OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 15 REPORTS OF EXPERT COMMITTEES TO THE EXECUTIVE BOARD These reports of expert committees are printed in the form in which they were presented to the Executive Board at its second session, held in Geneva from 25 October to 11 November 1948. The observations and decisions of the Executive Board are recorded as footnotes. WORLD HEALTH ORGANIZATION Palais des Nations, Geneva April 1949 TABLE OF CONTENTS Page EXPERT COMMITTEE ON TUBERCULOSIS :Report on the third session 5 EXPERT COMMITTEE ON VENEREAL DISEASES :Report on the second session 18 EXPERT COMMITTEE ON THE UNIFICATION OF PHARMACOPOEIAS :Report On the third session 39 3708 Lop [WHO/TBC/3] II October 1948 EXPERT COMMITTEE ON TUBERCULOSIS REPORT ON THE THIRD SESSION 1 Held 30 September-4 October 1948, Office International d'Hygigne Publique, Paris Contents Proposals of the Delegation of Czechoslovakia 2 . Consideration of matters referred to the The listed suggestions for tuberculosis control, committee by the Health Assembly and made in the first part of the Czechoslovak pro- the Executive Board posals, are in accord with the general principles 2. Reconsideration of previous reports set out in the committee's first and second reports.8 Since, however, conditions vary from country to 3 .Other items country, the committee feels that advice on a Annexes detailed plan of operations should be given by the tuberculosis section of WHO in each indi- vidual case.For example, the committee ques- The Expert Committee on Tuberculosis held tions the value of attempting " registration of its third session in Paris from 30 September to every case of confirmed and suspected tubercu- 4 October 1948. The following members were losis " in such large countries as China and India, present : where at present little use would be made of such Dr. P. M. D'Arcy Hart, Farm Laboratories, information. NationalInstituteforMedicalResearch The other comments of the delegation of (Medical Research Council), London, United Czechoslovakia consisted of suggested modifica- Kingdom tions to the committee's first and second reports. Dr. H. E. Hilleboe, Commissioner of Health, They will now be considered in sequence. New York State Department of Health, The committee agrees that, to the four special Albany, N.Y., USA fields in which it was stated as essential to have Dr. J. H. Holm, Chief, Tuberculosis Division, trained medical officers in tuberculosis in each State Serum Institute, Copenhagen, Denmark country and to grant travelling fellowships, there (Chairman) should be added a fifth, namely, public-health nursing. (The member from the USSR has not yet been nominated.) The committee also accepts the recommendation regarding WHO fellowships-that facilities should Dr. J. B. McDougall (Secretariat) was secretary be provided in training centres for training of the committee. teams, as well as individuals. It was noted that the Executive Board of the The committee fully agrees that, in the train- World Health Organization at its first session ing of fellows from central and eastern Europe, appointed the expert committee of the Interim full consideration should be given to the health Commission to serve as an ad hoc committee conditions in these countries following the war. until a new committee is appointed. The committee agrees also with the comments made on the scope of consultation services and 1. Consideration of Matters referred to the mass radiography. Committee by the Health Assembly and the The committee is of the opinion that it is not Executive Board possible to prepare a general statement, applicable to all countries throughout the world, on the type The committee noted that the reports of its and size of buildings, number of beds, clinical first and second sessions were generally accepted equipment and provision of staff needed for by the World Health Assembly.It first con- effective tuberculosis control.It feels that these sidered matters referred to it by the Health details must be determined by a first-hand survey Assembly and the Executive Board. of the country concerned by qualified personnel, taking into account current local conditions. 1 The Executive Board, at its second session, " took note of the report of the third session of With regard to the proposal that the production the Expert Committee on Tuberculosis and decided and distribution of tuberculin, streptomycin and to publish it as submitted, without observations but with a note stating that the Board had post- poned discussion of the report until itsthird 2 See Annex 1, p. 8 session ". Oft. Rec. World Hlth Org. 14, 19 3 Off. Rec. World Hlth Org. 8, 49 ;11, 5 TUBERCULOSIS - 6 - BCG vaccine be increased, steps in these matters establishment of WHO and of the decisions made are being taken by the Joint Committee on Health by the first Health Assembly in the field of Policy, UNICEF/WHO. The recommendation of tuberculosis.7 the expert committee's own Sub-Committee on Streptomycin contains practical suggestions on the distribution and use of streptomycin. 2.1Composition of Expert Committee on Tuber- The Sub-Committee on Tuberculin and BCG culosis 8 has made recommendations on uniform procedures under these headings.(Annex 2 and Appendix This ad hoc committee has carefully considered pp. 9, TO.) the question of the size and type of representation The expert committee agrees that when advice is of the new Expert Committee on Tuberculosis given to a country by the Secretariat on the plan- of WHO. On the basis of extensive experience ning of the WHO tuberculosis programme for that in a number of countries, the committee is firmly country, special attention should be given to the of the opinion that the number should be as needs, resources and attitudes of the people in small as is consistent with effectiveness. A small assessing what could be accomplished in the first committee works more rapidly than a large one, year. To assist in this, the committee has drawn is more economical, and reduces language diffi- up, as part of the report on its third session, an culties.Itpermits the members to become outline of the stages of a campaign that might acquainted with one another more quickly, so be undertaken in a country with an undeveloped that they act as an integrated advisory body. programme. The committee is in full agreement with the The type of representation on the new com- suggestion that WHO should, at the beginning, mittee should include administrators, epidemio- concentrate its work on areas of the greatest logists,laboratory experts and clinicians,so need and in which the best results could be asto consider tuberculosisasa community achieved in the most economical way.It believes problem as well as a disease affecting the indi- also that, in the first year, WHO should place vidual. What is wanted is special knowledge of special emphasis on stimulating provision for all the main phases of tuberculosis control and laboratory facilities for the exact detection of not only that of the clinical care of patients. tubercle bacilli ;this is an essential first step in the prevention of the spread of the disease Geographical representation should also be given from infectious cases. careful consideration. Accordingly, it is recommended that the new 1.2Proposals of the Delegation of Greece 4 expert committee consist of six regular members, and that a panel of five specialists, including Experience of the UNICEF teams now operat- a public-health nurse, should also be formed ; ing in the field has demonstrated that the pro- one or more of the panel should be co-opted for posals concerning three-monthly tuberculin-test- special problems under Rule 14 of the Rules of ing of children and adolescents are impracticable. Procedure for Expert Committees and their Sub- Accordingly,therecommendations were not Committees.9 The regular committee should meet accepted. twice a year to consider current problems, and at one of these meetings each year one or more 1.3 BCG Vaccination 5 of the panel, as well as further specialists if need The expert committee has reviewed this docu- be, should be brought in to consider special ment and wishes to restate the views expressed problems and -alb long-term plan. In this way, in its previous reports, namely, that BCG vaccina- special problems could be handled in the future tionalone cannot control tuberculosisina through the co-option of individual specialists, country ;however,it can play an important rather than through sub-committees. part in the preventive aspects of the total control programme. 2.2Regionalization 1.4Addition to Expert Committee The committee noted that the Health Assembly The expert committee discussed the recom- gave high priority to tuberculosis.Therefore, in mendations of the Executive Board,6 that a fifth the development of the regional programme of member who is expert in antibiotics should be WHO, the committee recommends that there be added to it.Because of the fact that one of its attached to each of the regional offices a full- members is recognized as expert in the field of antibiotics in tuberculosis, the committee is of the opinion that this field is well covered. 7 Off. Rec. World Hlth Org. 13, 300, 302 8 The Executive Board, at its second session, made the following comment :" Concerning the 2. Reconsideration of Previous Reports composition and meetings of the expert committee, the Board agreed that (r) the membership should The expert committee then reconsidered matters be increased to nine, taking into account the need for specialists in all the different aspects of the in its previous reports in the light of the final problems and adequate geographical distribution, and (2) no definite number of meetings a year 4 See Annex /, p. 9 should be specified. " Oft. Rec. World Hlth Org.