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Acute infectious diseases. A handbook for practitioners and students
19~5.
PUBLIC H E A L T H .
a p p e a r to be s t r o n g l y entrenched. But it is, at least, possible that the n e a t future may have, in this direction some surprising c h a n g e s in store for tlS.
The m e t a p h y s i c a l parts of the book are less successful than are the psychological sections. A monistic conception of the universe need not neeessarih- be nmterialistic, as Mr. Pitt a p p e a r s to assume. Idealistic monism is quite a tenable view. N o r does animism necessarlh" imply a dualistic view of the universe. Like all presentday w r i t e r s , Mr. P i t t sees the f u n d a m e n t a l n a t u r e of d e t e r m i n i s m . But, if this doctrine is to be dealt with at all, it should be a d e q u a t e l y discussed, and not dismissed in a few lines of assertion. But the book, as a whole is f a s c i n a t i n g and stimulating. T h e sections which deal with specialization, versatility, and money values are most i n t e r e s t i n g and s u g g e s t i v e . And we can c o m m e n d their study, not merely to educationalists, but to all students of social p r o b l e m s . The book is enriched by a p r e f a t o r y letter from the late M. Emile Boutroux. :\CUTE INFECTIOUg DISEASES.
A H a n d b o o k for
P r a c t i t i o n e r s and Students. By J. D. ROI.LESTOX, ~I.A., M . D . , Oxon. London. t I e i n e m a n n (Medical Books), Ltd. Demy 8vo. pp. 381. 12s. 6d. net. 1925. Thls publication is a notable contribution to the l i t e r a t u r e of the acute infectious diseases. To those who for one reason or a n o t h e r have been unable to keep a b r e a s t of recent w o r k in this country and abroad. Dr. R o l l e s t o n ' s h a n d b o o k should be especially welcome. The a u t h o r has s u p p l e m e n t e d his own extensive experience bv t h a t of Continental and American workers. The result is an a d m i r a b l e reflex of the present state of k n o w l e d g e of those of the acute infections " w h i c h are mainly or exclusively t r e a t e d in isolation h o s p i t a l s " - - i n this country. In p a r t due to the exigencies of w a r and in part to the enlightened policy of the A m e r i c a n s in e n c o u r a g i n g research in the c o m m o n F e v e r s r a t h e r than merely t o l e r a t i n g it, the a d v a n c e in k n o w l e d g e of m a n y of the acute infections from the dual s t a n d p o i n t s of prevention and t r e a t m e n t , has (luring the last decade been r e m a r k a b l e . Dr. Rolleston g i v e s a well balanced account of the chief of these a d v a n c e s for each of the diseases he discusses. F o r those whose daily w o r k m a y necessitate f u r t h e r enquiry a well selected b i b l i o g r a p h y is a t t a c h e d to each chapter. But whilst a d d u c i n g the new, and even the very new in m a n y instances,
2~7
Dr. Rolleston does not neglect the old. Each c h a p t e r contains an historical note which is of g r e a t interest and value. The discoverers of fresh diseases and varieties would s o n l e t l m e s receive a salutary cold douche if they would b u t m a k e themselves a c q u a i n t e d with the o b s e r v a t i o n s of the old m a s t e r s of medicine w h o m a d e these same disc o v e r i e s - - w e l l ! - - e v e r so long ago. The a u t h o r sometimes puts " t o o fine a point upon i t " in the m a t t e r of statistics. Considerable statistical use has been made of the ahundant clinical m a t e r i a l of the F e v e r Hospltals of the M.A.B. \ V h e n l a r g e series of cases are employed for analysis, the p e r c e n t a g e figures are reliable; there are, however, a n a l y s e s of short series of complications and so forth in which pe,c e n t a g e s are carried to two places of decimals. The " p r o b a h l e e r r o r " in these short series must be very considerable. N o real increase in accuracy is obtained by w o r k i n g to the second decimal place. As m i g h t be expected Dr. Rolleston writes a most i n t e r e s t i n g c h a p t e r on Diphtheria. Medicine is indebted to him for m a n y original and vahmble observations upon this disease. There is an excellent account of S e r u m sickness largely founded upon the a u t h o r ' s own work. It m a y be interpolated p e r h a p s t h a t the " v e r y perp l e x i n g " scarlatlnlform eruption following the injection of some batches of serum m a y be rendered much tess p e r p l e x i n g by the p e r f o r m a n c e of the Schultz Charlton test (duly described in its place by the author). Dr. Rolleston was the first to a d v o c a t e in this country the i n t r a m u s c u l a r route for the injection of diphtheria antitoxin. This is now the routine method in most l a r g e fever hospitals. H e is not convinced t h a t the i n t r a v e n o u s route has any a d v a n t a g e s over the i n t r a m u s c u l a r . If rapid adsorption of toxin in a bad case is an essential then the rapid reversal of the Schick test from positive to n e g a t i v e after i n t r a v e n o u s a d m i n i s t r a tion c o m p a r e d with the much slower reversal after i n t r a m u s c u l a r injection are facts a g a i n s t Dr. Rolleston's view. Surprisingly, there is no mention of the use of concentrated antitoxin. The c h a p t e r on c e r e b r o s p l n a l fever gives a g o o d account of the a d v a n c e s m a d e d u r i n g the w a r and since, T h e a u t h o r e m p h a s l s e s the fact that the disease is p r i m a r i l y a s e p t i c a e m i a and may remain such--without meningeal localisation--throughout. The u p - t o - d a t e accounts of the P a r a t y p h o l d s and of T y p h u s were badly w a n t e d in text book
228
PUBLIC HEALTH.
form. The early appearance and extraordinary profuseness of the rash in the Paratyphoids is noted. The [Wilson]-WeiI-Felix reaction in Typhus is rightly considered as equal in diagnostic value to those of Widal and Wassermann. In t h e chapter on Scarlet Fever brief mention is made of the Dick toxin. With regard to Smallpox the author believes that "in spite of a few dissentients A m a a s and A tastrim are merely mild forms of Smallpox . . . capable under certain conditions of taking on a virulent character and causing the severe and fatal form of Smallpox." Having regard to the known facts of Smallpox in particular and of epidemiology in general, this is the only sound view to take. The book is not illustrated. The author rightly considers that patients themselves should form the illustrations. He also thinks that " s o m e excellent text books have been disfigured rather than improved" by drawings and photographs. Some, possibly, but not all. Dr. Rolleston will agree that the illustrations in some of the large Continental works on the infections are accurate and beautiful productions. But these tomes cannot be sold at the very modest price asked for the admirable handbook under review.
R E P R E S E N T A T I O N OF P U B L I C H E A L T H S E R V I C E ON B.M.A. C O U N C I L A N D A.R.M.
The constitution of the British Medical Association provides for nomination and election by the Public Health Service members of the Association as a whole, in the United Kingdom, of (1) two members of the Council, and (2) four Representatives (and four Deputy-Representatives) in the Representative Body of the Association. A Public Health Service member is defined (By-laws 1 and 10) as a member of the Association permanently employed in the whole-time medical service (other than service at a mental hospital) of any council or education authority of any county, county borough, municipal borough, metropolitan borough, burgh, urban district, rural district, parish, or port sanitary authority in the United Kingdom whose name appears as such member in the annual list of members of the Association. The term of office of those elected begins with the commencement of the Annual Representative Meeting at Bath this year, and terminates at the commencement of the Annual Representative Meeting, 1926,
APRIL, 1925.
Nomination papers must be returned to the Medical Secretary not later than Saturday, April 25th, I925. Members elected to the Council are ex officio members of the Representative Body. If more candidates are nominated than vacancies exist v o t i n g papers containing the names of all candidates will be issued through the post to all Public Health Service members of the Association on May 9th, and must be returned so as to reach the Medical Secretary not later than May 16tb, 1925. The counting of the votes will be conducted in accordance with, and the result of the election ascertained by, the method of the single transferable vote. In the election of Representatives, first preferences given for any candidate who is elected to one of the two seats on the Council will be ignored, as such member of Council becomes ex officio a member of the Representative Body. The voting papers affected will not be invalidated, as the remaining preferences shown thereon will be used. The four candidates who head the poll for election of Representatives will be elected Representatives, and the next four will be elected Deputy-Representatives, the fifth successful candidate acting as deputy for the first successful candidate, the sixth as deputy for the second, the seventh as deputy for the third, and the eighth as deputy for the fourth. In order to ensure the representative character of candidates for the above elections, the Council or the Society of Medical Officers of Health are arranging for the following nominations. For Council :
Dr. Robert A. Lyster. Dr. G. F. Buchan. For A.R.,V[., 1925 : (l) Dr. T. \V. Naylor Barlow, O.B.E. (2) Prof. Harold Kerr, O.B.E. (3) Dr. R. Wolsey Stocks. (4) Dr. T. Eustace Hill, O.B.E. (5) Dr. R. H. ~Vilshaw. (6) Dr. D. Morley Mathieson. (7) Dr. P. H. Stlrk. (8) Dr. H. Gibbons Ward. The Council trust that the above nominations will be supported by members of the Society in the event of their election being contested.
ThE Minister of Health announces (circular 567, dated 27th February, 1925) that the revlew of civil service bonus on 1st March, 1925, is based on an average cost of living figure of 8 0 - - t h a t is, on the same basis as obtained on 1st March, 1924.
PUBLIC H E A L T H .
a p p e a r to be s t r o n g l y entrenched. But it is, at least, possible that the n e a t future may have, in this direction some surprising c h a n g e s in store for tlS.
The m e t a p h y s i c a l parts of the book are less successful than are the psychological sections. A monistic conception of the universe need not neeessarih- be nmterialistic, as Mr. Pitt a p p e a r s to assume. Idealistic monism is quite a tenable view. N o r does animism necessarlh" imply a dualistic view of the universe. Like all presentday w r i t e r s , Mr. P i t t sees the f u n d a m e n t a l n a t u r e of d e t e r m i n i s m . But, if this doctrine is to be dealt with at all, it should be a d e q u a t e l y discussed, and not dismissed in a few lines of assertion. But the book, as a whole is f a s c i n a t i n g and stimulating. T h e sections which deal with specialization, versatility, and money values are most i n t e r e s t i n g and s u g g e s t i v e . And we can c o m m e n d their study, not merely to educationalists, but to all students of social p r o b l e m s . The book is enriched by a p r e f a t o r y letter from the late M. Emile Boutroux. :\CUTE INFECTIOUg DISEASES.
A H a n d b o o k for
P r a c t i t i o n e r s and Students. By J. D. ROI.LESTOX, ~I.A., M . D . , Oxon. London. t I e i n e m a n n (Medical Books), Ltd. Demy 8vo. pp. 381. 12s. 6d. net. 1925. Thls publication is a notable contribution to the l i t e r a t u r e of the acute infectious diseases. To those who for one reason or a n o t h e r have been unable to keep a b r e a s t of recent w o r k in this country and abroad. Dr. R o l l e s t o n ' s h a n d b o o k should be especially welcome. The a u t h o r has s u p p l e m e n t e d his own extensive experience bv t h a t of Continental and American workers. The result is an a d m i r a b l e reflex of the present state of k n o w l e d g e of those of the acute infections " w h i c h are mainly or exclusively t r e a t e d in isolation h o s p i t a l s " - - i n this country. In p a r t due to the exigencies of w a r and in part to the enlightened policy of the A m e r i c a n s in e n c o u r a g i n g research in the c o m m o n F e v e r s r a t h e r than merely t o l e r a t i n g it, the a d v a n c e in k n o w l e d g e of m a n y of the acute infections from the dual s t a n d p o i n t s of prevention and t r e a t m e n t , has (luring the last decade been r e m a r k a b l e . Dr. Rolleston g i v e s a well balanced account of the chief of these a d v a n c e s for each of the diseases he discusses. F o r those whose daily w o r k m a y necessitate f u r t h e r enquiry a well selected b i b l i o g r a p h y is a t t a c h e d to each chapter. But whilst a d d u c i n g the new, and even the very new in m a n y instances,
2~7
Dr. Rolleston does not neglect the old. Each c h a p t e r contains an historical note which is of g r e a t interest and value. The discoverers of fresh diseases and varieties would s o n l e t l m e s receive a salutary cold douche if they would b u t m a k e themselves a c q u a i n t e d with the o b s e r v a t i o n s of the old m a s t e r s of medicine w h o m a d e these same disc o v e r i e s - - w e l l ! - - e v e r so long ago. The a u t h o r sometimes puts " t o o fine a point upon i t " in the m a t t e r of statistics. Considerable statistical use has been made of the ahundant clinical m a t e r i a l of the F e v e r Hospltals of the M.A.B. \ V h e n l a r g e series of cases are employed for analysis, the p e r c e n t a g e figures are reliable; there are, however, a n a l y s e s of short series of complications and so forth in which pe,c e n t a g e s are carried to two places of decimals. The " p r o b a h l e e r r o r " in these short series must be very considerable. N o real increase in accuracy is obtained by w o r k i n g to the second decimal place. As m i g h t be expected Dr. Rolleston writes a most i n t e r e s t i n g c h a p t e r on Diphtheria. Medicine is indebted to him for m a n y original and vahmble observations upon this disease. There is an excellent account of S e r u m sickness largely founded upon the a u t h o r ' s own work. It m a y be interpolated p e r h a p s t h a t the " v e r y perp l e x i n g " scarlatlnlform eruption following the injection of some batches of serum m a y be rendered much tess p e r p l e x i n g by the p e r f o r m a n c e of the Schultz Charlton test (duly described in its place by the author). Dr. Rolleston was the first to a d v o c a t e in this country the i n t r a m u s c u l a r route for the injection of diphtheria antitoxin. This is now the routine method in most l a r g e fever hospitals. H e is not convinced t h a t the i n t r a v e n o u s route has any a d v a n t a g e s over the i n t r a m u s c u l a r . If rapid adsorption of toxin in a bad case is an essential then the rapid reversal of the Schick test from positive to n e g a t i v e after i n t r a v e n o u s a d m i n i s t r a tion c o m p a r e d with the much slower reversal after i n t r a m u s c u l a r injection are facts a g a i n s t Dr. Rolleston's view. Surprisingly, there is no mention of the use of concentrated antitoxin. The c h a p t e r on c e r e b r o s p l n a l fever gives a g o o d account of the a d v a n c e s m a d e d u r i n g the w a r and since, T h e a u t h o r e m p h a s l s e s the fact that the disease is p r i m a r i l y a s e p t i c a e m i a and may remain such--without meningeal localisation--throughout. The u p - t o - d a t e accounts of the P a r a t y p h o l d s and of T y p h u s were badly w a n t e d in text book
228
PUBLIC HEALTH.
form. The early appearance and extraordinary profuseness of the rash in the Paratyphoids is noted. The [Wilson]-WeiI-Felix reaction in Typhus is rightly considered as equal in diagnostic value to those of Widal and Wassermann. In t h e chapter on Scarlet Fever brief mention is made of the Dick toxin. With regard to Smallpox the author believes that "in spite of a few dissentients A m a a s and A tastrim are merely mild forms of Smallpox . . . capable under certain conditions of taking on a virulent character and causing the severe and fatal form of Smallpox." Having regard to the known facts of Smallpox in particular and of epidemiology in general, this is the only sound view to take. The book is not illustrated. The author rightly considers that patients themselves should form the illustrations. He also thinks that " s o m e excellent text books have been disfigured rather than improved" by drawings and photographs. Some, possibly, but not all. Dr. Rolleston will agree that the illustrations in some of the large Continental works on the infections are accurate and beautiful productions. But these tomes cannot be sold at the very modest price asked for the admirable handbook under review.
R E P R E S E N T A T I O N OF P U B L I C H E A L T H S E R V I C E ON B.M.A. C O U N C I L A N D A.R.M.
The constitution of the British Medical Association provides for nomination and election by the Public Health Service members of the Association as a whole, in the United Kingdom, of (1) two members of the Council, and (2) four Representatives (and four Deputy-Representatives) in the Representative Body of the Association. A Public Health Service member is defined (By-laws 1 and 10) as a member of the Association permanently employed in the whole-time medical service (other than service at a mental hospital) of any council or education authority of any county, county borough, municipal borough, metropolitan borough, burgh, urban district, rural district, parish, or port sanitary authority in the United Kingdom whose name appears as such member in the annual list of members of the Association. The term of office of those elected begins with the commencement of the Annual Representative Meeting at Bath this year, and terminates at the commencement of the Annual Representative Meeting, 1926,
APRIL, 1925.
Nomination papers must be returned to the Medical Secretary not later than Saturday, April 25th, I925. Members elected to the Council are ex officio members of the Representative Body. If more candidates are nominated than vacancies exist v o t i n g papers containing the names of all candidates will be issued through the post to all Public Health Service members of the Association on May 9th, and must be returned so as to reach the Medical Secretary not later than May 16tb, 1925. The counting of the votes will be conducted in accordance with, and the result of the election ascertained by, the method of the single transferable vote. In the election of Representatives, first preferences given for any candidate who is elected to one of the two seats on the Council will be ignored, as such member of Council becomes ex officio a member of the Representative Body. The voting papers affected will not be invalidated, as the remaining preferences shown thereon will be used. The four candidates who head the poll for election of Representatives will be elected Representatives, and the next four will be elected Deputy-Representatives, the fifth successful candidate acting as deputy for the first successful candidate, the sixth as deputy for the second, the seventh as deputy for the third, and the eighth as deputy for the fourth. In order to ensure the representative character of candidates for the above elections, the Council or the Society of Medical Officers of Health are arranging for the following nominations. For Council :
Dr. Robert A. Lyster. Dr. G. F. Buchan. For A.R.,V[., 1925 : (l) Dr. T. \V. Naylor Barlow, O.B.E. (2) Prof. Harold Kerr, O.B.E. (3) Dr. R. Wolsey Stocks. (4) Dr. T. Eustace Hill, O.B.E. (5) Dr. R. H. ~Vilshaw. (6) Dr. D. Morley Mathieson. (7) Dr. P. H. Stlrk. (8) Dr. H. Gibbons Ward. The Council trust that the above nominations will be supported by members of the Society in the event of their election being contested.
ThE Minister of Health announces (circular 567, dated 27th February, 1925) that the revlew of civil service bonus on 1st March, 1925, is based on an average cost of living figure of 8 0 - - t h a t is, on the same basis as obtained on 1st March, 1924.