Pædiatrics and the General Practitioner

I REGARD myself as being greatly honoured and privileged to give this, the first Stephen Garvin Memorial Lecture. I met Stephen Garvin for the first time more than thirty years ago, and all his subsequent lifetime I enjoyed his personal friendship and that of his family. Apart from our medical association we had a common interest in another of his activities and he taught me a great deal. He had an innate and abiding interest in the diseases and illnesses of children and he had acquired a profound knowledge of conditions which interfered with child health. I have no doubt that had he been born fifty years later he would have been a successful and distinguished consultant in padiatrics. I find that the first professional consultation I had with Stephen Garvin was thirty years ago. The child was suffering from tuberculous meningitis. This was always a depressing diagnosis to nmake and confirm, because it meant that in less than three weeks the child would be dead. In these days the disease is much less common and when the diagnosis is assured treatment is usually successful. I can recall when the medical ward was rarely without at least one patient with tuberculous meningitis-always fatal. Now examples are unusual and, when they do occur, one is not so pessimistic as one was thirty years ago. The reason for this dramatic change is due to the discovery of anti-tuberculous drugs, to better segregation of sufferers from active tuberculosis and to improved social conditions of housing and nutrition as well as increased education and wider knowledge among the general public. The fact that tuberculous meningitis is now very rare, that tuberculosis is no longer the prime killing disease, and that effective treatment is available should not encourage us to be complacent. It is becoming generally recognised that the notifications of first infections has moved into the age group 35-50 years which was for long regarded as being relatively safe; and, of very great importance, that there is a massive reservoir of active tuberculosis, often of the fibroid type, among the elderly, now euphemistically referred to as the geriatric group. It would seem therefore that instead of regarding the disease as conquered, we must keep our minds open and active to the change in the features and pattern of the disease so that we may do the best for our patients. Along with the control …