146 T U B E R C L E

been fully presented and on the evidence care- fully weighed.

We would like to point out that the fall in mortality from pulmonary tuberculosis in Liverpool from I93i to I95I was greater than the fall in mortality for the rest of the country. The fall in Liverpool was from I x 5 per xoo,ooo of the population in 193i to 52 per ioo,ooo in I95I, whereas the fall in England and Wales was from 71 per Ioo,ooo in I93x to 27 per xoo,ooo in I95i. The decrease in Liverpool was therefore 63 per Ioo,ooo while that for England and Wales was 44 per Ioo,ooo.

The cause of the high mortality in Liverpool in I93t is to be found in the social conditions existing as a result of poverty, overcrowding and unemployment which were not experienced to the same degree in other Midland and Southern cities mentioned by you. Added to this was the problem produced by a very mixed and heterogeneous population including Irish,

Mortality rates per 100,000 persons from Respiratory Tuberculosis 1941 to 1951

II0 -

lOO~ \ 9 0 LIVERPOOL COUNTY

90 ~ BOROUGH

80 ~9 72 z~'

70 - 68

¢o 60 ~. s6 6o

""So-a--"°'-. ~2 ~z ENGLANDa 2 5(3 " - - - " - - 4 G 4 7

40 . . . j .o

~0 o.

2O

10

0 w , I I ! ~ l ! I I 19~1 1942 1943 1944 1945 1946 1947 1948 1949 1950 I~SI

Welsh, and British and foreign merchant sea- men - all groups of the population in which the attack rate of tuberculosis has in the past been notoriously high. In order to compare the mortality and the fall in mortality in such a way as to be fair to Liverpool, comparisons should be made with a comparable seaport with a similar population, for it is an elementary principle of statistics that in making deductions like should be compared with like.

As to recent years, the fall in mortality since I948 has been much more rapid in Liverpool

May 1953

than in England and Wales. The difference is shown in the following figures:

I948 I95X Liverpool . . . . . . . . 79 52 England and Wales . . . . . 44 27 Difference . . . . . . . . 35 25

This more rapid fall in Liverpool is revealed pictorially in the appended graph. I f the Liverpool fall continues at its present rate, it should approximate to the national figure in a few years from now which would be com- mendable having regard to the initial handicap.

These results have been the consequence of the improved preventive and therapeutic facilities which have been provided, and the following figures kindly collected by Dr O. F. Thomas, Physician Superintendent to the Aintree Hospital, bear eloquent testimony to the result of these efforts.

AINTREE HOSPITAL

Surgical Total Deaths opera- deaths as ~ of

A~,ailable Admis- lions of in admis- beds sions all kinds hospital aions

1942 x 94 289 108 74 25 % x943 265 352 206 75 2 I x944 313 543 23o xo4 t 9 ~ 1945 415 43 ° 396 1o4 24% I946 4t5 442 503 99 22 x 947 4 x 5 479 487 78 16 x948 415 585 93 ° 68 x2 x 949 415 683 849 56 8 x95o 463 8~ 9 8I i 66 8 ~ I95t 463 981 94 ~ 4 z 5 ~ I952 5o3 936 x,oI6 33 4 ~

In regard that from

to these figures it should be noted I95O chemotherapy has been freely

avaiIable, therefore larger numbers of acute progressive cases have been admitted which ordinarily would have increased the death-rate. There has been no change in policy throughout in advising hopeless cases to remain in hospital.

Our aim here is to continue to press fotavard with those measures which have already been instituted so that we ourselves can be satisfied that our efforts have been sufficiently dynamic having in mind the particular problems with which we have been confronted.

Yours faithfully, T . LLOYD HUGHES,

Senior Administrative Medical Officer, Liverpool Regional Hospital Board.

ANDREX, V B. SEMPLE, Medical Offcer of Health, City and Port of Liverpool.

The Ed i to r - 'Tubercle'. SIR,- Your leading article in the April issue of the journal discusses the proper dose of PAS

May 1953 T U B E R C L E 147

when given alone. I consider that to give PAS alone is a dangerous practice. Various publica- tions on the subject indicate that PAS-resistant tubercle bacilli are likely to emerge, figures for the incidence 5rarying from 13 per cent to too per cent. Our group in Edinburgh has investi- gated this point and also the efficacy of PAS in preventing streptomycin-resistance in patients who have previously received PAS alone for long periods. In an article, at present in the press, we review the relevant literature and report PAS-resistant organisms occurring in a high proportion of our patients who had previously received PAS alone for varying periods. When these patients were later treated with streptomycin and PAS in combination, streptomycin-resistant organisms emerged as rapidly as would have been the case had they received streptomycin with no accompanying PAS. In addition I have a patient who has been primarily infected with a PAS-resistant strain. Both these catastrophes are likely to be repeated many times if your recommendations are adopted. In view of these facts you will agree that to treat patients with PAS alone is no more justifiable than to treat them with either streptomycin or isoniazid alone.

Yours faithfully, JOHN CaovroN.

British Tuberculosis Association

Annual Conference in Conjunction with the Tuberculosis Society of Scotland.

E d i n b u r g h - J u l y I to July 4

Wednesday, July x AFTERNOON--

Opening Address by the Earl of Home, Minister of State for Scotland.

Drug Resistance in the Chemotherapy of Tuberculosis, by Professor John Crofton.

Antibiotics in Non-respiratory Tuberculous Disease, by Mr Stanley Evans.

Thursday, July 2 ~iORNING--

Tuberculous Endometritis, Treated by Streptomycin and PAS, by Dr Arthur Sutherland.

Genito-urinary Tuberculosis, by Dr W. Borthwick.

Tuberculosis in I n f a n c y - C e r t a i n Aspects of Immunity and Pathology, by Professor ~Vilfrid Gaisford and Dr Agnes Mac- gregor.

AFTERNOON-- Epidemiology and Control of Tuberculosis

in the light of Tuberculin ~[atriculation, by Dr Tobias Gedde-Dabl.

The National Tuberculosis Survey in Ire- land, by Dr James Deeny.

Friday, July 3 MORtoN,--

Functional Prophylaxis in Pulmonary Collapse Therapy, by Dr Birath.

Diagnostic Bronchoscopy in the Chest Clinic, by Mr S. J. McHale.

The Industrial Pulmonary Fibroses, by Dr A. I. G. McLaughlin.

The Inert Pneumokonioses and other Dust Conditions, by Dr A. T. Doig.

AFTERNOON-- Free for sight-seeing or trips.

Saturday, July 4 MORmNO--

Demonstrations at City Hospital, Edinburgh. Professor Crofton. Mr Logan.

ANNUAL GENERAL MEETING-- Wednesday 5 p.m.

CIVIC RECEP TION at CITY CHA MBERS-- Wednesday 8.3o p.m.

B . M . A . - Tuberculosis Group Annual General Meeting--

Thursday 5 p.m. ANNUAL DINNER--

Friday.

Further information can be obtained from the secretary, Dr Hugh Ramsay, I6, Grosvenor Place, London, SAV. I. Telephone SLOane 2 r t 5.

Obituary Dr MARC DANIELS

Dr George Canetti, a distinguished French phthisiologist and a friend of Dr Daniels from their student days, writes:

It is not easy for me to speak of Marc Daniels, for modesty was his outstanding q u a l i t y - h e hated to be discussed. And with that, his sense of exactitude was strongly developed, everything vague or approximate displeasing him. Thus he remained silent, conversation was to him a bit like an accumulation of unprecise fac t s - th i s house of cards made him laugh. His was a rich nature, but reluctant to reveal itself. I have known few with a vaster scale of interests; and what he loved, he loved tenaciously, never t empora r i ly -hence the deep warmth in his eyes. His feeling for nature was intense, there alone he felt at ease; as a student he escaped into the open whenever possible. He travelled