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Conferences on Infantile Tuberculosis
260
THE JOURNAL OF PEDIATRICS
highly controversial and uncertain in their end result, the report i s most worth while and valuable. I t should and will lead to discussion and thought, and undoubtedly to experiments in medical practice and economics. We see no reason for passing resolutions for or against either the majority or minority reports. It seems quite certain that many changes in the character of " m e d i c a l s e r v i c e " will take place in the future as they have in the past. We cannot see how any specific program can be laid down in such rapidly changing times as the present. I f one could speak definitely of the character of our social structure for even the next ten years, some fairly definite form of a program might be ]aid down for medicine. Without this it seems rather futile. I n fact so many social and economic changes have taken place in the five-year period since the Committee started its work that certain parts or studies seem already out-dated. The medical profession is an old one--much older than the social sciences--and one that has persisted through many forms of civilization and various types of government. All that we know of the prevention of disease and public health, all the wonderful progress that has been made in the care and treatment of the sick, all hospitals and medical institutions, have originated in the medical profession itself. We are at present in, or have at least been passing through, a commercial age when economic standards have been the yardstick of comparison. We must not be led astray from the high ideals of a profession by an over emphasis of economic or commercial standards. The report is a valuable presentation of the complexities, troubles and problems of medicine in the present stage of world-wide turmoil. Taken as a whole--lncluding both the majority and minority r e p o r t s - - i t presents a fairly complete picture of the situation and suggests remedies to be put into effect. The solution, or rather the final pattern, of the changes, will undoubtedly depend more upon the trend of the basic social and economic conditions than upon the remedies as outlined in the report.
]~O~DEN S. VEEDER.
C o n f e r e n c e s On I n f a n t i l e Tuberculosis.
Welfare.
I n s t i t u t e of Clinical Pediatrics and Child Director: Professor Luis l~orquio, ]932, pages 745.
This volume, the third in a series of major publications a])pearing from the Institute of Clinical Pediatrics and Child Culture under the direction of the distinguished Latin-American pediatrist Luis lV[orquio, deals with every phase of childhood tuberculosis. Morquio and a group o f distinguished collaborators cover the various topics in the form of conference reports and discuss exhaustively, and with critical appraisal, the present-day knowledge and accepted practice in this field. The newer conceptions regarding immunity against the disease, and particularly the production of active immunity through such agents as the Calmette-Guerin immunizatlon procedure, receive most extensive consideration and critical evaluation and are the most valuable contributions of this report. The introductory article by Morquio gives a masterly survey of the entire subject, passing in cM'onologieal review all of the great and epoch-making discoveries which have revealed so much of the true etiology and pathology of this disease. Morquio's critical comments on various procedures of prophylaxis and treatment, brought forward from time to time, are invaluable because they are the fruit of a vast personal clinical experience. He points out t h a t two technical procedures, the curl-reaction and the x-ray, have probably been the most important factors in advancing our knowledge of the disease and demonstrating its great frequency in the infant and child. This early recognition has led to more effective prophylaxis and treatment.
BOOK REVIEWS
261
The mode of infection in childhood tuberculosis is discussed in the light of the a u t h o r ' s vast clinical experience, l i e believes that the i n f a n t or child acquires a tuberculous infection only by contact and t h a t the source of i n f e c t i o n is almost universally human, l i e finds t h a t the frequency of tuberculosis increases with the child's age. His statistics for Uruguay show an involvement in the i n f a n t under one year of about one per cent, whereas in the child between the ages of eleven and fifteen years, it may reach as high as seventy-five per cent. No age is free from the disease. The author points out t h a t juvenile or adult tuberculosis is frequently the result of an infection acquired in early childhood, and discusses the factors which cause the juvenile or young adult to fall victim so easily to this disease. The author favors Ranke's view on the development of tuberculosis and describes fully the three stages into which he divides it, namely the primary infection generally localizing in the pulmonary ganglia and developing allergic reactions leading to calcification; the second stage, or stage of generalized baeillemia and allergic hypersensibility; and the t h i r d stage, or localized phthisis accompanied by diminishing allergy, a decreased toxic hypersensibi]ity, and the development of a stage of relative immunity. The types of tuberculosis seen in infancy and later childhood are grouped according to the scheme and division suggested by Lwesque. I n discussing prognosis, the author expresses the view t h a t tuberculosis is curable in the child in the majority of cases, but t h a t such a possibility depends somewhat upon the age, the pathological changes, and the social condition of the subject. The Calmette-Guerin immunization procedure is discussed favorably. The a u t h o r ~is convinced t h a t it is an absolutely harmless procedure and t h a t i t confers a manifest resistance to the organism against tuberculous infection. The treatment of the disease is discussed under the headings of general indications, medicinal therapy, and treatment of localized areas of tuberculosis. Hellotherapy, actinotherapy, radiotherapy, artificial pneumothorax all have their indications. There is no specific treatment of tuberculosis, but all forms must, above all, stress the hygienic and dietetic factors. Following Morquio's comprehensive review, various special forms of tuberculosis, special symptoms, peculiar pathologicM conditions, the most approved prophylactic measures, and successful forms of treatment are discussed in minute detail by a group of the leading pediatricians in Uruguay. The collected presentations form a most complete resum~ and critical appraisal of all t h a t is known today about this prevalent disease, and crystallize in authorative opinion what is good and useful in combating this great plague. The illustrations throughout the book are numerous and are excellent. This is particularly true of radiograph reproductions. The almost complete absence of bibliographic references is a notable defect in a publication which in all other respects must be classed as a valuable reference work. Chicago.
F~ED W. SeHLvTZ.
P o l i o m y e l i t i s . - - A survey made possible b y a g r a n t f r o m the I n t e r n a t i o n a l Committee for t h e Study of I n f a n t i l e P a r a l y s i s organized b y J e r e m i a h Milbank. Williams a n d Wilkins, 1932, p. 562. l~r. /r w i t h competent advisers has started a new method of approaching the problem of a disease w h i c h is even more and more t h r u s t i n g itself on the public consciousness. His Committee is headed b y William/-I. P a r k , as chairman, a n d Josephine B. Nea], as secretary. The other members are the heads of various large laboratories t h r o u g h o u t t h e world. They have financed research workers
THE JOURNAL OF PEDIATRICS
highly controversial and uncertain in their end result, the report i s most worth while and valuable. I t should and will lead to discussion and thought, and undoubtedly to experiments in medical practice and economics. We see no reason for passing resolutions for or against either the majority or minority reports. It seems quite certain that many changes in the character of " m e d i c a l s e r v i c e " will take place in the future as they have in the past. We cannot see how any specific program can be laid down in such rapidly changing times as the present. I f one could speak definitely of the character of our social structure for even the next ten years, some fairly definite form of a program might be ]aid down for medicine. Without this it seems rather futile. I n fact so many social and economic changes have taken place in the five-year period since the Committee started its work that certain parts or studies seem already out-dated. The medical profession is an old one--much older than the social sciences--and one that has persisted through many forms of civilization and various types of government. All that we know of the prevention of disease and public health, all the wonderful progress that has been made in the care and treatment of the sick, all hospitals and medical institutions, have originated in the medical profession itself. We are at present in, or have at least been passing through, a commercial age when economic standards have been the yardstick of comparison. We must not be led astray from the high ideals of a profession by an over emphasis of economic or commercial standards. The report is a valuable presentation of the complexities, troubles and problems of medicine in the present stage of world-wide turmoil. Taken as a whole--lncluding both the majority and minority r e p o r t s - - i t presents a fairly complete picture of the situation and suggests remedies to be put into effect. The solution, or rather the final pattern, of the changes, will undoubtedly depend more upon the trend of the basic social and economic conditions than upon the remedies as outlined in the report.
]~O~DEN S. VEEDER.
C o n f e r e n c e s On I n f a n t i l e Tuberculosis.
Welfare.
I n s t i t u t e of Clinical Pediatrics and Child Director: Professor Luis l~orquio, ]932, pages 745.
This volume, the third in a series of major publications a])pearing from the Institute of Clinical Pediatrics and Child Culture under the direction of the distinguished Latin-American pediatrist Luis lV[orquio, deals with every phase of childhood tuberculosis. Morquio and a group o f distinguished collaborators cover the various topics in the form of conference reports and discuss exhaustively, and with critical appraisal, the present-day knowledge and accepted practice in this field. The newer conceptions regarding immunity against the disease, and particularly the production of active immunity through such agents as the Calmette-Guerin immunizatlon procedure, receive most extensive consideration and critical evaluation and are the most valuable contributions of this report. The introductory article by Morquio gives a masterly survey of the entire subject, passing in cM'onologieal review all of the great and epoch-making discoveries which have revealed so much of the true etiology and pathology of this disease. Morquio's critical comments on various procedures of prophylaxis and treatment, brought forward from time to time, are invaluable because they are the fruit of a vast personal clinical experience. He points out t h a t two technical procedures, the curl-reaction and the x-ray, have probably been the most important factors in advancing our knowledge of the disease and demonstrating its great frequency in the infant and child. This early recognition has led to more effective prophylaxis and treatment.
BOOK REVIEWS
261
The mode of infection in childhood tuberculosis is discussed in the light of the a u t h o r ' s vast clinical experience, l i e believes that the i n f a n t or child acquires a tuberculous infection only by contact and t h a t the source of i n f e c t i o n is almost universally human, l i e finds t h a t the frequency of tuberculosis increases with the child's age. His statistics for Uruguay show an involvement in the i n f a n t under one year of about one per cent, whereas in the child between the ages of eleven and fifteen years, it may reach as high as seventy-five per cent. No age is free from the disease. The author points out t h a t juvenile or adult tuberculosis is frequently the result of an infection acquired in early childhood, and discusses the factors which cause the juvenile or young adult to fall victim so easily to this disease. The author favors Ranke's view on the development of tuberculosis and describes fully the three stages into which he divides it, namely the primary infection generally localizing in the pulmonary ganglia and developing allergic reactions leading to calcification; the second stage, or stage of generalized baeillemia and allergic hypersensibility; and the t h i r d stage, or localized phthisis accompanied by diminishing allergy, a decreased toxic hypersensibi]ity, and the development of a stage of relative immunity. The types of tuberculosis seen in infancy and later childhood are grouped according to the scheme and division suggested by Lwesque. I n discussing prognosis, the author expresses the view t h a t tuberculosis is curable in the child in the majority of cases, but t h a t such a possibility depends somewhat upon the age, the pathological changes, and the social condition of the subject. The Calmette-Guerin immunization procedure is discussed favorably. The a u t h o r ~is convinced t h a t it is an absolutely harmless procedure and t h a t i t confers a manifest resistance to the organism against tuberculous infection. The treatment of the disease is discussed under the headings of general indications, medicinal therapy, and treatment of localized areas of tuberculosis. Hellotherapy, actinotherapy, radiotherapy, artificial pneumothorax all have their indications. There is no specific treatment of tuberculosis, but all forms must, above all, stress the hygienic and dietetic factors. Following Morquio's comprehensive review, various special forms of tuberculosis, special symptoms, peculiar pathologicM conditions, the most approved prophylactic measures, and successful forms of treatment are discussed in minute detail by a group of the leading pediatricians in Uruguay. The collected presentations form a most complete resum~ and critical appraisal of all t h a t is known today about this prevalent disease, and crystallize in authorative opinion what is good and useful in combating this great plague. The illustrations throughout the book are numerous and are excellent. This is particularly true of radiograph reproductions. The almost complete absence of bibliographic references is a notable defect in a publication which in all other respects must be classed as a valuable reference work. Chicago.
F~ED W. SeHLvTZ.
P o l i o m y e l i t i s . - - A survey made possible b y a g r a n t f r o m the I n t e r n a t i o n a l Committee for t h e Study of I n f a n t i l e P a r a l y s i s organized b y J e r e m i a h Milbank. Williams a n d Wilkins, 1932, p. 562. l~r. /r w i t h competent advisers has started a new method of approaching the problem of a disease w h i c h is even more and more t h r u s t i n g itself on the public consciousness. His Committee is headed b y William/-I. P a r k , as chairman, a n d Josephine B. Nea], as secretary. The other members are the heads of various large laboratories t h r o u g h o u t t h e world. They have financed research workers