of morbid symptoms according to the different races, and the influence of industrial development on the spread of tuberculosis. The meeting of July 28 was entirely given over to the discussion of the role of the doctor in the fight against tuberculosis. The subject was introduced by Sir Humphrey Rolleston, who gave a very interesting definition of the duties of the medical profession in fighting tuberculosis. The speaker described the role of the doctor with regard to his clients, in epidemiological, pathological, and clinical research work, and his duties as a teacher, after which he referred briefly to the task which a doctor charged with official duties is called upon to accomplish, and which was to be stated in detail by Sir George Newman. In conclusion, the speaker described the field of action open to doctors in their capacity of advisers to the public and of members of local organisations for combating tuberculosis. Sir George Newman then submitted his report regarding Government collaboration in the fight against tuberculosis. After having emphasised the reasons which justify and necessitate Government intervention, and having given an outline of what has been accomplished in this respect up to the present, both in England and elsewhere, the speaker referred to the programme worked out in 1912 by the departmental committee on tuberculosis, and summarised the principal elements of a complete programme for an anti-tuberculosis campaign. The following points were gone into: the question of obligatory notification of tuberculosis; the work of dispensaries, hospitals, and sanatoria; "after care;" institutions for scientific research; and the role of doctors as public health officers. In the discussion which followed this report several speakers, and especially Dr. Rist (Paris), emphasised the necessity of providing doctors with the requisite knowledge to enable them to carry out reliable diagnosis, recommending for this purpose the institution of special university chairs for phthisiology, such as those already existing in certain medical faculties. Other speakers pointed out the importance of educating the public and the work which the doctor, especially the family physician, can and should undertake in this field. During the conference there were three meetings of the Council of the International Union, the principal subjects for consideration being the elaboration and adoption of the statutes of the International Union against tuberculosis. It was further decided that the headquarters of the Union should be in Geneva and that the functions of Secretary should be confided to the Chief of the Division of Tuberculosis of the League of Red Cross Societies. The Board of Governers of the International Union against Tuberculosis, which was provisionally constituted in Paris in October, 1920, was definitely and unanimously elected. For the year 1922 the Board is made up as follows: M. Dewez (Belgium), Chairman, Mr. Gerald Webb (United States), Vice-Chairman, Professor Calmette (France), Professor Cantacuzène (Roumania), Professor Léon Bernard (France), Secretary-General. The Council decided that the next meeting would be held at Brussels under the Chairmanship of Monsieur Dewez from July 12 to 15 next and that the following meeting should be in Washington in 1924. During the last meeting the following resolutions were unanimously adopted: 1) Resolution submitted by Professor Léon Bernard and Professor Cal mette: "In view of the mortality caused by tuberculosis throughout the world and of the fact that although this mortality is decreasing it is still high and that a great number of lives are uselessly sacrificed to this disease at the time when they are most useful to society, the International Union against Tuberculosis, comprising representatives of 40 nations, assembled in London, urges governments to vote large credits for developing the application of prophylactic measures against tuberculosis. 2) Resolution submitted by Dr. Renon, Dr. Trémescu, Dr. Rist and Colonel Bushnell: "That the International Conference for combating tuberculosis assembled in London, in view of the generally insufficient knowledge of doctors regarding this disease, and the extreme importance of being accurately informed, recommends that in all medical schools in all countries tuberculosis be made the subject of special instruction to enable doctors to learn the precise diagnosis of this malady as well as all methods for combating it." In terminating this summary account of the work of the London meeting, mention should be made of the various entertainments offered to the delegates, including a 'lunch given by the British Government, a reception at the Mansion House by the Lord Mayor of London, etc. The various anti-tuberculosis institutions of London and the surroundings were also visited, including Colindale Hospital, the Sanatoria at Harpenden and Brompton, the research laboratories of Cambridge and the Papworth Colony, which in many ways presents and ideal solution of the question of the collective grouping of tubercular patients, as well as a type of the sanitary village. PROTECTING THE HEALTH OF ENGLISH SCHOOL CHILDREN. S IR George Newman, Chief Medical Officer of the Board of Education in England, has just issued the annual report for 1920. The report states that there are approximately 800 whole-time medical officers in the service, showing an increase of 576 over the previous year. The figures for 1918 are 183. There are now also 1900 school nurses. About 2,400,000 children have been medically examined during 1920, and there are 900 school clinics used mainly for treatment. Sir George Newman reports that this scheme of supervision from infancy to adolescence is "in process of building." He instances the decline of infant mortality as an example of "State preservation "; medical treatment of 400,000 children a year he describes as "State economy. During 1920, 6954 cases of various kinds were reported to the Society for Prevention of Cruelty to Children. These cases, which affected in all 34,680 children of different ages, included neglect, lack of food and clothing, unclean dwellings, ill-treatment, immoral surroundings, ring-worm, operation, tonsils and adenoids, and defective vision. It is stated that in 120 cases recommended for operation and where it was found difficult to obtain the parents' consent, the Society's inspectors, after winning the formers' confidence and explaining to them their duties as parents, succeeded in persuading them to consent to the operation. Records are given of the findings in connection with the health of secondary school children. In the case of elementary pupils, it is stated that two fifths of the examined children were suffering from defects in greater or less degree. The treatment centres were very busy: thus 145,079 children were referred for treatment for tonsils and adenoids and 78,532 received treatment. Some 55,293 underwent operation. The report says that "it is probably correct to say that from 5 to 7 per cent of all school children in England and Wales suffer from these conditions in such a degree as to call for surgical interference. " The reports further adds: "For children to be left to recover after operation with bleeding throats, on the floor of a hospital waiting-room, or to be sent home suffering from haemorrhage or vomiting in a tram-car, or to be allowed, on the day following operation, to play in the street and eat anything they like, is obviously improper; and the surgeon who operates and neglects to satisfy himself that proper after care is practised on each of his parents is incurring serious risks of criticism." It is added that “while in some few hospitals there is, it appears, disregard of the essential points... it is not believed that this occurs in any hospitals or clinics receiving grants in aid from the Board of Education or from the local education authorities. THE ROSCOFF SANATORIUM IN FRANCE FOR TUBERCULAR CHILDREN. Dr. Massard, Assistant Director of the Surgical Clinic of the Children's Hospital, Paris, has published an interesting article on a recent visit to certain sanatoria in France, from which the following is takent : D URING a visit to several sanatoria for tubercular children situated near the Channel and the ocean, Dr. Massard ascertained the fact that there are two categories of sea-side sanatoria: one in which surgical care leaves nothing to be desired, and another in which, unfortunately, patients afflicted with tuberculosis of the bones and joints are left without proper care to get along as best they may. If the action of sea-air is beneficial, it should in no way cause medical treatment to be overlooked, including continual supervision, in fact, all that which constitutes efficient treatment of surgical tuberculosis. The difference between the sanatorium which hospitalises children suffering from Pott's Disease, coxalgia or cold abscess, and a preventorium or sanatorium for lung tuberculosis, is that the former can only effect its purpose if, in addition to the advantages resulting from exposure to sun and fresh air, patients are accorded the same treatment as in a surgical sanatorium. The direction of a sea-side sanatorium should be in the hands of a surgeon who is a specialist in child tuberculosis. The Roscoff Sanatorium (Finisterre), situated on the gulf of Laber at the extremity of the peninsular which protects the Ile-de-Batz, is not only one of the most attractively situated, but is also very comfortably and practically arranged. It can, in fact, be cited as a model of its kind. Air, light and cleanliness were the three main specialities in view. The buildings form two rectangles, having one wing in common, and are united by a large glass covered court where the cure is taken in bad weather. A cement path, connecting the rooms with the beach, enables the children to be rolled in their transportable beds to the shore. Boys and girls are cared for separately, which facilitates supervision. All the dormitories are on the same model, 73 ft. in length and 23 ft. broad with a height of 12 ft.; they have a double exposure and have ten large windows. The walls are oil-painted and have rounded angles. Each dormitory opens at one end into an assistant's room and an isolation ward and at the other end into a toilet room with enamel washbasins and a bath for taking warm sea-baths. Children not confined to their beds, convalescents and those suffering from ganglia, live on the first floor and spend their time out of doors, on the beach when it is fine, in the play-rooms when the weather is bad or in the class-rooms, where they continue their lessons. The rooms on the ground floor are reserved for bed patients (Pott's disease, coxalgia and cold abscess), their treatment consisting either of immobilisation by plaster of Paris splints, or of absolute rest on mattresses which are placed on wheels so that it is easy, even with a small staff, to transport children under the galleries or to the beach, thus facilitating an open-air existence. This institution is being completed with the addition of a pavilion containing forty beds on the model of the pavilions for contagious diseases at the Pasteur hospital. The rooms are surrounded with glass, making it possible to keep children under observation before putting them into the general ward, thus avoiding the epidemics of scarlet fever, measles or mumps which are often the result of mingling children as soon as they arrive. The Sanatorium has about four hundred beds and is capable of enlargement. The service is so organised that if the building is extended, it is only necessary to add pavilions. It is, however, preferable not to hospitalise too many children, for when the number of patients is too great, individual cases are not sufficiently watched, especially by the surgeon, the result being that the sanatorium, instead of being a surgical institute, becomes a sort of holiday colony. In fighting tuberculosis in all its forms, the main thing is not to disseminate one's efforts and not to weary willing helpers nor to make useless sacrifices. The common aim is to protect the race in saving the child, to prevent disease when it is not too late, but, above all, when disease is manifest, to fight it with all the means which nature and science have placed at our disposal. |