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Anthropology and tuberculosis
M a r c h , 19129]
ANTHROPOLOGY AND TUBERCULOSIS
TUBERCLE. M A R C H , 1929.
Anthropology and Tuberculosis. FI~oM time to time reference has been made in this journal [lj to regional surveys in tuberculosis. Such surveys have been made in Norway, Sweden, Wales and America. The :Framingham Survey in America was made on a big scale and its results are well known. The others have been small and often necessarily incomplete. One of the outsLanding difficulties of the work is the reduction of the variable factors l~o manageable proportions, hence no doub~ the lack of information on this subject in large communities with free communication with the outside world. A new and interesting investigation on original lines has recently been made by Mr. E m r y s G. Bowen [2], in which he has outlined the physical anthropology and other sociological features of certain areas in Wales in such a way as to demonstrate their relation to the incidence and distribution of certain types of tuberculosis. A wealth of material on physical anthropology had already been accumulated during the past twenty years by Professor Fleure at Aberystwyth and Mr. Bowen was able to avail himself of this material. To this fortunate circumstance may be added the valuable material at hand in the Welsh blational Memorial Association with Professor S. Lyle Cummins' records, and the exceptionally favourable geographical features of certain parts of Wales which enabled the conditions, both environmental and human, to be studied within a small compass. :For these reasons Cardiganshire was chosen as the area for investigation. This area. has been well surveyed anthropologically. It possesses, moreover, one of the highest tuberculosis death-rates of all the English and Welsh counties. The county is divisible physically into a coastal plateau, the valleys of which support a fairly large population dependent upon stock raising, and a high moorland plateau culminating in Plynlymon
275
with much cold boulder-clay soil and a sparsely scattered, relatively poor population engaged in sheep rearing. On the latter plateau the short, dark, longheaded person with a cephalic index between 75 and 79, often known as the Mediterranean or Neolithic type, prodominates. On the former the fair, often tall, well built, medium-headed Nordic type predominates. With the intensive data of the investigation, including numerous m a p s and diagrams, it is impossible to deal here. Briefly it may be stated that Mr. Bowen considers, tentatively, that the short, dark, long-headed person living under rural conditions mainly based on shepherding, often poorly housed and not too well fed, seems to be much addicted to tuberculosis, whilst the fair type living under rural conditions based on more mixed farming under better conditions seems to suffer less. The short, dark, long-haired person tends to acquiesce in the poor feeding of his moorland home, and, especially in certain regions socially depressed by the decay of the old lead mining, he tends also to be very prone to the progressive type of tuberculosis. In short, when he is attacked by the tubercle bacillus the balance between health and disease quickly goes against him. When, however, he migrates to the industrial areas where he can get better food more easily his bodily resistance tends to be increased, and the balance swings in his favour. I n such instances there are fewer of Brownlee's " young adult " types of fatal cases, and chronic cases exceed acute. On the other hand, the fair Nordic type living on good agricultural soil with opportunities for some degree of adaptation to infection exhibits far more numerous chronic than acute cases. Once he leaves his good agricultural environment, however, and migrates to the town or the dark, smokeinfested industrial valleys, he tends to lose his resistance, the balance swings against him and acute types of tuberculosis become common. Mr. Bowen concludes from this investigation that physical anthropological and associated cultural characters seem to be determinants of the general constitution of individuals, and that these
TUBERCLE
276
differences may possibly be related, no~ only to adaptability to environment, but also to resistance to disease. Thus, by taking into account the social environmental factor alongside the racial one, light may be thrown upon the natural history of disease. This method of
BOOK NOTICES Book Notices. R o e n t g e n a t l a s der Lungentuberkulose des Erwachsenen. Part II. By H. Alexander and A. t~ecklnann. L.ipzig: Johann A. Barth. 1928. Pp. 193. Price Rm. 17. Vol. 39, of the Tuberkulose Biblio~hek is supplementary to vol. 9.9, a review of which appeared in Tubercle, 199.8, 9, 441. The same plan is followed as in the earlier volume, of giving a full clinical description and a summary of the cases from which the illustrative radiograms are reproduced. The main thesis, which the cases support, is that an apical onset is much less common than was previously supposed, and that frequently the disease originates and spreads from the region of the hilum, in the middle field of the lung, and in the infraclavieular region. Some 9.0 pages are given to differential diagnosis, and a bibliography is included. Detailed criticism of the records and radiograms is impossible, but in the majority of cases the reader will not disagree with the chief conclusions. Attention should, however, be drawn to Case 36, in which an annular shadow which had persisted for a year or more was found to have disappeared after a course of tuberculin treatment. The authors, who, as was mentioned in the review of vol. 9,9, regard annular shadows always as evidence of excavation, are forced to assume that in the case in question the cavity had been obliterated by fibrotic contraction attributable to the tuberculin treatment. But it must be confessed that the final radiogram (No. 82) shows little, if any, evidence of contraction and, indeed,
[ M a r c h , 19'29
approach to tuberculosis is worthy of extended trial. REFERENCES. [I] T~ibercZe, 1928, 9, 370.
[2] BOWEN, E. G. Jou~tal of tl~e Royal Anthro2~ological Institute, 1928, 58 (JulyDecember).
AND
ABSTRACTS.
very little abnormality of any kind in the area in question. The volume is an exceedingly interesting one, and both the radiograms and their reproduction are of a uniformly high standard. Pneumotoraee terapeutico fisiomeeauiea teeniea. By F. Parodi. Rome: L'Editricie, ]~omana Medica. 1928. Pp. 166. Price L.25. This work, which forms the first of a series of volumes to be known as the " Biblioteea Italiana della Tubercolosi," has been published on the occasion of the Sixth International Congress of Tuberculosis, recently held in Rome, by one who, as our readers know (see Tubercle, 19'27, 8, "237), has had considerable experience of artificial pneumothorax. The work is divided into two parts. The first, which serves as an introduction, deals with the physiological aspects of the thoracic cage, lungs, diaphragm and mediastinum. The second, which forms the bulk of the work, consists of seven chapters dealing successively with the technique of artificial pneumothorax, complications, especially pleural effusion, the indications and eontra-indications for the operation, pneumothorax in children, the results of the operation, double simultaneous pneumothorax, oleothorax, and the influence of pneumothorax on the lung. An appendix is devoted to the description of an instrument to which the author has given the name of "ergomauometer," whereby the pressures in the pleural cavity can be measured. The work is warmly to be recommended as a clear, concise and up-to-date account of artificial pneumothorax.
ANTHROPOLOGY AND TUBERCULOSIS
TUBERCLE. M A R C H , 1929.
Anthropology and Tuberculosis. FI~oM time to time reference has been made in this journal [lj to regional surveys in tuberculosis. Such surveys have been made in Norway, Sweden, Wales and America. The :Framingham Survey in America was made on a big scale and its results are well known. The others have been small and often necessarily incomplete. One of the outsLanding difficulties of the work is the reduction of the variable factors l~o manageable proportions, hence no doub~ the lack of information on this subject in large communities with free communication with the outside world. A new and interesting investigation on original lines has recently been made by Mr. E m r y s G. Bowen [2], in which he has outlined the physical anthropology and other sociological features of certain areas in Wales in such a way as to demonstrate their relation to the incidence and distribution of certain types of tuberculosis. A wealth of material on physical anthropology had already been accumulated during the past twenty years by Professor Fleure at Aberystwyth and Mr. Bowen was able to avail himself of this material. To this fortunate circumstance may be added the valuable material at hand in the Welsh blational Memorial Association with Professor S. Lyle Cummins' records, and the exceptionally favourable geographical features of certain parts of Wales which enabled the conditions, both environmental and human, to be studied within a small compass. :For these reasons Cardiganshire was chosen as the area for investigation. This area. has been well surveyed anthropologically. It possesses, moreover, one of the highest tuberculosis death-rates of all the English and Welsh counties. The county is divisible physically into a coastal plateau, the valleys of which support a fairly large population dependent upon stock raising, and a high moorland plateau culminating in Plynlymon
275
with much cold boulder-clay soil and a sparsely scattered, relatively poor population engaged in sheep rearing. On the latter plateau the short, dark, longheaded person with a cephalic index between 75 and 79, often known as the Mediterranean or Neolithic type, prodominates. On the former the fair, often tall, well built, medium-headed Nordic type predominates. With the intensive data of the investigation, including numerous m a p s and diagrams, it is impossible to deal here. Briefly it may be stated that Mr. Bowen considers, tentatively, that the short, dark, long-headed person living under rural conditions mainly based on shepherding, often poorly housed and not too well fed, seems to be much addicted to tuberculosis, whilst the fair type living under rural conditions based on more mixed farming under better conditions seems to suffer less. The short, dark, long-haired person tends to acquiesce in the poor feeding of his moorland home, and, especially in certain regions socially depressed by the decay of the old lead mining, he tends also to be very prone to the progressive type of tuberculosis. In short, when he is attacked by the tubercle bacillus the balance between health and disease quickly goes against him. When, however, he migrates to the industrial areas where he can get better food more easily his bodily resistance tends to be increased, and the balance swings in his favour. I n such instances there are fewer of Brownlee's " young adult " types of fatal cases, and chronic cases exceed acute. On the other hand, the fair Nordic type living on good agricultural soil with opportunities for some degree of adaptation to infection exhibits far more numerous chronic than acute cases. Once he leaves his good agricultural environment, however, and migrates to the town or the dark, smokeinfested industrial valleys, he tends to lose his resistance, the balance swings against him and acute types of tuberculosis become common. Mr. Bowen concludes from this investigation that physical anthropological and associated cultural characters seem to be determinants of the general constitution of individuals, and that these
TUBERCLE
276
differences may possibly be related, no~ only to adaptability to environment, but also to resistance to disease. Thus, by taking into account the social environmental factor alongside the racial one, light may be thrown upon the natural history of disease. This method of
BOOK NOTICES Book Notices. R o e n t g e n a t l a s der Lungentuberkulose des Erwachsenen. Part II. By H. Alexander and A. t~ecklnann. L.ipzig: Johann A. Barth. 1928. Pp. 193. Price Rm. 17. Vol. 39, of the Tuberkulose Biblio~hek is supplementary to vol. 9.9, a review of which appeared in Tubercle, 199.8, 9, 441. The same plan is followed as in the earlier volume, of giving a full clinical description and a summary of the cases from which the illustrative radiograms are reproduced. The main thesis, which the cases support, is that an apical onset is much less common than was previously supposed, and that frequently the disease originates and spreads from the region of the hilum, in the middle field of the lung, and in the infraclavieular region. Some 9.0 pages are given to differential diagnosis, and a bibliography is included. Detailed criticism of the records and radiograms is impossible, but in the majority of cases the reader will not disagree with the chief conclusions. Attention should, however, be drawn to Case 36, in which an annular shadow which had persisted for a year or more was found to have disappeared after a course of tuberculin treatment. The authors, who, as was mentioned in the review of vol. 9,9, regard annular shadows always as evidence of excavation, are forced to assume that in the case in question the cavity had been obliterated by fibrotic contraction attributable to the tuberculin treatment. But it must be confessed that the final radiogram (No. 82) shows little, if any, evidence of contraction and, indeed,
[ M a r c h , 19'29
approach to tuberculosis is worthy of extended trial. REFERENCES. [I] T~ibercZe, 1928, 9, 370.
[2] BOWEN, E. G. Jou~tal of tl~e Royal Anthro2~ological Institute, 1928, 58 (JulyDecember).
AND
ABSTRACTS.
very little abnormality of any kind in the area in question. The volume is an exceedingly interesting one, and both the radiograms and their reproduction are of a uniformly high standard. Pneumotoraee terapeutico fisiomeeauiea teeniea. By F. Parodi. Rome: L'Editricie, ]~omana Medica. 1928. Pp. 166. Price L.25. This work, which forms the first of a series of volumes to be known as the " Biblioteea Italiana della Tubercolosi," has been published on the occasion of the Sixth International Congress of Tuberculosis, recently held in Rome, by one who, as our readers know (see Tubercle, 19'27, 8, "237), has had considerable experience of artificial pneumothorax. The work is divided into two parts. The first, which serves as an introduction, deals with the physiological aspects of the thoracic cage, lungs, diaphragm and mediastinum. The second, which forms the bulk of the work, consists of seven chapters dealing successively with the technique of artificial pneumothorax, complications, especially pleural effusion, the indications and eontra-indications for the operation, pneumothorax in children, the results of the operation, double simultaneous pneumothorax, oleothorax, and the influence of pneumothorax on the lung. An appendix is devoted to the description of an instrument to which the author has given the name of "ergomauometer," whereby the pressures in the pleural cavity can be measured. The work is warmly to be recommended as a clear, concise and up-to-date account of artificial pneumothorax.