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MORAL AND MATERIAL PROGRESS
581
absent from those men engaged in slaughtering pigs, but were present in those dealing with were
cattle and to a rather less extent with sheep. In view of the fact that contagious abortion has never been observed in pigs in this country, the negative results in pig-slaughterers lend additional weight to the thesis that antibodies in the blood LONDON:SATURDAY, SEPTEMBER 10, 1932 to a titre of 1/20 or 1/40 are the result of actual infection with Br. abortus. The positive results in a number of slaughterers of sheep suggest that these animals may be infected with an organism INFECTION WITH BRUCELLA ABORTUS of the brucella group, and they clearly demand IT is now becoming fairly clear that man may further investigation. become infected with Brucella abortus from two While those in actual contact with animals may main sources-milk and direct contact with be infected through the skin, it is usually _animals. Since, according to the most recent perhaps assumed that townspeople and milk-drinkers observations, 20-40 per cent. of the mixed milk- generally are infected through the alimentary supplies in towns not practising pasteurisation tract. The theory is that when the bacilli are contain living abortus bacilli, and since a high ingested in milk or cream, they are swallowed, . proportion of our herds of cattle are infected, the pass through the stomach, and are apt to find question is often asked why undulant fever is not their way through the wall of the intestine and so more common in this country than it appears to Another route, reach the mesenteric glands. be. Even admitting that only a fraction of the however, is possible-namely, through the tonsil. cases are correctly diagnosed, and that the number In support of this C. M. CARPENTER and RUTH A. of reported cases affords but a poor index of the BoAK3at Rochester, New York, have recently true incidence of the disease, there is still a serious adduced some interesting evidence. Fifty-six discrepancy between the frequency with which pairs of tonsils removed from children and adults human beings are exposed to infection and the for various causes were examined culturally and frequency with which they develop clinical symp- by guinea-pig inoculation, and in eight of them toms of infection. The answer seems to be that Br. abortus was demonstrated. Except for one infection with Br. abortus resembles in many patient who lived on a dairy farm and about respects infection with the tubercle bacillus. We whom exact information was unobtainable, all know that 6.4 per cent. of the mixed milks of this the positive cases had drunk raw milk known to country contain living tubercle bacilli of the contain Br. abortus, though only one patient was bovine type, and we know that only a small proactually suffering from undulant fever at theportion of those consuming this milk develop time. CARPENTER and BOAK suggest that the clinical tuberculosis. The evidence of the tuberor organism may invade the tonsil and culin test, however, shows that latent infections, accumulate there until the resistance multiply of the host either with the bovine or the human type of is sufficiently lowered by fatigue or disease to bacillus, are extremely common. Most of these permit of its invading the blood stream. How latent infections give rise to little or no trouble, common primary invasion of the body via the and only a small proportion of them progress to tonsil may be it is impossible to say; it will be the stage of becoming clinically manifest. remembered that this route of entry has also been If the analogy with tuberculosis is correct, claimed for the typhoid bacillus, though the latent infections with Br. abortus should likewise balance of evidence-especially that obtained be common, and this, in fact, appears to be so. from the experimental study of mouse typhoidThe evidence obtained by examining Wassermann is against it. Before coming to any decision it sera indicates that latent infection resulting from would be necessary to make a comparative examinathe ingestion of raw milk may often be encountered, tion of the tonsils and mesenteric glands of rawespecially in the first 20 years of life. With regard milk drinkers coming to autopsy. Some large to infections by direct contact, the evidence is hospital in a provincial town in which pasteurisaeven more conclusive. A. THOMSEN, in Denmark, tion is exceptional might well make this a subject found that veterinary surgeons working with of inquiry. infected cattle frequently had antibodies to Br. abortus in the absence of any history of unduMORAL AND MATERIAL PROGRESS lant fever. Prof. J. H. DIBLE and Dr. MARGARET British Association for the Advancement THE POWNALL2 at Liverpool have now brought eviwas born in York 101 years ago. Its of Science dence to show that much the same holds true were " to make the cultivators of science men engaged in slaughtering animals and dressing objects meat. Of 100 slaughterers examined, 12 had an acquainted -with each other, to stimulate one agglutination titre of 1/40 or over to Br. abortus, another to new exertions, to bring the objects while of 100 control males of the same age-groups of science more before the public eye, and to only 2 reacted at this titre. Particularly take measures for advancing its interests and interesting was their observation that antibodies accelerating its progress "-an admirable summary of the ideals which have, with so much benefit, Jour. Infect.
THE LANCET
of
1
Dis., 1931, xlviii., 484.
2Jour. Hygiene, 1932, xxxii., 349.
2 Jour. Amer. Med. Assoc., July 23rd, p. 296.
582
,
led to the founding of the innumerable learned passes into alarm. Where are we going to ?r societies which have arisen during the century. The engineer has showered over the earth an We doubt whether medical men affect the meetings unimagined wealth of capacities and powers of the Association as much as they might. They which has made for such happiness as material have at any rate the advantage that doctors things may secure. But his gifts may be abused can there meet many interesting people with and the President goes so far as to say that ethically whom they would be unlikely to come into contact and morally man is not fit for the responsibilities elsewhere and that there is no section of medicine which his material progress involves. or pathology or hygiene, nothing indeed of a more While it is true that man is never morally professional complexion than the section of physio- fit we venture to think that Sir ALFRED underlogy, and even this was omitted this year in estimates the ethical progress which has been view of the international gathering at Rome. made since the British Association was founded, The doctors therefore are free from obligations and and that if he had had more contact with biology can wander at will to papers and discussions on he would not be so pessimistic about man’s capacity archaeology or zoology or economics or what not to meet effectively any situation which may arise. for edification rather than instruction ; they will He has been used to machines which need outalso find well-organised facilities for entertaining side intervention if their hurts are to be healed, which work only under limited conditions and excursions. to at York-the fifth be which have no power to adapt themselves to their The present meeting held in that splendid city-opened on August 31st surroundings. The tale which biology tells is with the presidential address by Sir ALFRED far more cheerful ; we see everywhere self-regulating EwiNG, the veteran leader of scientific engineering, adaptable organisms which evade and surmount and though he made no direct reference to our their difficulties and fit themselves to what they immediate interests his words are worth some find about them. The great lesson of the postconsideration by those who care to reflect on the mortem room is not that man often fails to carry broader aspects of medical practice. As might be on his life, but that the body faces overwhelming expected, he celebrates particularly the sweeping troubles with a cheerful courage which keeps pageant of discovery and invention which he has many an active spirit alive for years in a carcass watched go by in his own experience and which which is irretrievably maimed. The biologist has led man to a control of his material will have few qualms about man’s suitability to environment no one could have dreamed of when play his part in a world which he has himself the President attended his first meeting of the transformed. Sir DANIEL HALL has watched Association 65 years ago. The miraculous has the same pageant as Sir ALFRED EWING but from progressively become the commonplace, human the agriculturalist’s standpoint : "righteousness," life thereby has become richer, fuller, wider, he says in a striking essay, "is just as much healthier, and time and space have been so far a quality of the human mind as intelligence. Both abolished that the whole world is now in closer are fitful in their operations, irregular in their contact than Edinburgh was with Inverness 100 distribution, and unequal in their intensity. I hold years ago. The pageant must needs have moved that both are growing in the human race from the wonder and admiration and delight of anyone generation to generation, and this again I maintain who had eyes to see it. But Sir ALFRED goes to be a fact of observation, dependent on no on to two comments which really contain the assumptions of how or why." The fearful may of his address. he now is well take fresh Uncertainty, pith says, courage. replacing the cocksureness of the Victorian spokesmen of science who used to think that there was THORACOPLASTY IN PULMONARY somewhere a finite explanation of the world to of which the progress knowledge would inevitably TUBERCULOSIS lead. This quest of truth has gone on ceaselessly THE most important part in the treatment of and it has brought us now to doubt whether there is any truth to find more final than the steps which chronic pulmonary tuberculosis is the treatment We discover new of cavities. There is always hope for the tuberopen up fresh questions. relations between observed phenomena, but the culous lung which is free from these incubators nature of what is found to be related continues which might have been designed by nature for of tubercle bacilli. The closure of a to evade our comprehension. Relationships are the breeding means more than the closing of an apparently the only kind of discovery which cavity in anmuch essential organ ; it implies a subwe can make ; we see more clearly where the ugly gap of stantial reduction the attacking forces. By the procession is and it becomes more inclusive,time that the are the seat of chronic tuberlungs but we do not now know where it is going to. the culous disease of period haematogenous infecThe nature of things becomes more and more tion has and we can aim at local probably passed incomprehensible, and the procession becomes more with some of hope permanent cure. The and more absorbingly interesting by our very victory of associated with early infiltration cavity realisation that it can never reach a goal. And types 4often heal if spontaneously the patient by taking to a stimulating statement of this great truth ito his bed relieves the lungs of the extra work Sir ALFRED adds some rather gloomy reflections. active life. for Cavities of a slightly Admiration is, he says, now tempered withnecessary Fortnightly Review, December, 1931. criticism, complacency gives way to doubt, doubt I
1
absent from those men engaged in slaughtering pigs, but were present in those dealing with were
cattle and to a rather less extent with sheep. In view of the fact that contagious abortion has never been observed in pigs in this country, the negative results in pig-slaughterers lend additional weight to the thesis that antibodies in the blood LONDON:SATURDAY, SEPTEMBER 10, 1932 to a titre of 1/20 or 1/40 are the result of actual infection with Br. abortus. The positive results in a number of slaughterers of sheep suggest that these animals may be infected with an organism INFECTION WITH BRUCELLA ABORTUS of the brucella group, and they clearly demand IT is now becoming fairly clear that man may further investigation. become infected with Brucella abortus from two While those in actual contact with animals may main sources-milk and direct contact with be infected through the skin, it is usually _animals. Since, according to the most recent perhaps assumed that townspeople and milk-drinkers observations, 20-40 per cent. of the mixed milk- generally are infected through the alimentary supplies in towns not practising pasteurisation tract. The theory is that when the bacilli are contain living abortus bacilli, and since a high ingested in milk or cream, they are swallowed, . proportion of our herds of cattle are infected, the pass through the stomach, and are apt to find question is often asked why undulant fever is not their way through the wall of the intestine and so more common in this country than it appears to Another route, reach the mesenteric glands. be. Even admitting that only a fraction of the however, is possible-namely, through the tonsil. cases are correctly diagnosed, and that the number In support of this C. M. CARPENTER and RUTH A. of reported cases affords but a poor index of the BoAK3at Rochester, New York, have recently true incidence of the disease, there is still a serious adduced some interesting evidence. Fifty-six discrepancy between the frequency with which pairs of tonsils removed from children and adults human beings are exposed to infection and the for various causes were examined culturally and frequency with which they develop clinical symp- by guinea-pig inoculation, and in eight of them toms of infection. The answer seems to be that Br. abortus was demonstrated. Except for one infection with Br. abortus resembles in many patient who lived on a dairy farm and about respects infection with the tubercle bacillus. We whom exact information was unobtainable, all know that 6.4 per cent. of the mixed milks of this the positive cases had drunk raw milk known to country contain living tubercle bacilli of the contain Br. abortus, though only one patient was bovine type, and we know that only a small proactually suffering from undulant fever at theportion of those consuming this milk develop time. CARPENTER and BOAK suggest that the clinical tuberculosis. The evidence of the tuberor organism may invade the tonsil and culin test, however, shows that latent infections, accumulate there until the resistance multiply of the host either with the bovine or the human type of is sufficiently lowered by fatigue or disease to bacillus, are extremely common. Most of these permit of its invading the blood stream. How latent infections give rise to little or no trouble, common primary invasion of the body via the and only a small proportion of them progress to tonsil may be it is impossible to say; it will be the stage of becoming clinically manifest. remembered that this route of entry has also been If the analogy with tuberculosis is correct, claimed for the typhoid bacillus, though the latent infections with Br. abortus should likewise balance of evidence-especially that obtained be common, and this, in fact, appears to be so. from the experimental study of mouse typhoidThe evidence obtained by examining Wassermann is against it. Before coming to any decision it sera indicates that latent infection resulting from would be necessary to make a comparative examinathe ingestion of raw milk may often be encountered, tion of the tonsils and mesenteric glands of rawespecially in the first 20 years of life. With regard milk drinkers coming to autopsy. Some large to infections by direct contact, the evidence is hospital in a provincial town in which pasteurisaeven more conclusive. A. THOMSEN, in Denmark, tion is exceptional might well make this a subject found that veterinary surgeons working with of inquiry. infected cattle frequently had antibodies to Br. abortus in the absence of any history of unduMORAL AND MATERIAL PROGRESS lant fever. Prof. J. H. DIBLE and Dr. MARGARET British Association for the Advancement THE POWNALL2 at Liverpool have now brought eviwas born in York 101 years ago. Its of Science dence to show that much the same holds true were " to make the cultivators of science men engaged in slaughtering animals and dressing objects meat. Of 100 slaughterers examined, 12 had an acquainted -with each other, to stimulate one agglutination titre of 1/40 or over to Br. abortus, another to new exertions, to bring the objects while of 100 control males of the same age-groups of science more before the public eye, and to only 2 reacted at this titre. Particularly take measures for advancing its interests and interesting was their observation that antibodies accelerating its progress "-an admirable summary of the ideals which have, with so much benefit, Jour. Infect.
THE LANCET
of
1
Dis., 1931, xlviii., 484.
2Jour. Hygiene, 1932, xxxii., 349.
2 Jour. Amer. Med. Assoc., July 23rd, p. 296.
582
,
led to the founding of the innumerable learned passes into alarm. Where are we going to ?r societies which have arisen during the century. The engineer has showered over the earth an We doubt whether medical men affect the meetings unimagined wealth of capacities and powers of the Association as much as they might. They which has made for such happiness as material have at any rate the advantage that doctors things may secure. But his gifts may be abused can there meet many interesting people with and the President goes so far as to say that ethically whom they would be unlikely to come into contact and morally man is not fit for the responsibilities elsewhere and that there is no section of medicine which his material progress involves. or pathology or hygiene, nothing indeed of a more While it is true that man is never morally professional complexion than the section of physio- fit we venture to think that Sir ALFRED underlogy, and even this was omitted this year in estimates the ethical progress which has been view of the international gathering at Rome. made since the British Association was founded, The doctors therefore are free from obligations and and that if he had had more contact with biology can wander at will to papers and discussions on he would not be so pessimistic about man’s capacity archaeology or zoology or economics or what not to meet effectively any situation which may arise. for edification rather than instruction ; they will He has been used to machines which need outalso find well-organised facilities for entertaining side intervention if their hurts are to be healed, which work only under limited conditions and excursions. to at York-the fifth be which have no power to adapt themselves to their The present meeting held in that splendid city-opened on August 31st surroundings. The tale which biology tells is with the presidential address by Sir ALFRED far more cheerful ; we see everywhere self-regulating EwiNG, the veteran leader of scientific engineering, adaptable organisms which evade and surmount and though he made no direct reference to our their difficulties and fit themselves to what they immediate interests his words are worth some find about them. The great lesson of the postconsideration by those who care to reflect on the mortem room is not that man often fails to carry broader aspects of medical practice. As might be on his life, but that the body faces overwhelming expected, he celebrates particularly the sweeping troubles with a cheerful courage which keeps pageant of discovery and invention which he has many an active spirit alive for years in a carcass watched go by in his own experience and which which is irretrievably maimed. The biologist has led man to a control of his material will have few qualms about man’s suitability to environment no one could have dreamed of when play his part in a world which he has himself the President attended his first meeting of the transformed. Sir DANIEL HALL has watched Association 65 years ago. The miraculous has the same pageant as Sir ALFRED EWING but from progressively become the commonplace, human the agriculturalist’s standpoint : "righteousness," life thereby has become richer, fuller, wider, he says in a striking essay, "is just as much healthier, and time and space have been so far a quality of the human mind as intelligence. Both abolished that the whole world is now in closer are fitful in their operations, irregular in their contact than Edinburgh was with Inverness 100 distribution, and unequal in their intensity. I hold years ago. The pageant must needs have moved that both are growing in the human race from the wonder and admiration and delight of anyone generation to generation, and this again I maintain who had eyes to see it. But Sir ALFRED goes to be a fact of observation, dependent on no on to two comments which really contain the assumptions of how or why." The fearful may of his address. he now is well take fresh Uncertainty, pith says, courage. replacing the cocksureness of the Victorian spokesmen of science who used to think that there was THORACOPLASTY IN PULMONARY somewhere a finite explanation of the world to of which the progress knowledge would inevitably TUBERCULOSIS lead. This quest of truth has gone on ceaselessly THE most important part in the treatment of and it has brought us now to doubt whether there is any truth to find more final than the steps which chronic pulmonary tuberculosis is the treatment We discover new of cavities. There is always hope for the tuberopen up fresh questions. relations between observed phenomena, but the culous lung which is free from these incubators nature of what is found to be related continues which might have been designed by nature for of tubercle bacilli. The closure of a to evade our comprehension. Relationships are the breeding means more than the closing of an apparently the only kind of discovery which cavity in anmuch essential organ ; it implies a subwe can make ; we see more clearly where the ugly gap of stantial reduction the attacking forces. By the procession is and it becomes more inclusive,time that the are the seat of chronic tuberlungs but we do not now know where it is going to. the culous disease of period haematogenous infecThe nature of things becomes more and more tion has and we can aim at local probably passed incomprehensible, and the procession becomes more with some of hope permanent cure. The and more absorbingly interesting by our very victory of associated with early infiltration cavity realisation that it can never reach a goal. And types 4often heal if spontaneously the patient by taking to a stimulating statement of this great truth ito his bed relieves the lungs of the extra work Sir ALFRED adds some rather gloomy reflections. active life. for Cavities of a slightly Admiration is, he says, now tempered withnecessary Fortnightly Review, December, 1931. criticism, complacency gives way to doubt, doubt I
1