Clinical Practice in Infectious Diseases

Clinical Practice in Infectious Diseases

PUBLIC H E A L T H , April, 1947 of health. H e stresses the necessity for the integration of medicine with h u m a n life, this being brought about b...

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PUBLIC H E A L T H , April, 1947 of health. H e stresses the necessity for the integration of medicine with h u m a n life, this being brought about by f o u r f a c t o r s - - t h e recognition of disease, not merely as a pathological entity b u t as s o m e t h i n g w h i c h interferes with t h e sufferer's practice of living, the definition of health as no mere f r e e d o m f r o m disease b u t as a s t u d y of o p t i m u m functional efficiency, t h e proper u n d e r s t a n d i n g of the relationship of e n v i r o n m e n t to health and disease, and lastly the proper u n d e r s t a n d i n g of the social importance of disease. Apart f r o m those s u c h as t h e doctor, the n u r s e , the medical auxiliary and the s t u d e n t w h o m i g h t be expected to be the p r i m e motive powers in social medicine there are a m o n g others the teacher, the architect, the engineer, the social worker, the politician and the e m p l o y e r w h o are vitally concerned in the life of society, having an i m p o r t a n t share in d e t e r m i n i n g t h e social conditions u n d e r w h i c h m e n live. T h e a i m of the a u t h o r t h e n is the production of a v o l u m e which is an approach to the subject designed to be read by a wide range of persons a n d in fact by t h e interested layman. T o the doctor and those with a similar background it e m p h a s i s e s the i m p o r t ance of the social e n v i r o n m e n t of the patient and its influence n o t only on the causation of disease, b u t u p o n t r e a t m e n t , prognosis and t h e achievement and m a i n t e n a n c e of health. T o those others concerned in social activities and organisations it presents the relation o f e n v i r o n m e n t to mental and physical health a n d the part w h i c h t h e y can play in t h e furtherance of h u m a n welfare. Each of the subjects has been dealt with adequately and clearly. T h e r e is a very useful s u m m a r y at the end of each of the larger chapters, while t h e needs of t h e serious s t u d e n t are m e t by t h e inclusion of a list of v o l u m e s for f u r t h e r reading. M u c h doubtless is to be heard in the near future of this n e w social medicine and the production of this hook is m o s t timely, its s t u d y affording the necessary background to t h o s e - - a n d t h e y m u s t be m a n y of varying walks of l i f e - - w h o will find themselves in one way or another associated with its practice. In its restricted scope of being literally an approach to social medicine it is a m o s t readable and very useful introduction, and the a u t h o r is to be congratulated both on its conception and its achievement.

Clinical Practice in Infectious Diseases. By E. H. R. HARRIES and M. MITMAN. 3rd edition. (Pp. v i i i + 6 7 9 . Price 22s. 6d.) E d i n b u r g h : E. & S. Livingstone. 194:7. T h i s excellent textbook h a s n o w reached its third edition a n d h a s been e x p a n d e d by the inclusion of fresh diseases and of t h e results of advances in epidemiology a n d c h e m o t h e r a p y . It is t h o r o u g h l y u p to date. It was n e v e r logical to exclude p n e u m o n i a f r o m t h e infectious diseases, certainly n o t since it b e c a m e notifiable. It is doubtful w h e t h e r atypical p n e u m o n i a is often notified, t h o u g h it certainly s h o u l d be, if only that its epidemiology m a y be studied. A n excellent a c c o u n t of p r i m a r y atypical p n e u m o n i a is given ; short accounts of s o m e of the rarer, non-notifiable diseases, e.g., glandular fever, epidemic myalgia, etc., are g i v e n ; curiously no m e n t i o n is given in t h e references with regard to t h e latter, to Pickles' classical account. T h e occurrence of the P a u l - B u n n e l test in cases of m e n i n g o - e n c e p h a litis prior to, or without, m o n o n u c l e o s i s is n o t m e n t i o n e d . U n d e r " E x a n t h e m a s u b i t u m " the s t a t e m e n t that this appears to be confined to infants u n d e r two years of age requires alteration, as the reviewer has seen an otherwise typical case in a boy of six years of age. Should n o t m o r e of these infections, including hepatitis, be notifiable ? T h e excellent chapter on c h e m o t h e r a p y has been e x p a n d e d and b r o u g h t u p to date and should be r e a d by all. T a b l e (I), s h o w i n g the m o d e s of infection a n d etiological agents of a large n u m b e r of infective diseases of non-tropical distribution, is an excellent a t t e m p t at two-fold classification, b u t has its obvious limitations w h e r e m o r e t h a n one m e t h o d of t r a n s m i s s i o n is effective, t h o u g h an a t t e m p t is m a d e td overcome this. B u t to place " infectious enteritis " in b o t h t h e inhalation a n d the ingestion g r o u p is to overlook the h i g h probability that the two types of infection---one can hardly call t h e m " diseases " - - a r e due to entirely different agents or groups of agents. Moreover, to place a n t h r a x in t h e directly inoculable g r o u p a n d rabies a n d rat-bite fever in t h e indirect g r o u p does n o t appear logical. Is it true to regard actinomycosis, leprosy a n d tularaemia as of u n k n o w n or u n c e r t a i n m o d e of transmission ? O n w h a t grounds, o t h e r t h a n t h e u s u a l location in the cord rather t h a n the brain, is acute poliomyelitis regarded as normally ingested rather t h a n inhaled ? T h e s e are "trifling criticisms and this is a book that s h o u l d be in the h a n d s of every medical officer of health and medical s u p e r i n t e n d e n t of an isolation hospital. Milk : Production and Control. By W. CLUNIE HARVEY,M.D., D.P.H., and H. HILL, F.R.SAN.I., A.M.I.S.E. 2nd edition. (Pp. v i i i + 5 1 2 . Illustrations. Price 37s. 6d. net.) L o n d o n : H. K. L e w i s & Co. 1946. T h i s book covers every aspect of the importance of milk to t h e nation. It is a second edition after nine years, d u r i n g w h i c h the s u b j e c t m a t t e r has u n d o u b t e d l y been m u c h appreciated by a wide

147 range of reader. N o book of so c o m p r e h e n s i v e a character could achieve complete success. T h e expert in each of t h e services covered is almost certain to be critical on points of detail. As the preface says, " the producer, the distributor, the retailer, t h e bacteriologist, t h e chemist, the veterinary surgeon, the medical officer of health, the sanitary inspector and, last b u t n o t least, t h e c o n s u m e r " are all in varying degrees involved. Over s u c h a wide range accuracy is well-nigh impossible to secure and differences of opinion a n d outlook by different specialists wou!d i n a n y e v e n t force the writers to be dogmatic on some m a t t e r s to avoid c o n f u s i n g the reader with an excess of detail. T h e s e are the pen~/lties of tackling so vast a task b u t there are safeguards : in particular, reference to the expert of m a t t e r s w h i c h concern him. It is scarcely likely that H a r v e y and Hill have omitted s u c h an obvious step b u t if it has been done there is no m e n t i o n m a d e of this, excepting advice on architectural and distributive aspects. T h e weakest c h a p t e r is that dealing with " L a b o r a t o r y and o t h e r control." T h i s is a highly technical subject in w h i c h accuracy is of p a r a m o u n t importance and it would be better to say n o t h i n g t h a n to be w r o n g or o u t of date. Y o u r reviewer is advised by an e m i n e n t pathologist that there are m a n y sins of omission and c o m m i s s i o n w h i c h the a u t h a r s would be well advised to remedy. T h e following are a f e w - - H o l y does the microscopic colony technique obviate dilution errors w h e n a low volume half dilution is used ? (p. 364). No m e n t i o n is m a d e of selective m e d i a for detection of B . t y p h o s u m (p. 375). No m e n t i o n is m a d e of m o d e m m e d i a for C o r y n e b a c t e r i u m diphtheriae (p. 375). T h e s t a t e m e n t that B r u c e l l a abortus vaccines inoculated to cows m a y cause infection in m a n (p. 374) is open to question. N o m e n t i o n is m a d e of false positives for M i c r o b a c t e r i u m tuberculosum by confusion with saprophytic acid fast bacilli (p. 353). T h e s t a t e m e n t that diagnosis of tuberculosis is obtained b y culture in 10 to 14 days is misleading (p. 373). T h e diagram on p. 403 showing an improvised Kjeldahl a p p a r a t u s would be d a n g e r o u s in t h e absence of an outlet, since t h e receiving flask appears to be closed by a r u b b e r bung. I n the chapter on " T h e t r e a t m e n t of milk by heat " the s t a t e m e n t s about rickets wou!d be questioned by m a n y clinicians, Are t h e causes n o t n o w definitely ascertained ? Is t h e disease still c o m m o n a m o n g children in o u r large cities ? Are persons of any age attacked ? W e take this o p p o r t u n i t y of appealing to all writers on scientific subjects, particularly those intended to be read by the general public, to avoid repetition and redundancies. H a r v e y and Hill's would have been a m u c h better book if, like Bernard Shaw, t h e y had gone t h r o u g h the text ruthlessly deleting everything n o t essential to t h e m e a n i n g . It is particularly confusing to t h e reader to be p r e s e n t e d m o r e t h a n once with t h e same fact in s o m e w h a t different words. One last grouse ; please, m a y the word " tubercular " be used in its true sense ? Cows a n d h u m a n s often have k n o b s on b u t it is n o t usual to record this fact. T h i s is the only really c o m p r e h e n s i v e book on milk. T h e value is to some extent m a r r e d by the sort o f mistake referred to above b u t it has t h e m a k i n g of a first-class reference book if the a u t h o r s could again revise the m a t t e r with meticulous attention to detail.

The Nature of Disease Up to Date. By J. E. R. McDONAGH, F.R.C.S. (Pp. x v i + 1 6 8 . 13 figs. Price 15s. net.) L o n d o n : W i n . H e i n e m a n n . 1946. Attention has in the past been focussed too m u c h on the chloroplasts and t h e structures in plants, and on the blood corpuscles, t h e vegetative n e r v o u s system, and the tissues of animals and m a n , instead of on the p r o t e i n - - t h e m a t r i x of t h e m all. T h o u g h it h a s m a n y manifestations there is only one disease, t h e result of c h a n g e s in t h e protein. T h e m a i n t e n a n c e of h a r m o n y between soil, plants, animals and m a n is the only w a y t h e protein can protect the host against invaders, while as a corollary food o f inferior quality is t h e m o s t i m p o r t a n t cause of disease, t h e pathological manifestations being b u t an expression of the d a m a g e suffered by t h e protein. T h i s is a s u m m a r y of t h e view of the author of " T h e N a t u r e of Disease U p to Date " - - a v o l u m e written to introduce a larger work entitled " A n A t t e m p t to A p p r o a c h the W h o l e . " I n this he discusses the progress of " activity " f r o m s u b - a t o m i c m a t t e r , t h r o u g h the protein u p to m a n as the final product. He t h e n considers protein in health, protein in disease, acquired disease, t h e inherited m a n i festations of disease and finally t h e action of chemical invaders. A l t h o u g h its avowed object is to explain the a u t h o r ' s interpretation of " protein " a n d " activity," t h e book is n o t easy reading. T o t h e difficulty of following the basis of t h e t h e o r y on w h i c h all is f o u n d e d is the complication of t h e u s e of w o r d s in o t h e r t h a n their usual meanings. T h e central t h e m e is that every b o d y in t h e universe is a p r o d u c t of t h e condensation of " activity " a n d every p r o d u c t pulsates, u n d e r g o i n g alternate expansion a n d contraction, giving rise to a cyclical r h y t h m in the product. T h e r h y t h m is d e t e r m i n e d by " climate," in t h e f o r m of cosmic ~adiation, releasing " activity " f r o m where it is stored. T h e released " a c t i v i t y " exhibits in t u r n the f u n c t i o n of radiation, of attraction a n d finally of storing. The behaviour of every product is reducible to t h e exhibition of one or