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Industrial settlements for consumptives
NOTICES
OF
BOOKS
39
view can only be justified so long as j u d i c i o u s t r e a t m e n t and strict control is maintained. M o r e o v e r , " t h e b e t t e r the results o b t a i n e d , f r o m a n y m e t h o d of t r e a t m e n t , the less frequent will be the hsemoptysis." -Dr. J a q u e r o d holds that " on principle, when a n hsemoptysis occurs, t h e t r e a t m e n t should at first be restricted to the most simple physical a n d dietetic m e a s u r e s (rest, milk diet, ice, etc.), m,~d the use of all medicines held over f o r ' a t least t w e n t y - f o u r h o u r s . ' H i s concluding a d v i c e merits the thoughtful consideration of all medical practitioners h a v i n g to deal with consumptives. VITAL
PULMONARY
CAPACITY.
THE vital c a p a c i t y of the lungs in health and disease has for long been a favourite subject for research a n d discussion by physiologists and clinicians. Dr. M y e r s has rendered a real service by bringing together all essential facts relating to the v i t a l - c a p a c i t y test, and providing data which enable it to be e m p l o y e d without any intricate m a t h e m a t i c a l calculations. 1 T h e significance and application of the v i t a l c a p a c i t y is discussed, and various references are made to its value in p u l m o n a r y tuberculosis. I t is shown t h a t v i t a l - c a p a c i t y readings d e s e r v e a definite place as a s u p p l e m e n t a r y method in diagnosis and prognosis in these cases. Reference is m a d e to a n u m b e r of interesting clinical examples. Dr. M y e r s ' s m o n o g r a p h deserves the serious s t u d y of tuberculosis officers and other medical advisers dealing with patients t h r e a t e n e d with or actually suffering f r o m tuberculosis of the lungs. INDUSTRIAL
SETTLEMENTS
FOR
CONSUMPTIVES.
I n this j o u r n a l we h a v e repeatedly dealt with the question of Industrial Colonies for C o n s u m p t i v e s , p a r t i c u l a r l y as exemplified by the fine o r g a n i z a t i o n which, under the wise and enthusiastic directorship of D r . Varrier-Jones, has m a d e the Village S e t t l e m e n t at P a p w o r t h k n o w n a m o n g tuberculosis workers t h r o u g h o u t the world. It is well t h a t t h r e e of the chief p a p e r s relating to this successful a d v e n t u r e should h a v e been collected and issued in convenient form. ~ Sir J a m e s K i n g ston : F o w l e r ' s s y m p a t h e t i c introduction merits serious consideration. H e shows r i g h t l y t h a t no little of the d i s a p p o i n t m e n t which is now reflected in the p o p u l a r cry that s a n a t o r i a have been failures has been due t o lack of proper training of those w h o select cases and those who i ,, Vital Capacity of the Lungs : A Handbook for Clinicians and Others Interested in the Examination of the Heart and Lungs both in Health and Disease," by J. A. Myers~ M.S., Ph.D., M.D., Assistant Professor of Preventive Medicine and Public Health in the Medical and Graduate Schools of the University of Minnesota. With an Introduction by S. Marx White, B.S., M.D., F.R.C.P., Professor of .Medicine, and Chief of the Department of Medicine, University of Minnesota. Pp. I4o ; with 32 diagrams, 23"tables and bibliography. Baltimore : The Williams and Wilkins Company ; London : Bailli~re, Tindall and Cox. 1925. Price i6s. 6d. 2 ,, Papworth: Administrative and Economic Problems in Tuberculosis." By the late Sir German Sims Woodhead, K.B.E., V.D., M.A., M.D., LL.D. ; the late Right Hon. Sir Clifford Allbutt, K.C.B., M.A., M.D., LL.D., D.Sc., F.R.C.P., F.R.S. ; and P. C. Varrier-Jones, M.A., M.R,C.S,, L.R.C.P., with an Introductory Chapter by Sir James Kingston Fowler, K.C.V.O., C.M.G., M.A., M.D. Pp. vd: 63. Cambridge : The University Press. I925. Price : Paper boards, 2s. 6d. net ; cloth; 3s. 6d. net.
4~
THE
BRITISH
JOURNAL
OF TUBERCULOSIS
have been responsible for the organization and administration oF sanatoria. It is shown that "amongst the industrial classes there are no early cases of pulmonary tuberculosis, apart from such as begin with tuberculous pleurisy or h~cmoptysis, or are discovered by the examination of contacts. The working man has no time to be an early case of pulmonary tuberculosis. W h e n the onset of the disease is insidious, the early symptotias are capable of so many interpretations that, as a rule, its presence is not recognized until a considerable area of the lung first affected is already involved." W e quite agree with Sir James Kingston Fowler that the ideal result of sanatorium treatment is " t o fit the patient for the occupation in which he was engaged before the onset of his illness." The chief lessons to b e learned from the success of the P a p w o r t h experiment are summarized as follows: " ( i ) There must be no question that the patients really are suffering from tuberculosis. (2) If the disease cannot be arrested, they must still be capable of work which must be suited to their diminished strength. (3) They cannot be trained to a new occupation and fitted to battle alone with the industrial conditions which obtain in this imperfect World. (4) But they can be trained to do ' repetition' Work, and earn wages graded to their skill. (5) The wages paid to the skilled men must be at the trade-union rate for the number of hours which their physical condition allows them to work without injury to their health. (6) All the heads of the departments must be men who have themselves suffered from the disease, although they may have recovered from it, either completely or partially. Men who have not had this experience cannot enter into the feelings of those who are working under their direction. (7) There must be a prospect of promotion in the mind of every settler--e.g., from sanatorium to hut, to hoste!, to a cottage ; and in the industries, from part time at the lower rare of Wages to full time: at the higher trades:union rate, according to skill and application, and, finally, to the position of head of a department. (8) The stores, which contain all the necessaries of village life, must be run on the same lines as the industries. (9) The products of the labour Of the settlers must be sold in the open market under competitive contracts or by travellers employed after the manner followed by wholesale firms. (io) The industries best suited for a tuberculosis settlement are such as can be carried on in well-ventilated hygienic workshops, where a considerable number of men can be employed. ( i i ) Our old but elusive friend, the 'light occupation in the open air,' although not to be exeluded, is, speaking generally, less suitable than those carried on indoors under conditions in which the worker i s s h e l t e r e d from inclement weather. (12) All heavy work :on the land is unsuitable, and all the heavy work of the industries must be done by machinery. (13) The computation Of costs of the various industries, of profit and loss, of prices at which tenders for contracts are to be made, are matters which require as close supervision as they receive in any wellordered manufacturing concern. All the secretarial work must be done by the settlers. (~4) The medical treatmen},and clinical supervision of the settlers must be as efficmnt as obtains m the best sanatoria. It should be noted that the printing of the volume has been -done entirely at Papworth by the Papworth Press, an arrangement doubtless unique in the annals of printing.
OF
BOOKS
39
view can only be justified so long as j u d i c i o u s t r e a t m e n t and strict control is maintained. M o r e o v e r , " t h e b e t t e r the results o b t a i n e d , f r o m a n y m e t h o d of t r e a t m e n t , the less frequent will be the hsemoptysis." -Dr. J a q u e r o d holds that " on principle, when a n hsemoptysis occurs, t h e t r e a t m e n t should at first be restricted to the most simple physical a n d dietetic m e a s u r e s (rest, milk diet, ice, etc.), m,~d the use of all medicines held over f o r ' a t least t w e n t y - f o u r h o u r s . ' H i s concluding a d v i c e merits the thoughtful consideration of all medical practitioners h a v i n g to deal with consumptives. VITAL
PULMONARY
CAPACITY.
THE vital c a p a c i t y of the lungs in health and disease has for long been a favourite subject for research a n d discussion by physiologists and clinicians. Dr. M y e r s has rendered a real service by bringing together all essential facts relating to the v i t a l - c a p a c i t y test, and providing data which enable it to be e m p l o y e d without any intricate m a t h e m a t i c a l calculations. 1 T h e significance and application of the v i t a l c a p a c i t y is discussed, and various references are made to its value in p u l m o n a r y tuberculosis. I t is shown t h a t v i t a l - c a p a c i t y readings d e s e r v e a definite place as a s u p p l e m e n t a r y method in diagnosis and prognosis in these cases. Reference is m a d e to a n u m b e r of interesting clinical examples. Dr. M y e r s ' s m o n o g r a p h deserves the serious s t u d y of tuberculosis officers and other medical advisers dealing with patients t h r e a t e n e d with or actually suffering f r o m tuberculosis of the lungs. INDUSTRIAL
SETTLEMENTS
FOR
CONSUMPTIVES.
I n this j o u r n a l we h a v e repeatedly dealt with the question of Industrial Colonies for C o n s u m p t i v e s , p a r t i c u l a r l y as exemplified by the fine o r g a n i z a t i o n which, under the wise and enthusiastic directorship of D r . Varrier-Jones, has m a d e the Village S e t t l e m e n t at P a p w o r t h k n o w n a m o n g tuberculosis workers t h r o u g h o u t the world. It is well t h a t t h r e e of the chief p a p e r s relating to this successful a d v e n t u r e should h a v e been collected and issued in convenient form. ~ Sir J a m e s K i n g ston : F o w l e r ' s s y m p a t h e t i c introduction merits serious consideration. H e shows r i g h t l y t h a t no little of the d i s a p p o i n t m e n t which is now reflected in the p o p u l a r cry that s a n a t o r i a have been failures has been due t o lack of proper training of those w h o select cases and those who i ,, Vital Capacity of the Lungs : A Handbook for Clinicians and Others Interested in the Examination of the Heart and Lungs both in Health and Disease," by J. A. Myers~ M.S., Ph.D., M.D., Assistant Professor of Preventive Medicine and Public Health in the Medical and Graduate Schools of the University of Minnesota. With an Introduction by S. Marx White, B.S., M.D., F.R.C.P., Professor of .Medicine, and Chief of the Department of Medicine, University of Minnesota. Pp. I4o ; with 32 diagrams, 23"tables and bibliography. Baltimore : The Williams and Wilkins Company ; London : Bailli~re, Tindall and Cox. 1925. Price i6s. 6d. 2 ,, Papworth: Administrative and Economic Problems in Tuberculosis." By the late Sir German Sims Woodhead, K.B.E., V.D., M.A., M.D., LL.D. ; the late Right Hon. Sir Clifford Allbutt, K.C.B., M.A., M.D., LL.D., D.Sc., F.R.C.P., F.R.S. ; and P. C. Varrier-Jones, M.A., M.R,C.S,, L.R.C.P., with an Introductory Chapter by Sir James Kingston Fowler, K.C.V.O., C.M.G., M.A., M.D. Pp. vd: 63. Cambridge : The University Press. I925. Price : Paper boards, 2s. 6d. net ; cloth; 3s. 6d. net.
4~
THE
BRITISH
JOURNAL
OF TUBERCULOSIS
have been responsible for the organization and administration oF sanatoria. It is shown that "amongst the industrial classes there are no early cases of pulmonary tuberculosis, apart from such as begin with tuberculous pleurisy or h~cmoptysis, or are discovered by the examination of contacts. The working man has no time to be an early case of pulmonary tuberculosis. W h e n the onset of the disease is insidious, the early symptotias are capable of so many interpretations that, as a rule, its presence is not recognized until a considerable area of the lung first affected is already involved." W e quite agree with Sir James Kingston Fowler that the ideal result of sanatorium treatment is " t o fit the patient for the occupation in which he was engaged before the onset of his illness." The chief lessons to b e learned from the success of the P a p w o r t h experiment are summarized as follows: " ( i ) There must be no question that the patients really are suffering from tuberculosis. (2) If the disease cannot be arrested, they must still be capable of work which must be suited to their diminished strength. (3) They cannot be trained to a new occupation and fitted to battle alone with the industrial conditions which obtain in this imperfect World. (4) But they can be trained to do ' repetition' Work, and earn wages graded to their skill. (5) The wages paid to the skilled men must be at the trade-union rate for the number of hours which their physical condition allows them to work without injury to their health. (6) All the heads of the departments must be men who have themselves suffered from the disease, although they may have recovered from it, either completely or partially. Men who have not had this experience cannot enter into the feelings of those who are working under their direction. (7) There must be a prospect of promotion in the mind of every settler--e.g., from sanatorium to hut, to hoste!, to a cottage ; and in the industries, from part time at the lower rare of Wages to full time: at the higher trades:union rate, according to skill and application, and, finally, to the position of head of a department. (8) The stores, which contain all the necessaries of village life, must be run on the same lines as the industries. (9) The products of the labour Of the settlers must be sold in the open market under competitive contracts or by travellers employed after the manner followed by wholesale firms. (io) The industries best suited for a tuberculosis settlement are such as can be carried on in well-ventilated hygienic workshops, where a considerable number of men can be employed. ( i i ) Our old but elusive friend, the 'light occupation in the open air,' although not to be exeluded, is, speaking generally, less suitable than those carried on indoors under conditions in which the worker i s s h e l t e r e d from inclement weather. (12) All heavy work :on the land is unsuitable, and all the heavy work of the industries must be done by machinery. (13) The computation Of costs of the various industries, of profit and loss, of prices at which tenders for contracts are to be made, are matters which require as close supervision as they receive in any wellordered manufacturing concern. All the secretarial work must be done by the settlers. (~4) The medical treatmen},and clinical supervision of the settlers must be as efficmnt as obtains m the best sanatoria. It should be noted that the printing of the volume has been -done entirely at Papworth by the Papworth Press, an arrangement doubtless unique in the annals of printing.