891TRAINING IN TUBERCULOSIS.—STREPTOCOCCAL INFECTION.

THE LANCET.

LONDON: SATURDAY, APRIL 23, 1932.

TRAINING IN TUBERCULOSIS.i

THE Joint Tuberculosis Council consists of 30 members representing the various societiesinterested in tuberculosis, with delegates fromthe Society of Medical Officers of Health, theBritish Medical Association, the Ministries ofHealth and Pensions, and eight coopted members.The Council was formed in 1924 for the purpose of

coordinating the study and treatment of tubercu-losis and to promote research. Questions are

referred to it by government departments, localauthorities, and workers in various fields. Import-ant memoranda on notification, disinfection, andemployment have been issued, and in 1930 a

scholarship tour was arranged in collaborationwith the Sun Life Assurance Company of Canada.A report just issued by a committee of the Councildiscusses the problem of teaching tuberculosis tostudents and officers of the tuberculosis service.Most of the tuberculous patients who used toattend teaching hospitals now attend the tuber-culosis dispensaries or from there are sent to oneof the special institutions provided by localauthorities. It is possible at the moment for amedical student to present himself for his finalexamination without having seen a single case ofpulmonary tuberculosis, although each year some40,000 people die of this disease in England andWales alone. Apart from its importance as a

disease, tuberculosis has some claims to be con-sidered a subject on which medical teaching shouldbe based. The teaching of tuberculosis to studentswould give them an insight into the relationshipbetween social and industrial conditions and theincidence of disease. It would also assist themto know how to examine the chest, for physicalsigns and X ray interpretations can be learntbetter at a chest hospital than elsewhere. Again,the principles of orthopsedics can be well taught at ahospital for surgical tuberculosis. To arrangefor a more thorough teaching of tuberculosisneed not increase the burden of the student whosecurriculum is already overcrowded. A knowledgeof tuberculosis would help him to understandthe principles of pathology and treatment as

applied to other diseases ; there is no subjectbetter suited for instructing students in firstprinciples. While the claims of syphilis, mentaldisease, or rheumatism may be admitted, tuber.culosis stands alone in this : although one ofthe most common causes of illness and death it is

becoming more and more uncommon in the outpatient departments and wards of teaching hospitals,except such as have a tuberculosis dispensary.

The report makes the following recommendationsfor training :-

1. That with some notable exceptions the presentmethods of training students in tuberculosis are

inadequate for lack of arrangements ensuring closecooperation between the public health service, andthe medical schools and teaching hospitals, thus notutilising clinical material in the dispensaries andsanatoria belonging to public authorities. TheGeneral Medical Council might urge upon theseschools and hospitals the importance of cooperation.

2. That the arrangements for teaching at certainmedical schools, where medical officers of the tuber-culosis service are lecturers in tuberculosis and havecharge of beds, are worthy of consideration at othermedical schools where no arrangements at presentexist to utilise the personnel and material availableunder the tuberculosis schemes of the local authorities.

3. That, where Local Government grants are givento assist medical schools or teaching hospitals, itwould be reasonable for the authorities to require,as a condition of the grant, proper cooperation withthe work of tuberculosis schemes.

These recommendations are worthy of carefulconsideration, and although it may be impossibleor unwise to give to all students a special trainingin tuberculosis it is undoubtedly a disease withwhich they should be familiar before qualification.The work of the tuberculosis officer is becomingmore and more specialised, and only a man ofhigh professional standing with experience in allforms of tuberculosis can act adequately as con-sultant and adviser to the general practitioner.It is reasonable to require that every tuberculosisofficer should have hospital beds at his disposal andthat, where convenient, the medical staff of a

, sanatorium should be responsible for some clinical

.

work outside the institution. The report is signed.

by twelve members of the Council and the convener,Dr. G. LISSANT Cox. Copies may be obtained

- from Dr. ERNEST WARD, hon. secretary of theCouncil, 123, Torquay-road, Paignton, Devon.

STREPTOCOCCAL INFECTION.THE subject of this year’s Milroy lectures ha s

; been aptly chosen. Since the war the volume) of original work on streptococcal infection has

been immense though of very various value.With some of that work Prof. C. C. OKELL has

1 been intimately associated, and his own contri-b butions have been among the most enlightening.,

These years have seen a return to many ideaswhich were long forgotten ; in the latter part

3 of the nineteenth century, for instance, boths the toxic properties of streptococci and the strepto-e coccal aetiology of scarlet fever were well accreditede theories. There are now many established facts1 to go upon and the time was ripe for the compre-s hensive summary and criticism which the lecturert concludes in our present issue.t To many surgeons and physicians the present

position is a disappointing one It is very true- that scarlet fever is now a relatively slight disease,

that the terribly virulent cases of cellulitis ands septicaemia are rarer. As Prof. OKELL admits,;- this result is a by-product of medical hygiene,;, if in fact medicine can claim any credit for it.

In much the same way small-pox appears to have