570

, combine efforts of these authorities should suffice to deal

I

with any situation that may arise - in a disciplined’European community. In dealing with the more back-ward and uneducated Indian inhabitants of the denselypopulated endemic areas problems too numerous to assessarise ; but among these religious and social customs attimes are formidable obstacles to the employment ofscientific knowledge.YOUNG NURSES IN TUBERCULOSIS WARDS

SHORTAGE of nursing staff in some institutions is nowso acute that at least one isolation hospital-whichincludes a sanatorium of 36 eds-is frankly advertisingin the nursing press for girls of 16 and over. We haveheard of more than one case in which girls of 16, and evenof 15, were put straight into .tuberculosis wards andrapidly acquired the disease. Unfortunately there is nolegislation to prevent girls of this age from entering thenursing service, ’though formerly hospitals customarilyrefused to accept them below the age of 172 or 18. Lastyear the Ministry of Health advised hospitals on theprotection of girls undertaking to nurse tuberculouspatients.2 Good arrangements were described for routineexamination, including chest radiography, and it was

suggested-but not required-that " a Mantoux test

(or similar tuberculin test) should be included."Reports still reach us, however, of newly acceptedtuberculosis nurses examined neither by Mantoux testnor X rays, taught no precautions whatever before being

. sent into the wards, left unprovided with masks thoughexposed to heavy infection (perhaps from ill-disciplinedpatients in _a late stage of tubercle), and snubbed orneglected when their own first symptoms appear.Contrasted with this is the practice in good sanatoriumswhere supervision of nurses is thorough and responsible,and gives gratifying results, as a recent contributionto our columns shows.3

If, in the present nursing crisis, it is really impossibleto enforce rejection of very young or vulnerable candi-dates, the Ministry should ensure that they are supervisedand instructed in such a way that they are not exposedto unnecessary risk. If they take the infection despitesuch precautions, early diagnosis should make it possible

, to restore them to full health. Any lower order of carethan this cannot be justified.

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CANCER RECORDS IN CONNECTICUTTHE methods adopted by the Department of Health in

the State of Connecticut to facilitate cancer researchand encourage early treatment deserve study in thiscountry, particularly -now when our new system of

recording cases of cancer is under trial. Eleanor J.Macdonald,4 the research statistician, discusses the sur-vival-rates of people with proved cancer and explainshow the figures are obtained. A special effort was madeto get a follow-up of all cases of cancer treated in Con-necticut since 1935, with the result that many cases ofproved cancer were found to be alive and well. It isbelieved that the records of these patients can be used toteach the general public that cancer is an ordinarydisease, dangerous but curable, about which they shouldknow enough to seek medical advice if they need it.

Miss Macdonald’s paper, one of several similar publica-tions, may be regarded as cancer propaganda of a simpleand satisfactory type. She points out that the crudedeath-rate from cancer is fairly constant, showing howmuch remains to be done, but the divergence betweenthe primary hospital admission-rate for cancer and thecancer death-rate is getting steadily wider. In the pastthe number of deaths from cancer and the number of.patients admitted to hospital suffering from cancer wereapproximately the same in any one year, so, although1. Nursing Times, April 7 and 14.2. Circular 33/44. See Lancet, 1944, i, 456.3. Edwards, P. W.. Penman, A. C. Lancet, April 7, p. 429.4. Connecticut Health Bulletin, November, 1944.

patients dying were in most cases not those first recordedthat year, it seemed that practically all cases of provedcancer died of that disease. Now for a number of yearsconsiderably more patients have been admitted forcancer but the death-rate has not risen, an indication thatan increasing number of the cases treated are eithercured or have their life much prolonged. Early treat-ment remains the obvious method of increasing thesurvival-rate, and only by the collaboration of everyone

concerned, whether in diagnosis, treatment, or education,can awareness of the symptoms of cancer be inculcatedwithout frightening the individual.

The Connecticut system might well be adapted to meetthe needs of the Regional Cancer Organisation nowtaking shape in Britain. Beginning at the periphery,small meetings and discussion groups, often taught bythe local doctor, obtain the interest of lecturer and lis-tener,, and this leads to earlier diagnosis. Special clinicsin local hospitals, where points are allotted on whichclaims for payment for the investigation of patientssuspected of cancer may be made, form the next link inthe chain. Treatment in central hospitals which providethe most modern specialised methods gives to all provedcases the best possible chance of cure ; and finally acareful system of follow-up and aftercare provides datafor research and ensures that no patient relapses merelyfrom lack of skilled attention.

STUDENTS AS RELIEF WORKERS

LAST week 95 senior medical students left London forBelsen camp, where in teams of 12, under the guidance ofexperts from the Ministry of Health and the Ministry ofFood, they will help in the treatment of the starving. Thestudents, who volunteered in response to an appeal fromthe Ministry of Health, are drawn from the followingLondon medical schools : St. Bartholomew’s, Guy’s,King’s College Hospital, London, St. Mary’s, Middlesex,St. Thomas’s, University College Hospital, and West-minster. They are wearing a khaki uniform’ withthe shoulder flashes of the Red Cross and St. JohnAmbulance, under whose auspices they are travelling. AtBelsen there are already six civilian teams in action, fivemanned by members of the Red Cross and St. John andthe sixth by Friends. Each team of 12 men and womenis self-supporting, with its own cooking and’ washingapparatus, stores, and equipment, and to each is attachedtwo ambulances,’two trucks, and a 3-ton lorry.

THE MEDICAL REGISTER

THE Medical Register for 1945 appears at a time whendoctors and patients are planning the future healthservices of the country. It sets out clearly the resources,that are available. At the end of 1944 it contained thenames of 73,646 doctors, more than ever before. But thenumber of new names added during the year was only2971 as against 3532 in 1943. The number of registra-tions in Scotland remained steady, and the number of" colonials " increased, but in England registrationsfell by over 300 to 1196 and in Ireland by just under100 to 307. The rest of the decrease is accounted for

by a fall in foreign registrations of over 300. During thewar the intake of medical students has been rationed,and in answer to a parliamentary question Mr. Williiik

"

stated last week that the number of students entering themedical schools last autumn was the same as in 1943.A rise in the number of new registrations is therefore

not to be expected in the first post-war years.

Dr. STEPHEN TAYLOR has been adopted as Labour candidatefor Barnet and Dr. W. B. J. PEMBERTON as Liberal Nationalcandidate for West Bermondsey. ’

THE Tuberculosis Association will meet at 26, PortlandPlace, London, WI, on Friday, May 11, at 3.30 PM, when Dr.M. H. Logg and Dr. Josephine Barnes will’ open a discussion onpregnancy and tuberculosis. ,

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