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TUBERCLE THE JOURNAL OF THE BRITISH TUBERCULOSIS ASSOCIATION A STAPLES Single Copy U.K. 3s. 6d. ; (3s. 7½d, post free) Single Copy U.S.A. (75 cents post free) ® PUBLICATION Annual Subscription U.K. 40s, post free Annual Subscription U.S.A. ~6. post free Pull Devil, Sometimes a problem that has lain sleeping in one's mind is reawakened by the touch of some passing idea or perhaps two or three related observations remind one that the old "difficulties posed in the problem are still unresolved. At the NAPT conference the Minister of Health singled out thoracic surgery as the field in which expansion was contemplated in his department whereas at Cambridge at the BTA conference Professor Leslie Banks said that he thought that we could get tuberculosis completely under control within ten years but only if we turned our minds from treatment to prevention. The minister was speaking to a body by name devoted to prevention while the Professor was speaking to a clinical body whom he supposed to be mostly interested in treatment. The case is not without its irony. But can we not have it both ways? Treatment is expensive and the most ex- pensive part of treatment is surgery even though it may be applicable to but a small fraction of our tuberculous patients. It has the advantage of being a conception readily understood in general terms but it has the great disadvantage in that it is without discipline and subject to surgical fashion whicfi changes from year to year. At present in some districts pulmonary tuberculosis is regarded almost as a 'surgical' disease: it was not so a year or two ago and it may not be so a year or two hence. In fact to many observers it appears doubtful whether there is a future for thoracic surgery on any large scale. The conception of prevention on the Pull Baker other hand is hard to grasp and is dramatic only to the statistician. Its successes are negative. Something does not happen. Nobody falls ill but this does not have the same appeal as the wonderful recovery of say Betty Jones saved by the devoted skill and attention of doctors and nurses. Nevertheless a little imagination should tell us where we ought to put our main effort. Surgery is important but limited whereas in prevention we have the key to success. It is unfortunately dull in detail like the conquest of diphtheria. Preventive measures are not particularly skilled or clever but they are sufficiently clear. They include the use of mass x-ray focused on particular groups, districts or industries, tuberculin testing, BCG vacci- nation, contact examination, high pressure almoning to keep up or raise the standard of living of tuberculous families, minor treat- ment on the principles described by Drs Aslett and Erin in the July issue &TUBERCLE, propaganda amongst general practitioners and public and careful follow up of estab- lished patients. All these activities which properly emanate from the Chest Clinic are important and necessary and apart from world calamity their success is assured. The confidence expressed in Professor Banks' speech surely finds an echo in the hearts of chest physicians when they survey the changing scene of the past few years. It has improved beyond all expectation and only the perverse will shake their heads over a future surely not darkened by the continued survival of their patients.

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Page 1: Pull devil, pull baker

T U B E R C L E T H E J O U R N A L O F

T H E B R I T I S H T U B E R C U L O S I S A S S O C I A T I O N

A STAPLES

Single Copy U.K. 3s. 6d. ; (3s. 7½d, post free) Single Copy U.S.A. (75 cents post free)

® PUBLICATION

Annual Subscription U.K. 40s, post free Annual Subscription U.S.A. ~6. post free

Pull Devil, Sometimes a problem that has lain sleeping in one's mind is reawakened by the touch of some passing idea or perhaps two or three related observations remind one that the old "difficulties posed in the problem are still unresolved. At the NAPT conference the Minister of Health singled out thoracic surgery as the field in which expansion was contemplated in his department whereas at Cambridge at the BTA conference Professor Leslie Banks said that he thought that we could get tuberculosis completely under control within ten years but only if we turned our minds from treatment to prevention. The minister was speaking to a body by name devoted to prevention while the Professor was speaking to a clinical body whom he supposed to be mostly interested in treatment. The case is not without its irony. But can we not have it both ways? Treatment is expensive and the most ex- pensive part of treatment is surgery even though it may be applicable to but a small fraction of our tuberculous patients. It has the advantage of being a conception readily understood in general terms but it has the great disadvantage in that it is without discipline and subject to surgical fashion whicfi changes from year to year. At present in some districts pulmonary tuberculosis is regarded almost as a 'surgical' disease: it was not so a year or two ago and it may not be so a year or two hence. In fact to many observers it appears doubtful whether there is a future for thoracic surgery on any large scale. The conception of prevention on the

Pull Baker other hand is hard to grasp and is dramatic only to the statistician. Its successes are negative. Something does not happen. Nobody falls ill but this does not have the same appeal as the wonderful recovery of say Betty Jones saved by the devoted skill and attention of doctors and nurses. Nevertheless a little imagination should tell us where we ought to put our main effort. Surgery is important but limited whereas in prevention we have the key to success. It is unfortunately dull in detail like the conquest of diphtheria. Preventive measures are not particularly skilled or clever but they are sufficiently clear. They include the use of mass x-ray focused on particular groups, districts or industries, tuberculin testing, BCG vacci- nation, contact examination, high pressure almoning to keep up or raise the standard of living of tuberculous families, minor treat- ment on the principles described by Drs Aslett and Erin in the July issue &TUBERCLE, propaganda amongst general practitioners and public and careful follow up of estab- lished patients. All these activities which properly emanate from the Chest Clinic are important and necessary and apart from world calamity their success is assured. The confidence expressed in Professor Banks' speech surely finds an echo in the hearts of chest physicians when they survey the changing scene of the past few years. It has improved beyond all expectation and only the perverse will shake their heads over a future surely not darkened by the continued survival of their patients.