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Diseases of the chest
120
TUBERCLE
male than female victims among both whites and non-whites: DEATII-RATES PER IOOj000~ 195o
Tuberculosis Pneumonias
" ..
White Non-whites 3Iale Female ,~lale Female
36 34
9 °-3
129 6o
6I 34
Gradually at first, but with quickening pace institutional accommodation has been set aside for the isolation and treatment of tuberculosis. T h e story has been the same for tuberculosis, clinics and dispensary services. At the same time notification was started; and one after another anti-tuberculosis associations, usually voluntary, came into action. Another important factor has been the eradication of bovine tuberculosis. Since I937 New York State, whence the milk supply comes, has been practically free from bovine tuberculosis- a wonderful achievement. Even so pasteurization is the rule. T o d a y tuberculous, crippled, hunchbacks, and children with necks scarred from adenitis, are not in the city. Nevertheless, while the death-rate fell from I 2 6 i n 192o to 29 in x95o , or by 77 per cent, the notifications numbering 14,o35 in I92o only fell to 6,518 , or by 54 per cent, by x95o. This last figure is some indication of the extent of the infectious foci still r a m p a n t in the city. Overpopulated M a n h a t t a n still remains a hot-bed of infection. Still far too few of the new cases coming under notice are minimal; too man). are advanced. Attention must be drawn to the unequal way in which the disease kills at different ages and to the unequal way the mortalities at these ages have responded during the century, and to the extraordinary age differences between the sexes. Notable is the reduction for females in early adult life when child bearing throws upon that sex special strain; it coincides with a falling birth-rate. 3,Vomen probably benefit far more than men from labour-saving devices in the home which eases the strain as life extends. Men feel this advance far less in industry, and today the peak of the mortality rate has receded into the seventies. Interesting as these falls in mortalities are for whites, they become even more so for the negroes. O t h e r tremendous raeiaI differences are found, brought with them by immigrants; in each case the inheritance of today was the environment of yesterday. In the years i93o-3x Chinese headed the list with a figure of 626; natives of Puerto Rico followed with 434; at the bottom were Russians with 53 and Poles with 46; native-born whites stood at 51 • A unique measure of control and almost eradication is exhibited by mortality from tuberculosis among children under age 15. I n
April
1953
I9OO the mortality figure was 13o; in I949 it was 3"2. Most of the few cases are to be found among the coloured population. And not one of the deaths was of the abdominal type. Infection in the home is the ruling factor determining tuberculosis among children. T h e threshold below which, as for other infectious diseases, the infection ceases to be endemic must be nearly attained in New York. W h a t a half-century of humanitarian victories, with no help from Kant, Hegel, Heine, or Marx! DISEASES OF T H E CHEST. By Sir Geoffrey Marshall and Kenneth Perry. Butten~'orth & Co. 2 Vols. Pp. 865, 35 ° Figs. Price £ 7 7sT h e fact that Butterworth have published another symposium on diseases of the chest within a few months of their 'Modern Practice of Tuberculosis' reflects the increasing importance of respirator)" diseases in the medical teaching of today. T h e student need no longer be nurtured on theories and methods of treatment dating from the days before x-rays were universally used, and handed down faithfully from textbook to textbook. In fact, Professor Christie, and some of the other contributors to this work, make a point of exploding m a n y of these old statements. There is a great deal of excellent material in this book, both for those who specialize in chest medicine, and for students and general practitioners. T h e standard of writing is somewhat uneven, as must surely be inevitable in any work of this kind, but in the main the style is lucid and eminently readable. T h e reproduction of x-rays still leaves considerable room for improvement, but in m a n y of the plates, in particular the bronchograms, it seems probable that the original films were at least partly to blame for the poor results. I n a work of this standard it is difficult to pick out any chapters of especial merit, but I think Dr Andrew Morland's and Sir Clement Price T h o m a s ' comprehensive article on the T r e a t m e n t of Pulmonary Tuberculosis must be mentioned. This is a most excellent chapter, full of technical detail, and yet never losing sight of the patient as a person: one might only wish that there had been more space for the development of their section on ' T h e Mind'. M r Reid's article on Physiotherapy in Chest Disease is also a welcome addition to a book of this type. In the chapter on Whooping Cough Dr Perry uses somewhat heroic doses of antibiotics, and an obvious misprint in the recommended dosage of ephedrine requires revision. This is a book to read for interest and pleasure, and to keep by one for future reference.
TUBERCLE
male than female victims among both whites and non-whites: DEATII-RATES PER IOOj000~ 195o
Tuberculosis Pneumonias
" ..
White Non-whites 3Iale Female ,~lale Female
36 34
9 °-3
129 6o
6I 34
Gradually at first, but with quickening pace institutional accommodation has been set aside for the isolation and treatment of tuberculosis. T h e story has been the same for tuberculosis, clinics and dispensary services. At the same time notification was started; and one after another anti-tuberculosis associations, usually voluntary, came into action. Another important factor has been the eradication of bovine tuberculosis. Since I937 New York State, whence the milk supply comes, has been practically free from bovine tuberculosis- a wonderful achievement. Even so pasteurization is the rule. T o d a y tuberculous, crippled, hunchbacks, and children with necks scarred from adenitis, are not in the city. Nevertheless, while the death-rate fell from I 2 6 i n 192o to 29 in x95o , or by 77 per cent, the notifications numbering 14,o35 in I92o only fell to 6,518 , or by 54 per cent, by x95o. This last figure is some indication of the extent of the infectious foci still r a m p a n t in the city. Overpopulated M a n h a t t a n still remains a hot-bed of infection. Still far too few of the new cases coming under notice are minimal; too man). are advanced. Attention must be drawn to the unequal way in which the disease kills at different ages and to the unequal way the mortalities at these ages have responded during the century, and to the extraordinary age differences between the sexes. Notable is the reduction for females in early adult life when child bearing throws upon that sex special strain; it coincides with a falling birth-rate. 3,Vomen probably benefit far more than men from labour-saving devices in the home which eases the strain as life extends. Men feel this advance far less in industry, and today the peak of the mortality rate has receded into the seventies. Interesting as these falls in mortalities are for whites, they become even more so for the negroes. O t h e r tremendous raeiaI differences are found, brought with them by immigrants; in each case the inheritance of today was the environment of yesterday. In the years i93o-3x Chinese headed the list with a figure of 626; natives of Puerto Rico followed with 434; at the bottom were Russians with 53 and Poles with 46; native-born whites stood at 51 • A unique measure of control and almost eradication is exhibited by mortality from tuberculosis among children under age 15. I n
April
1953
I9OO the mortality figure was 13o; in I949 it was 3"2. Most of the few cases are to be found among the coloured population. And not one of the deaths was of the abdominal type. Infection in the home is the ruling factor determining tuberculosis among children. T h e threshold below which, as for other infectious diseases, the infection ceases to be endemic must be nearly attained in New York. W h a t a half-century of humanitarian victories, with no help from Kant, Hegel, Heine, or Marx! DISEASES OF T H E CHEST. By Sir Geoffrey Marshall and Kenneth Perry. Butten~'orth & Co. 2 Vols. Pp. 865, 35 ° Figs. Price £ 7 7sT h e fact that Butterworth have published another symposium on diseases of the chest within a few months of their 'Modern Practice of Tuberculosis' reflects the increasing importance of respirator)" diseases in the medical teaching of today. T h e student need no longer be nurtured on theories and methods of treatment dating from the days before x-rays were universally used, and handed down faithfully from textbook to textbook. In fact, Professor Christie, and some of the other contributors to this work, make a point of exploding m a n y of these old statements. There is a great deal of excellent material in this book, both for those who specialize in chest medicine, and for students and general practitioners. T h e standard of writing is somewhat uneven, as must surely be inevitable in any work of this kind, but in the main the style is lucid and eminently readable. T h e reproduction of x-rays still leaves considerable room for improvement, but in m a n y of the plates, in particular the bronchograms, it seems probable that the original films were at least partly to blame for the poor results. I n a work of this standard it is difficult to pick out any chapters of especial merit, but I think Dr Andrew Morland's and Sir Clement Price T h o m a s ' comprehensive article on the T r e a t m e n t of Pulmonary Tuberculosis must be mentioned. This is a most excellent chapter, full of technical detail, and yet never losing sight of the patient as a person: one might only wish that there had been more space for the development of their section on ' T h e Mind'. M r Reid's article on Physiotherapy in Chest Disease is also a welcome addition to a book of this type. In the chapter on Whooping Cough Dr Perry uses somewhat heroic doses of antibiotics, and an obvious misprint in the recommended dosage of ephedrine requires revision. This is a book to read for interest and pleasure, and to keep by one for future reference.