d a y , M a y 21st, 1948, at 12.15 p.m. T h e President (Dr. F. Hall) was in t h e c h a i r a n d a b o u t 20 m e m b e r s attended. A f t e r t h e m i n u t e s of t h e last m e e t i n g h a d been confirmed a n d signed, t h e m e e t i n g proceeded to the election of t h e President for 1948-49. Dr. H a l l reported t h a t the only n a m e s u b m i t t e d by t h e Council was t h a t of Prof. R. H. Parry, Medical Officer of H e a l t h , City a n d Port of Bristol a n d Pxofessor of Preventive Medicine in t h e U n i v e r s i t y of Bristol. T h e m e e t i n g u n a n i m o u s l y elected Prof. Parry, who briefly gave t h a n k s for t h e h o n o u r done to h i m . T h e n e x t business was t h e presentation b y Dr. Mellin T h o m a s on b e h a l f of the W e l s h B r a n c h of a portrait of Prof. R. M. F. Picken, President of t h e Society, 1944-45. T h i s was received by t h e President on b e h a l f of t h e Society. T h e m e e t i n g t h e n elected t h e following as fully-paid Life m e m bers on t h e n o m i n a t i o n s of their B r a n c h e s a n d t h e C o u n c i l : Prof. E. W. Hope, O.B.E. (formerly M.O.H., Liverpool) C.B. Joined t h e Society 1 8 9 5 . ( N o m i n a t e d b y t h e N o r t h - W e s t e r n Branch). Dr. A. H. W i l s o n (formerly M.O.H., E a s t Wilts. C.S.D.). Joined t h e Society 1911. ( N o m i n a t e d by t h e W e s t of E n g l a n d Branch). T h e following candidates for m e m b e r s h i p , h a v i n g been duly pxoposed a n d seconded, were t h e n e l e c t e d : As Fellows.--Bamber, William, M.B., CH.B. (BELF./, D.p.H. ; Baster, Norman, M.B., CI-I.B. (LENS), D.P_H.; Beaumont, Dorothy May, M.B., eH.m (t~nt~r.); Blakiston, May Walton, M.B., CH.tL (MANCtI.) ; Brereton, Eileen Mary, M.B., cn.m (6L;~SO.); Cairns, Margaret Dempster, M.B., etLB. (EDIN.), D.t'.H. ; Campbell, Arthur David, M.B. (BELF.), D.P.H. ; Caswell, James Wallace, Surg.-Cdr., R.N., M.D. (TOm), D.P.H. ; Clarke, 'Brice Richard, M.D. (BELIe.); Cooper, William James Douglas, M.B., CH.B., a.A.O., D.P.H. ; Corbett, Kathleen May, B.SC., M.D. (BELF.), D.e.H. ; Cormae, Cyril Dove, M.A.,B.M., men. (OXON.),n.p.I-I. ; Corrigan, Julia Mary Dympna, M.B., B.CH. (IRE.), D.P.m ; Cromb, Edith Elizabeth, M.B., CH.B. (EDIN.), D.P.H. ; Crowley, .Matthew, M.B., B.eH. (IRE.), D.P.H. ; Davies, Sadie Margaret, B se ) M B., B.CH (WA)', Duncan . , David , Surg . Capt , R.N , M.D., CH.B . • (OREAD) ., O.P.H. ; Elder, Charles Lmdsey, M.B., CH.B. (MANCtt.), D.p.H. ; Erskme, Frances Mary M,B. (BELF.), n.se., n.P.n. ; Fletcher, Frank Edward, M.B., eH.B. (BRIS.), D.P.H., Barrister-at-Law ; Gordon, ]ames Leslie, M.R.C.S., L.R.C.P.; Gourlay, Robert John, M.IL (OLAS.), D.P.H. ; Halperin, Rachel, M.B., B.S. (LOND.), D.P.H. Hayes, Samuel, M.D. (BELF.), D.P.H. ; Howorth, Irene Elsie, B.SC., M.B., CH.B. LMANCH.), D.C.H., D.OBST., R.C.O.O.; Hudson, John Harral, B.SC., M.B., CH.B. EEDS), D.T.M. ~ H., D.P.H. ; Lambert, Donald Page, M.D. (EDIN.), D.T.M. & H., D.P.tL ;
CHARLES
SAMSON
THOMSON, M . D . n.~.H.,
( G L A S G . ) , M . R . C . P . (ED.), D. H Y . ( D U R H . ) ,
o.~.M.
(C~EECE).
W e record w i t h g r e a t r e g r e t t h e d e a t h a t his h o m e in A y r on M a y 3 o t h of Dr. Charles S. T h o m s o n , w h o was Medical Superi n t e n d e n t Officer of H e a l t h in B e l f a s t f r o m 1928 to 1945. W e are i n d e b t e d to his successor, D r . S. B a r r o n , Ior t h e following tribute :Dr. T h o m s o n w a s a n a t i v e of A y r a n d g r a d u a t e d a t Glasgow U n i v e r s i t y in I9o6. Before c o m i n g to B e l f a s t he held a p p o i n t m e n t s as Medical Officer of H e a l t h a t W o r k i n g t o n , C u m b e r l a n d ; Hyde~ Cheshire; a n d D e p t f o r d , L o n d o n . H e was a Fellow of t h e R o y a l I n s t i t u t e of P u b l i c H e a l t h a n d H y g i e n e , a n d a M e m b e r of t h e R o y a l S a n i t a r y I n s t i t u t e , a n d w h e n he received t h e degree of D o c t o r of H y g i e n e a t D u r h a m U n i v e r s i t y in i938, he b e c a m e t h e s e v e n t h p e r s o n to hold t h a t qualification. " I n I937 he received t h e " S m i t h A w a r d " - - a bronze s t a t u e t t e of H y g e a - - a w a r d e d t r i e n n i a l l y b y t h e R o y a l I n s t i t u t e of P u b l i c H e M t h a n d H y g i e n e to t h e m e d i c a l officer of h e a l t h who, in t h e opinion of t h e Council of t h e I n s t i t u t e , h a d , in t h e d i s c h a r g e of his d u t i e s , rendered t h e m o s t n o t e w o r t h y w o r k in t h e d e p a r t m e n t of p r e v e n t i v e medicine. As a bacteriologist, Dr. T h o m s o n served w i t h t h e R . A . M . C . in t h e I914-18 w a r a n d , in a p p r e c i a t i o n of his services in Salonika d u r i n g t h e B a l k a n c a m p a i g n , t h e Greek G o v e r n m e n t a w a r d e d h i m t h e Order of Military Merit of Greece. W h i l s t in Belfast, Dr. T h o m s o n w a s a lecturer in P u b l i c H e a l t h A d m i n i s t r a t i o n in T h e Q u e e n ' s U n i v e r s i t y of Belfast, a n d corn t r i b u t e d several p a p e r s on ) u b l i c h e a l t h subjects, w h i c h were p u b l i s h e d in professional journals. H e w a s a m a n of genial disposition, k i n d a n d considerate, a n d h a v i n g t h e a p t i t u d e of m a k i n g friends. H e w a s held in h i g h e s t e e m b y t h e m e m b e r s of h i s h e a l t h a u t h o r i t i e s a n d his colleagues. H i s r e t i r e m e n t in 1945 w a s m a r k e d b y t h e p r e s e n t a t i o n of a n i l l u m i n a t e d a d d r e s s b y his staff in the" B e l f a s t P u b l i c H e a l t h Services. H i s wife p r e d e c e a s e d h i m in 1944, H i s son, D r . Charles S. T h o m s o n , is a. g r a d u a t e of Q u e e n ' s U n i v e r s i t y a n d h o l d s a n a p p o i n t m e n t as Medical Officer of H e a l t h a n d A s s i s t a n t C o u n t y Medical Officer in Norfolk. Dr. T h o m s o n h a d been a Fellow of t h e Society of Medical Officers of H e a l t h since 191o a n d w a s elected a fully paid life member after retirement. His f a m i l y a n d relatives are a s s u r e d of t h e deep s y m p a t h y of h i s m a n y friends a n d colleagues.
Lendon,
Nelson
Courtney,
M.A., M.B., B.CFI. (CAMB.), L.M.S.S.A., D.P.H. ;
McKenna, Aileen Isabelle (nee McMahon), M.ILC.S., L.R.C.P., D.P.H. ; McMordie, E. A. M., M.B. (BELF.), D.P.H. ; McNeill, Helen Marjorie, M.B. (BELF.), D.P.H. ; Maughan, John Harry, M.B., B.S. (DURH.), D.P.H. ; Milligan, M. patricia, M.B., B.A. (IRE.), D.P.H., B.SC.; O'Flanagan, Harry, M.R.C.P. (1), (IRE.), D.P.H. ; Pace, T. A., Major, R.A.M.C., B.se., M.D. (MALTA); Parker, Margaret Beryl, M.B., CH.a. (BIaM.), D.P.H. ; Perry, Eileen Elizabeth, M.B., n.CrI. (BELF.), D.P.H., D.C.H., D.OBST.,R.C.O.G. ; Robinsoo, Bennett Douglas, M.B., B.N.(I~URH.);D.P.ICI.; Robinson, Herbert James, M.D. (DIJBL.); Robinson, James Carnmell, Major, R.A.M.C., M.R,C.S., L.R.C.P. ; Simpson, Norman I- Y., M.D. (BELIe.),D.P.H. ; Slater, Margaret, M.m, CH.B. (LIV.) ; Taylor, James. M.B., B.CH. (BELF.) ; Thompson, Beatrice Mary, M.D. ( r l y g . ) ,
(LOND.), B.S., D.P.H. ;
Tinsdale,
George
F . W . , M.B., B.CH., B.A.O.,
B.se. ; Todd, Doris Mar~¢, M,B. (LORD.), B.S. ; Warnock, Hugh A., M.D., B,SC. (BELF.), D.P.H. ; W a t s o n ,
A n n a , M.B., B.CI-I.~ B.A.O., D.P.I-I.
As Assoeiates.--Adorjan, Stephen, M.D. (VIENNA), L.D.S. ; Connelly, Brian, R.C.S. ; Handforth, Claude Ellis, B.D.S., L.D.S. ; Hyland, Kenneth George, L.D.'S.(BRIS.); Irving, A. S., L.D.S, R.C.S. (EDIN.) ; Keith, William John Morrison, L.D.S., R.C.S. ; Leney, Kenneth, L.D.S. (LIV.); Massey, Kenneth Wood, L.D.S. ; Lloyd, Thomas, iX4ajor, R.A.M.C. (T.A.); Outlaw, Frederick Vaughan, Lieut., R.A.M.C. (T.A.); Pennington, Walter, L.D.S. (LIV.); Rattle, Violet Gordon, L.D.S. ; Rimmer, William Lenneth, L.D.S. (LIV.), D.D.S. (PENN.); Sqmer; Mrs. Agnes, L.D.S. ; Williams, Robert Charles, L.D.S. (LIV.); Young, t~lizabeth Z/i., L.D.S., a.e.s.
B.D.S. (LOND.), L.D.S.
COUNCIL MEETING A m e e t i n g of t h e Council was h e l d ' i n t h e HastinKs Hall~ T a v i stock H o u s e , L o n d o n , W . C . 1 , on Friday, M a y 21st, 1948, at 10 a.m. D r . G. F. B u c h a n was in t h e chair, and t h e r e were also p r e s e n t t h e P r e s i d e n t (Dr. F. Hall), M r . J. V. Bingay, L.D.S., Drs. Fraser Brockington, G. L. Brocklehurst, C. Metcalfe Brown, W . A. B u l l o u g h , H . D. Chalke, W . G. Clark, C. K . Cullen, Sir Allen Daley, Sir George Elliston, Drs. Jas. F e n t o n , J. M . Gibson, F, Gray, A. S. Hebblethwaite, C. H e r i n g t o n , K a t h e r i n e Hirst, Sir W i l s o n J a m e s o n , Prof. J. J o h n s t o n e Jervis, Drs. R. H, H. Jolly, J. M a d d i s o n , "M. M i t m a n , A. M o r r i s o n , G. A. W. Neill, A. A. E. N e w t h , W y n d h a m Parker, Prof. R. H . Parry, Drs. H u g h Paul, D. D. Payne, T . R u d d o c k - W e s t , J, E. Spence, J. A. Stirling, J. A. Struthers, M r . A. G o r d o n T a y l o r , L.D.S., Drs. G. M c K i m T h o m a s , N o r a W a t t l e , H . C. M a u r i c e W i l l i a m s and F. T . H . W o o d . Apologies for absence were received f r o m Drs. Cyril Banks, R. H . G. H. D e n h a m , R. M . Galloway, Prof. R. M . F. Picken a n d Dr. J. G r e e n w o o d W i l s o n . M i n u t e s o f t h e last m e e t i n g p u b l i s h e d in PUBLIC HEALTH, M a r c h , pp. 111-1 i4 find a d d e n d u m (April PUBLIC HEALTH, p. 136) were a p p r o v e d and signed by t h e C h a i r m a n . Northern Ireland Branch Representa t l o n . ~ A w e l c o m e was e x t e n d e d to D r . G. A. W . NeiI1 o n his a t t e n d a n c e as t h e first representative of t h e N o r t h e r n I r e l a n d B r a n c h . I n replying h e said t h a t t h e B r a n c h was already active a n d t h e r e was one m a t t e r
PUBLIC HEALTH, June, 1948 ~FE~NCES 1 Lancet, 1948, 1, 723. 2 H.M.S.O., 1947.
BOOK REVIEW Tuberculosis in Young Adults.
Report on the Prophit Tuberculosis Survey, 1935-44. By MARC DANIEL, M.D., D.P.H., F. RIDEHALGtI~ M.A., M.B-~ M.R..C.P.~ and V. It. SI)tlINGETT, M.B., R.S. (Pp. xvi. + 228. 58 plates and 22 illustrations. Price 30s. net.). London: H. K. Lewis & Co., 1948. This volume is the fruit of ten years' investigation (1935-.1944) organised under the aegis of the Royal College of Physicians. In the course of this Survey 10,000 presumably healthy young adults were both x-rayed and tuberculin tested at periodic intervals. The human material employed consisted of five groups: (1) Contacts--livlng in a family containing a case of pulmonary tuberculosis. (2) Controls--these comprised mainly of office workers in London who could be regarded as average citizens exposed to the ordinary risks of tuberculous infection. (3) Nurses--one group of whom were employed in institutions admitting ali classes of patients including chronic and advanced tuberculosis and a second who were engaged in hospitals'excluding tuberculous cases. (4) Medical S t u d e n t s - - b o t h in the clinical and pre-clinical stages. (5) Navy Boys.--Unfortunately due to the outbreak of war in 1939 the scope of the Survey had to be radically revised as the Navy Boys were rapidly called up, contacts began to attend less frequently, and many London medical students were " posted " to provincial universities, etc. As a result, the Prophit Research Scholars shifted the emphasis of their work to the investigation of tuberculosis among nurses. Their findings make fascinating reading to the epidemiologist as well as the phthisiologist. In the first place they confirm the general impression that the incidence "of tuberculin sensitivity has fallen 'markedly in this country since the early part of the century. Among young adillts only 85% of males and a slightly lower percentage of females gave a positive Mantoux reading to 1"0 mgm. or less of tuberculin. An interesting feature which emerges is that, whereas 80% of nurses working amongst tuberculosis cases showed a Mantoux conversion after one year of nursing, only 26% of controls became tuberculin positive during the same period. Over 95% of these primary infections in adults developed uneventfully, though about 8% of these revealed the presence of lung lesiofis on radiologleal examination. One of the most instructive features of this Survey was the finding that the morbidity rate among nurses (13'7 per 1,000) was twice as high as among the Control group, and furthermore the incidence of tubercle among nurses in contact with tuberculous cases was one and a half times that noted in nurses where hospital authorities adopted a policy of excluding tuberculous patients. As a proportion of many nursing staffs is Irish or Welsh one might conclude that ethnic factors were responsible for this remarkable difference in morbidity incidence. Yet closer scrutiny reveals that contact is an important factor in the development of adult phthisis which in this instance transcends ethnic differences. All this work is broadly in harmony with the teaching of Heimbeck of Norway about the lower susceptibility of Mantoux positive cases to tuberculosis. Whether a positive tuberculin test means increased resistance or whether it represents a survival group who have been "weeded-out " following infection in early life is a matter for conjecture rather than dogmatism. Perhaps the most striking conclusion of the Prophit Research Scholars is that (excluding Contacts and Navy Boys) the annual tuberculosis morbidity rate was 7"3 per 1,000 in the tuberculinpositive, as compared with 23'1 per 1,000 in those tuberculinnegative on entry to this Survey. T h e seriousness of this evidence becomes even graver when one reflects or~ the numbers of Irish and Welsh nurses from rural areas who commence their new careers with a negative Mantoux reaction. Fortunately however, the mortality rate among nurses does not appear to be higher than that among the equivalent age and sex groups of the general population. There are minor points of criticism with which one must tax the four doctors (Ridehalgh, Daniels, Springett and Hall) who were responsible for this investigation. While the m e d n a g e of the Controls corresponds closely to that of the Nurses group there is a considerable difference in the frequency distribution of the different age classes in both groups. Again, in the early days of the Survey a negative tuberculin reaction to 0"1 mgm. was at~parently not followed up in 260 individuals with an injection of the higher dosage of 1.0 mgm. of tuberculin. While the omission of this number will not substantially affect the comparison between groups, it m u s t alter the Mantoux conversion rate as a proportion of patients classified as showing conversion may well have been tuberculin positive to 1'0 mgm. on admission to this Survey. This volume represents the most thorough, detailed and pains-
175
PUBLIC H E A L T H , June, 1948 taking work o n t h e epidemiology of. tuberculosis that has yet b e e n u n d e r t a k e n in this, or as far as the reviewer is aware, any other c o u n t r y . T h e t y p o g r a p h y is of h i g h quality, t h e x - r a y r e p r o d u c t i o n s are excellent a n d t h e d i a g r a m s a n d h i s t o g r a m s readily c o m p r e h e n s i b l e . T h i s publication m a r k s a n e w h i g h level in the h o n e s t collation o f medical data a n d it reflects t h e h i g h e s t credit on t h e a u t h o r s a n d t h e P r o p h i t T r u s t e e s . OBITUARY ALEXANDER GiBE GLASS, M.A. (ABER.), M.D. (EDIN.), D.P.H. T h e n e w s f r o m G r a n t o w n on Spey of t h e death on April 30th of Dr. A. G. Glass, lately Medical Officer of H e a l t h of F a r n w o r t h a n d Kearsley U r b a n Districts, will be a m a t t e r of regret a m o n g m a n y friends. H e c a m e to F a r n w o r t h a n d K e a r s l e y in 1921, a d m i r a b l y e q u i p p e d to tackle t h e p r o b l e m s in a n u r b a n area in S o u t h L a n c a s h i r e , a n d served his authorities faithfully a n d well u n t i l his r e t i r e m e n t in 1943. G l a s s was t h e e m b o d i m e n t of t h e qualities w h i c h are traditionally associated w i t h t h e b e s t S c o t s m e n . H e h a d first class m e n t a l ability, worked h a r d h i m s e l f a n d expected his staff t o , y o r k h a r d . H e held d e e p - r o o t e d convictions a n d was a generous a n d easy friend. H e was f o r t u n a t e e n o u g h to be able to see t h e results of m u c h of his work in F a r n w o r t h . H e regarded bad h o u s i n g as t h e root cause of m o s t of t h e public h e a l t h evils, saw in t h e H o u s i n g A c t of 1930 t h e powers h e needed, a n d i m m e d i a t e l y c o m m e n c e d to use t h e m zealously. T h e first e n q u i r y in the c o u n t r y into a proposed clearance area was held in F a r n w o r t h . H e persisted in his progt:amme of sl'um clearance until it was possible before t h e war to say t h a t F a r n w o r t h h a d n o insanitary property. His c a m p a i g n for d i p h t h e r i a i m m u n i s a t i o n was a m o d e l in its p l a n n i n g a n d its execution. A. G. Glass was one of a n o t inconsiderable n u m b e r of m e n o f ability in t h e h u n d r e d years' history of Public H e a l t h w h o h a v e given disinterested service o f t h e h i g h e s t quality o u t of all proportion to t h e leeward a n d recognition they received. H e was a Fellow of "the Society f r o m 1920. I n S o u t h L a n c a s h i r e h i s ability a n d good fellowship will l o n g b e r e m e m b e r e d , a n d to his widow, a gracious lady w h o s h a r e d in all his interests a n d friendships," sincere s y m p a t h y is e x t e n d e d . R.M.G.
S O C I E T Y OF M E D I C A L O F F I C E R S OF H E A L T H ORDINARY MEETING A n O r d i n a r y M e e t i n g of t h e Society was h e l d at t h e H a s t i n g s Hall, Tavistock House, London, W.C.1, on F r i d a y , M a y 21st, 1948, at 12.15 p.m. T h e President (Dr. F. Hall) was in t h e c h a i r a n d a b o u t 20 m e m b e r s attended. A f t e r t h e m i n u t e s of t h e last m e e t i n g h a d been confirmed a n d signed, t h e m e e t i n g proceeded to the election of t h e President for 1948-49. Dr. H a l l reported t h a t the only n a m e s u b m i t t e d by t h e Council was t h a t of Prof. R. H. Parry, Medical Officer of H e a l t h , City a n d Port of Bristol a n d Pxofessor of Preventive Medicine in t h e U n i v e r s i t y of Bristol. T h e m e e t i n g u n a n i m o u s l y elected Prof. Parry, who briefly gave t h a n k s for t h e h o n o u r done to h i m . T h e n e x t business was t h e presentation b y Dr. Mellin T h o m a s on b e h a l f of the W e l s h B r a n c h of a portrait of Prof. R. M. F. Picken, President of t h e Society, 1944-45. T h i s was received by t h e President on b e h a l f of t h e Society. T h e m e e t i n g t h e n elected t h e following as fully-paid Life m e m bers on t h e n o m i n a t i o n s of their B r a n c h e s a n d t h e C o u n c i l : Prof. E. W. Hope, O.B.E. (formerly M.O.H., Liverpool) C.B. Joined t h e Society 1 8 9 5 . ( N o m i n a t e d b y t h e N o r t h - W e s t e r n Branch). Dr. A. H. W i l s o n (formerly M.O.H., E a s t Wilts. C.S.D.). Joined t h e Society 1911. ( N o m i n a t e d by t h e W e s t of E n g l a n d Branch). T h e following candidates for m e m b e r s h i p , h a v i n g been duly pxoposed a n d seconded, were t h e n e l e c t e d : As Fellows.--Bamber, William, M.B., CH.B. (BELF./, D.p.H. ; Baster, Norman, M.B., CI-I.B. (LENS), D.P_H.; Beaumont, Dorothy May, M.B., eH.m (t~nt~r.); Blakiston, May Walton, M.B., CH.tL (MANCtI.) ; Brereton, Eileen Mary, M.B., cn.m (6L;~SO.); Cairns, Margaret Dempster, M.B., etLB. (EDIN.), D.t'.H. ; Campbell, Arthur David, M.B. (BELF.), D.P.H. ; Caswell, James Wallace, Surg.-Cdr., R.N., M.D. (TOm), D.P.H. ; Clarke, 'Brice Richard, M.D. (BELIe.); Cooper, William James Douglas, M.B., CH.B., a.A.O., D.P.H. ; Corbett, Kathleen May, B.SC., M.D. (BELF.), D.e.H. ; Cormae, Cyril Dove, M.A.,B.M., men. (OXON.),n.p.I-I. ; Corrigan, Julia Mary Dympna, M.B., B.CH. (IRE.), D.P.m ; Cromb, Edith Elizabeth, M.B., CH.B. (EDIN.), D.P.H. ; Crowley, .Matthew, M.B., B.eH. (IRE.), D.P.H. ; Davies, Sadie Margaret, B se ) M B., B.CH (WA)', Duncan . , David , Surg . Capt , R.N , M.D., CH.B . • (OREAD) ., O.P.H. ; Elder, Charles Lmdsey, M.B., CH.B. (MANCtt.), D.p.H. ; Erskme, Frances Mary M,B. (BELF.), n.se., n.P.n. ; Fletcher, Frank Edward, M.B., eH.B. (BRIS.), D.P.H., Barrister-at-Law ; Gordon, ]ames Leslie, M.R.C.S., L.R.C.P.; Gourlay, Robert John, M.IL (OLAS.), D.P.H. ; Halperin, Rachel, M.B., B.S. (LOND.), D.P.H. Hayes, Samuel, M.D. (BELF.), D.P.H. ; Howorth, Irene Elsie, B.SC., M.B., CH.B. LMANCH.), D.C.H., D.OBST., R.C.O.O.; Hudson, John Harral, B.SC., M.B., CH.B. EEDS), D.T.M. ~ H., D.P.H. ; Lambert, Donald Page, M.D. (EDIN.), D.T.M. & H., D.P.tL ;
CHARLES
SAMSON
THOMSON, M . D . n.~.H.,
( G L A S G . ) , M . R . C . P . (ED.), D. H Y . ( D U R H . ) ,
o.~.M.
(C~EECE).
W e record w i t h g r e a t r e g r e t t h e d e a t h a t his h o m e in A y r on M a y 3 o t h of Dr. Charles S. T h o m s o n , w h o was Medical Superi n t e n d e n t Officer of H e a l t h in B e l f a s t f r o m 1928 to 1945. W e are i n d e b t e d to his successor, D r . S. B a r r o n , Ior t h e following tribute :Dr. T h o m s o n w a s a n a t i v e of A y r a n d g r a d u a t e d a t Glasgow U n i v e r s i t y in I9o6. Before c o m i n g to B e l f a s t he held a p p o i n t m e n t s as Medical Officer of H e a l t h a t W o r k i n g t o n , C u m b e r l a n d ; Hyde~ Cheshire; a n d D e p t f o r d , L o n d o n . H e was a Fellow of t h e R o y a l I n s t i t u t e of P u b l i c H e a l t h a n d H y g i e n e , a n d a M e m b e r of t h e R o y a l S a n i t a r y I n s t i t u t e , a n d w h e n he received t h e degree of D o c t o r of H y g i e n e a t D u r h a m U n i v e r s i t y in i938, he b e c a m e t h e s e v e n t h p e r s o n to hold t h a t qualification. " I n I937 he received t h e " S m i t h A w a r d " - - a bronze s t a t u e t t e of H y g e a - - a w a r d e d t r i e n n i a l l y b y t h e R o y a l I n s t i t u t e of P u b l i c H e M t h a n d H y g i e n e to t h e m e d i c a l officer of h e a l t h who, in t h e opinion of t h e Council of t h e I n s t i t u t e , h a d , in t h e d i s c h a r g e of his d u t i e s , rendered t h e m o s t n o t e w o r t h y w o r k in t h e d e p a r t m e n t of p r e v e n t i v e medicine. As a bacteriologist, Dr. T h o m s o n served w i t h t h e R . A . M . C . in t h e I914-18 w a r a n d , in a p p r e c i a t i o n of his services in Salonika d u r i n g t h e B a l k a n c a m p a i g n , t h e Greek G o v e r n m e n t a w a r d e d h i m t h e Order of Military Merit of Greece. W h i l s t in Belfast, Dr. T h o m s o n w a s a lecturer in P u b l i c H e a l t h A d m i n i s t r a t i o n in T h e Q u e e n ' s U n i v e r s i t y of Belfast, a n d corn t r i b u t e d several p a p e r s on ) u b l i c h e a l t h subjects, w h i c h were p u b l i s h e d in professional journals. H e w a s a m a n of genial disposition, k i n d a n d considerate, a n d h a v i n g t h e a p t i t u d e of m a k i n g friends. H e w a s held in h i g h e s t e e m b y t h e m e m b e r s of h i s h e a l t h a u t h o r i t i e s a n d his colleagues. H i s r e t i r e m e n t in 1945 w a s m a r k e d b y t h e p r e s e n t a t i o n of a n i l l u m i n a t e d a d d r e s s b y his staff in the" B e l f a s t P u b l i c H e a l t h Services. H i s wife p r e d e c e a s e d h i m in 1944, H i s son, D r . Charles S. T h o m s o n , is a. g r a d u a t e of Q u e e n ' s U n i v e r s i t y a n d h o l d s a n a p p o i n t m e n t as Medical Officer of H e a l t h a n d A s s i s t a n t C o u n t y Medical Officer in Norfolk. Dr. T h o m s o n h a d been a Fellow of t h e Society of Medical Officers of H e a l t h since 191o a n d w a s elected a fully paid life member after retirement. His f a m i l y a n d relatives are a s s u r e d of t h e deep s y m p a t h y of h i s m a n y friends a n d colleagues.
Lendon,
Nelson
Courtney,
M.A., M.B., B.CFI. (CAMB.), L.M.S.S.A., D.P.H. ;
McKenna, Aileen Isabelle (nee McMahon), M.ILC.S., L.R.C.P., D.P.H. ; McMordie, E. A. M., M.B. (BELF.), D.P.H. ; McNeill, Helen Marjorie, M.B. (BELF.), D.P.H. ; Maughan, John Harry, M.B., B.S. (DURH.), D.P.H. ; Milligan, M. patricia, M.B., B.A. (IRE.), D.P.H., B.SC.; O'Flanagan, Harry, M.R.C.P. (1), (IRE.), D.P.H. ; Pace, T. A., Major, R.A.M.C., B.se., M.D. (MALTA); Parker, Margaret Beryl, M.B., CH.a. (BIaM.), D.P.H. ; Perry, Eileen Elizabeth, M.B., n.CrI. (BELF.), D.P.H., D.C.H., D.OBST.,R.C.O.G. ; Robinsoo, Bennett Douglas, M.B., B.N.(I~URH.);D.P.ICI.; Robinson, Herbert James, M.D. (DIJBL.); Robinson, James Carnmell, Major, R.A.M.C., M.R,C.S., L.R.C.P. ; Simpson, Norman I- Y., M.D. (BELIe.),D.P.H. ; Slater, Margaret, M.m, CH.B. (LIV.) ; Taylor, James. M.B., B.CH. (BELF.) ; Thompson, Beatrice Mary, M.D. ( r l y g . ) ,
(LOND.), B.S., D.P.H. ;
Tinsdale,
George
F . W . , M.B., B.CH., B.A.O.,
B.se. ; Todd, Doris Mar~¢, M,B. (LORD.), B.S. ; Warnock, Hugh A., M.D., B,SC. (BELF.), D.P.H. ; W a t s o n ,
A n n a , M.B., B.CI-I.~ B.A.O., D.P.I-I.
As Assoeiates.--Adorjan, Stephen, M.D. (VIENNA), L.D.S. ; Connelly, Brian, R.C.S. ; Handforth, Claude Ellis, B.D.S., L.D.S. ; Hyland, Kenneth George, L.D.'S.(BRIS.); Irving, A. S., L.D.S, R.C.S. (EDIN.) ; Keith, William John Morrison, L.D.S., R.C.S. ; Leney, Kenneth, L.D.S. (LIV.); Massey, Kenneth Wood, L.D.S. ; Lloyd, Thomas, iX4ajor, R.A.M.C. (T.A.); Outlaw, Frederick Vaughan, Lieut., R.A.M.C. (T.A.); Pennington, Walter, L.D.S. (LIV.); Rattle, Violet Gordon, L.D.S. ; Rimmer, William Lenneth, L.D.S. (LIV.), D.D.S. (PENN.); Sqmer; Mrs. Agnes, L.D.S. ; Williams, Robert Charles, L.D.S. (LIV.); Young, t~lizabeth Z/i., L.D.S., a.e.s.
B.D.S. (LOND.), L.D.S.
COUNCIL MEETING A m e e t i n g of t h e Council was h e l d ' i n t h e HastinKs Hall~ T a v i stock H o u s e , L o n d o n , W . C . 1 , on Friday, M a y 21st, 1948, at 10 a.m. D r . G. F. B u c h a n was in t h e chair, and t h e r e were also p r e s e n t t h e P r e s i d e n t (Dr. F. Hall), M r . J. V. Bingay, L.D.S., Drs. Fraser Brockington, G. L. Brocklehurst, C. Metcalfe Brown, W . A. B u l l o u g h , H . D. Chalke, W . G. Clark, C. K . Cullen, Sir Allen Daley, Sir George Elliston, Drs. Jas. F e n t o n , J. M . Gibson, F, Gray, A. S. Hebblethwaite, C. H e r i n g t o n , K a t h e r i n e Hirst, Sir W i l s o n J a m e s o n , Prof. J. J o h n s t o n e Jervis, Drs. R. H, H. Jolly, J. M a d d i s o n , "M. M i t m a n , A. M o r r i s o n , G. A. W. Neill, A. A. E. N e w t h , W y n d h a m Parker, Prof. R. H . Parry, Drs. H u g h Paul, D. D. Payne, T . R u d d o c k - W e s t , J, E. Spence, J. A. Stirling, J. A. Struthers, M r . A. G o r d o n T a y l o r , L.D.S., Drs. G. M c K i m T h o m a s , N o r a W a t t l e , H . C. M a u r i c e W i l l i a m s and F. T . H . W o o d . Apologies for absence were received f r o m Drs. Cyril Banks, R. H . G. H. D e n h a m , R. M . Galloway, Prof. R. M . F. Picken a n d Dr. J. G r e e n w o o d W i l s o n . M i n u t e s o f t h e last m e e t i n g p u b l i s h e d in PUBLIC HEALTH, M a r c h , pp. 111-1 i4 find a d d e n d u m (April PUBLIC HEALTH, p. 136) were a p p r o v e d and signed by t h e C h a i r m a n . Northern Ireland Branch Representa t l o n . ~ A w e l c o m e was e x t e n d e d to D r . G. A. W . NeiI1 o n his a t t e n d a n c e as t h e first representative of t h e N o r t h e r n I r e l a n d B r a n c h . I n replying h e said t h a t t h e B r a n c h was already active a n d t h e r e was one m a t t e r