- Email: [email protected]
Some curiosities of the literature of tuberculosis
Tubercule (1974) 55, 153
OCCASIONAL SOME CURIOSITIES
SURVEY
OF THE LITERATURE
OF TUBERCULOSIS
By P. J. BISHOP from the Lihrary, Cardiothoracic Institrcte, Brompton Hospital, London
The word ‘curiosity’ is used in the above title in the sense of meaning anything curieus, rare, or strange. The word ‘curieus’ has had several meanings over the centuries, until it has gradually come to connote anything deserving or exciting curiosity; strange; singular; or queer. The older literature of tuberculosis (and diseases of the chest) naturally contains much that to modern observers appears ‘curieus’; but this paper is not so much concerned with these, but rather with items that were already curieus at the time of their appearance and which stood out from the genera1 pattern or trend because of their curiosity. Sometimes they stand out because the views expressed were far removed from the usual, accepted, orthodox views which prevailed at the time, sometimes because of their authors, and sometimes because of the form in which they were presented or published to the world. 1 am not concerned here with listing some of the many older works, with their quaint titles, incredibly detailed title-pages, and fulsomly flattering dedications; for these were not curiosities in their day, but rather the reflection of the accepted customs and tastes of the times. Although many of them are historically, and therefore inevitably, far removed from the present day, they were not regarded as being curieus in their own time. But undoubtedly many publications, both books and articles in periodicals, have been published on many aspects of tuberculosis which can be regarded as curieus by any standards. Some works could perhaps qualify for the title because of their pioneering influence, their innovative nature, or because of the catalytic effect they had on the contemporary literature; but again, I am not concerned here with these. In addition many publications can be considered bibliographic curiosities, because of their rarity or other factors; but these are outside the scope of my paper. 1 must emphasize that my choice of ‘curiosities’ has of necessity been selective. and also a strictly personal one. My examples of ‘curiosa’ could be placed in several categories, although like most attempts at classification, one cannot always place them neatly into a particular bracket. If, however, one were to attempt a classification, one category would be works of curieus title. The first example 1 have chosen is - *The young stethoscopist, or the student’s aid to aumdtation’, by Henry Z. Bowditch. M.D., New York and Boston, 1846. This work is generally regarded as being a classic among early American works on chest disease. The author Henry Ingersoll Bowditch (1808-92) studied medicine at Harvard and served as a house officer at the famous Massachusetts Genera1 Hospital. In 1832 he went to Paris, where he studied under such great figures as Andral, Chomel, and Louis. He was a particular admirer of Louis, and became bis friend as wel1 as his disciple. Dr. Saul Jarcho, in his introduction to the modern reprint of Bowditch’s work published in 1964, speaks very highly of it. It is plain that the book filled a real need, for students often found the large-scale and elaborate works of Laennec and others a little too much for them, and we know that such smaller, practica1 manuals on al1 aspects of medicine have always been popular. Bowditch’s introduction - ‘To the student of auscultation’ - starts with directness and simplicity: ‘For you 1 have prepared this book on physical diagnosis. In its preparation 1 have endeavoured to be concise, yet clear and comprehensive’. To my mind the most interesting thing about the work is that it makes use of wooden monaural stethoscopes to form the initial historiated letter at the beginnings of chapters. The use of stethoF
HI s Ii 0 1’
1.54
in this manner is. to the best of my knowledge. unique. A few of them are reproduced herc (Fig. 1). The great Laennec, who is known to have shown many acts of kindness to his pupils, although he is said to have been somewhat sparing in his praise, would doubtless have approved of such a work, and one suspects that he would have also approved of the title: while his artistic sense and feeling for style would have been gratified by the introduction of such drawings into a werk of practica1 utility. My next example is taken from the literature concerned with the evils of mouth-breathing. Such works tend to have somewhat arresting titles, but one strongly admonitory in tone was ‘S’/rli/ t’ou~’lnouth and saw your l(fC’, b_vGrorgr Catlin. the 6th edition of which was published at Londen ;n 1875. Catlin (1796-1872) was a well-known American ethnologist and traveller, and author of several works on the North American Indian. He lived among them for many years, and left us many drawings and paintings illustrating their life and customs. Like the works of many artists, his drawings are very distinctive (Figs. 2-3). Catlin’s work is perhaps typical of many such works of a polemic nature, in so far as they reveal a sort of ‘bee in the bonnet’ syndrome, which usually manifests itself in the inevitable book. lt is quite p1ai.n that he thought mouth-breathing the root cause of almost all man’s ills ‘Destructive irritation of the nervous system and inflammation of the lungs, with their consescopes
118
Tnx YoUNo
STETBOSCOPIST.
PALPATIONOF VEINS. DLSEASE of the veins is never recognised by palpation alonr, but this method affords generally similar result3 to those given in the last section.
-
AUSCULTATION OF VEINS. A~ELY is there any sound produced in the veins; but in certain cases, for example, in chlorotic females : in hssmorrhagic, and in anhsmic patients; in ah, in fact, who, from aoy cause, have less fibrine than usual in the blood, a sound called bruif ds Diable ar Devil’s noise, is heard (311). It was named by Bouillaud and resembles the sound produced by a toy. It is similar to the bellows murmur of the arteries, except that it is continuous. It becomes, in very marked cases, musical in its character, remioding one of FIG.
1
A page from Bowditch’s ‘The Young Stethoscopist’,
1846.
sIsoln3xI38n.L
do
s3111s01xfl3
IS6
li I S H 0 1’
quences, are the immediate results of this unnatural habil: and its continued and more remotc effects, consumption of the lungs and death. Besides this frequent and most fatal of all diseaseh, bronchitis, quinsey, croup, asthma, and other diseases of the respiratory organs. as wel1 as dyspepsia, gout of the stomach. rickets, diarrhoea. diseases of the liver, the heart. the sp;nr. and the whole of the nervous system, from the brain to the toes, may chiefly be attributed 10 this deadly and unnatural habit. . . .’ (P. 31) An example of a work I personally find curieus is - ‘The injfuence @atrong, prewlent. ruin-beurin,? winds on the prevalente qf’phthisis ‘, by Wiffiam Cordon, London, 1910. In spite of the well-known interest in climate and tuberculosis, clearly shown by the very large number of books and papers on the subject, this book always strikes me as a good example of the thorough approach interested people often brought to the topic. The histories of tuberculosis in general, and individual sanatoria in particular, clearly demonstrate that the founders of such institutions gave conriderable thought to the choice of site; often critically examining many possibilities before deciding on a particular locality. Dr. Gordon was Physician to the Royal Devon and Exeter Hospital. In his book he examined the influence of winds on phthisis mortality in Devonshire as a whole; on the female phthisis mortality in Okehampton rural district during the ten years 1890-1899: on the female phthisis mortality in Exeter streets during the ten years 1892-1901; the same in twenty-three parishes of North Devon d uring the forty-five years 1860-1904; and finally on the prevalente of phthisis in various parts of the world. He tells US in his first chapter that when he began his investigations, his views were at the time those generally held - ‘that the house should be protected from northerly and easterly winds, and well open to the South and west’. He was astonished to find that the ideally situated districts, well open to South and west, were just those in which the phthisis mortality was highest. In 1913 he gave the Samuel Hyde Memorial Lectures, before the Section of Balneology and Climatology of the Royal Society of Medicine, his title being - ‘The pluce of climatologv in medicine’, London, 1913. In 1920 Marcus Sinclair Paterson (1870-1932) the first Superintendent of the Brompton Hospita1 sanatorium at Frimley, and a man who had a considerable influence on the tuberculosis world of his day, published a work with a very curieus title - ‘The shibboleths of tuberculosis’, London, 1920. On the verso of the title page Paterson reproduced two definitions of the Hebrew word ‘shibboleth’: Shibboleth : ‘A catch phrase or cry to which the members of a party adhere after any signifìcance or meaning which it may have imparted has disappeared’ Ency. Brit. ‘Christians were ready to insist on that insensate shibboleth : Except ye be circumcised, ye cannot be saved’ H. J. Reynolds: John the Baptist If one consults the Shorter Oxford English Dictionary, one finds several defìnitions given 1. The Hebrew word used by Jephthah as a test-word by which to distinguish the fleeing Ephraimites (who could not pronounce the ‘sh’) from his own men the Gileadites. 2. (trans.) A word used as a test for detecting foreigners, or prrsons from another district, by their pronunciation. 3. loosely. A custom, habit, mode of dress, or the like, which distinguishes a particular class or set of persons. 3. fig. A catchword or formula adopted by a party or sect, by which their adherents or followers may be discerned, or those not their followers may be excluded. -Paterson discussed in his book fifty-nine shibboleths, and it seems to me that he was rather enlarging or extending the meaning of the word to describe certain generally accepted opinions or dogmas concerning tuberculosis, for which he thought there was no real ground for their acceptance. The following three samples illustrate some of his targets -
CURIOSITIES
OF TUBERCULOSIS
157
X111. ‘Once tubercu!ous, always tuberculeus’. This saying would be plainer if it were written, ‘once a patient has had pulmonary tuberculosis, he is never allowed to suffer from any other disease’. (P. 73) XLII. That sucking ice is good as an antidote for haemoptysis. ‘Ice applied direct to a bleeding surface does, as we are al1 aware control haemorrhage. In the case of haemoptysis, the blood is issuing from the lungs. The water from the melting ice goes to the stomach. The ice cannot have any effect on the bleeding point in the lung, unless the whole of the circulating blood is reduced in temperature by its action, which is, of course, impossible’ (Pp. 155-156) XLVI. That it is good practice to open a tuberculeus empyema. ‘It may be wel1 to do so, but 1 have seen too many such operations at Brompton ever to be induced to submit to draining tuberculeus pus from my chest. . . . It follows, of course. that 1 would not entertain the idea of an Estlander’s operation in a case due to tuberculosis’ (P. 162) LVII. That good housing wil1eradicate tuberculosis. ‘Good housing alone wil1 do no such thing. A perfect abode wil1 not prevent a man being infected outside of it, nor wil1 it afterwards prevent him from contaminating others within his domicile. It is a very narrow view to take, that any one thing wil1 eradicate tuberculosis. . . . Tuberculosis wil1 not be wiped out by any single measure - neither by Sanatoria, Tuberculosis Institutes, Health visitors, Education, Housing, nor Tuberculin. Tt wil1 demand a mobilisation of al1 forces. medical as wel1 as social, and even then it wil1 prove a great and difficult problem’ (Pp. 208211) Paterson’s work as a whole is very readable, and probably contains much that is stil1 true today. It is one of the relatively few which stand out from the rest, not only because of the somewhat iconoclastic nature of the views expressed, but also because of its very unusual title. Many readers wil1 doubtless remember the wide publicity given in the 1930’s to Umckaloabo in the treatment of pulmonary and surgical tuberculosis. The story of this substance, which had nothing, apart from its rather euphonious name to recommend it, goes back to 1897, when Charles H. Stevens, a seventeen-year old Birmingham mechanic, was found to have tuberculosis. and was advised to go to South Africa. In Bloemfontein he made the acquaintance of a witchdoctor, who was said to possess a remedy for lung diseases, prepared from certain roots. After two months treatment Stevens felt better and soon after his return to England was apparently pronounced cured by his doctor. He returned to South Africa, took part in the Boer War, attaining the rank of Major, and later set up in business. He revived his interest in Umckaloabo, and tried to interest medical men and various societies, but they al1 refused to take any interest. In 1904 he founded a company to promote his product under the name of Sacco. A friend in London (England) offered al1 doctors in the U.K. free samples so they could give it a trial. Only a few replied, and most of them wished to remain anonymous. Meanwhile, back at the Cape, Stevens had twice been fined for illegally practising medicine. By 1905 the London papers had got hold of the story, and the popular journal ‘Truth’ investigated the whole matter. In 1907 Stevens himself returned to London, where he founded the ‘Stevens Co.’ to trade in Umckaloabo, which he called ‘a vegetable germicide’. In 1909 the British Medical Association published its ‘Secret remedies: what theJ>tost and what they contain’. Their analytical chemist found the formula was approximately Rectified spirits of wine, 23.7 parts by measure Glycerine, 1.8 parts by measure Decoction of Krameria (1 in 3) to 100 parts by measure, or else it can be made with tincture of Krameria. The estimated tost of ingredients for 2: fluid oz., was lid. It sold for 5/-. The really curieus thing about the whole affair was perhaps that at least four separate books were published on ‘Stevens cure’. The first in English was probably - +The treatment of pulmonary
c Y~U‘Ituherculosis with umckulouho. It~tr~~al medicution (Stesens ’cuw). Historictrl. mentul researches. clinicul ohservutions. results ‘, 1~~.Adrien Sechehu,~~e.Trunsluted, fiwn the Frenclr London, 1928. The author of this work was a Doctor of Medicine of the Universities of Geneva and Lisbon, who had earlier written a work on the use of x-rays in the localisation of foreign bodies for which he had received the Prize of the Faculty of Medicine of the University of Geveva, and an honourable mention from the Academy of Medicine of Paris. He disclaimed any personal acquainatance with Major Stevens, although he did say he had corresponded with him. He gave a detailed account of the two lawsuits which had taken place over umckaloabo: the result of the second being that Stevens had to pay the defendant’s costs (about ff2,OOO). Sechehaye admitted that it was impossible for him to give a botanica1 description of the ‘umckaloabo’ plant. as he had never succeeded in getting a specimen from Stevens, and in fact had never seen it.
und surgical
The second book on the subject was ‘Tuherculosis. Its treutment und cure nVth the help of Umckulouho (Stevens) bjy un English ph.vsiciun M. R.C.S. (Eng), L. R.C. P. (Land., 1893) ‘. Londun. 1931. I do not know the identity of this ‘English Physician’. The third book was - ‘The treutment qf’tuherculous qjfections with Ilmckulouho. I~.~tructsf~om u com~nmicution made in Lausanne with some neM_ohservutions qf putients und complementur!~ b), Adrien Sechehaj,e. London. 1938. Therefore, no less remurks, ,fòllowed hy u ,f&fLom physicians’. than three books in English were published on this subject, al1 of them by B. Fraser 8~ Co., London -plus of course the original French version published in Switzerland. Stevens himself continued to manufacture and market the ‘drug’ from his private house, and later published a shilling booklet with the arresting title - ‘The doom of’ 150,000 people in Greut Brituin’. Coming nearer to our own times, in 1944 James Ernest Helme Roberts (1881-1948) pioneer thoracic surgeon at the Brompton Hospital, gave the Presidential Address to the Tuberculosis Association (later the BTA). He chose for his title ~ ‘Whur is the right time, pleusr. A surgeon’., unswer’. Published in the British Journal of Tuberculosis, 1944, 38, 105, it is a good example of an attention-catching title, sometimes found in such addresses. The point at issue was, what is the right time for certain surgical interventions. It may well be that as we move into a world of computerised indexing. such titles as the above. and those old favourites ‘new wine in old bottles’ and even ‘old wine in new bottles’, wil1 tend to disdppear. One advantage of such titles is that they tend to stick in the mind. It is gratifying to record that the paper by Roberts was adequately indexed in the Quarterly Cumulative Index Medicus of the day under ~ Tuberculosis, pulmonary, surgical therapy. Poetry has always had a place in medicine ~ the most famous example and one of the great First classics in medical literature being Girolamo Fracastoro’s ‘Syphili.v, sive morbus gallicus’. published at Verona in 1530, it has appeared in over a hundred editions. In our own time Sir Zachary Cope has given US ‘The diugnosis ?f’ the ucute ubdomen in rh.vme’. NO such wel1 known example exists in the literature of tuberculosis, although there are many references to consumption in poetry. Some of these are fairly well-known. but most of them are incidental. and merely provide further evidente. if it were needed, of the great part this disease has played in the history of mankind and medicine. Specilic examples of poems wholely devoted to the theme are less numerous. Richard Morton’s famous ‘Phthisiologiu’ is well known to students of the history of tuberculosis and is generally regarded as being one of the first important and influential works on the subject. First published in 1689, it went through several editions. But there is another work, far less known, which has the same general title - ‘Phthisiologiu. A poem miscelluneously descriptive und didacticul; in.four parts. To which ure prejìxed certuin preliminury, and phvsico-medicul observutions und admonitions’, London, 1798. The work bears no clue as to the author’s name. The poem contains several interesting lines, although it is rather turgid in tone. 1 wil1 confine myself to reproducing a few examples - leaving a detailed examination of the work as a whole until a later date -
CURIOSITIES
OF TUBERCULOSIS
159
‘Phthisis, my theme, thou slow destructive force! That canst so oft’ health’s property divorce Hectic - Consumption - or what name avow’d, The world thy deathly power has allow’d. That blastest fertile youth’s expanding bloom, And bring’st it prostrate to it’s finite doorn. ‘Gainst whom so little human art avails, When thy dire grasp the system frail assails, Tis thee, within the mental eye 1 see, Thou murd’rous cat’rer, for our destiny’ Several references are made to the value of travel or sea-voyages, which so long formed a part of the ‘treatment’ of the disease ‘Ere the disease is ripen’d in the frame, Or bodes the symptoms of the Phthisic same, Left be your winters on your native isle, For climes whose sway to gentle sense beguile’. The poem ends with ‘Whilst the tongue fault’ring, scarce to sound gives birth, As vision fades, upon the orb of earth. The low sigh’d whisper, seems a wish to tell, That breaths to al1 - here left, a last Farewell’. On June llth, 1844, a bazaar in aid of the building fund of the proposed new Hospita1 for Consumption, later built at Brompton, was held in the grounds of the Chelsea Hospital. On sale was a poem entitled - ‘Consurnption’, by a Mrs. T. K. Hervey, which sold for half-a-crown, and the profits from which went to the Hospital. Although the poem can perhaps be considered a fairly typical example of the style of poetry which appealed to our Victorian ancestors, it does contain some quite felicitous lines, and wel1 illustrates the knowledge people had of the disease at the time. In fact it was eminently suited to the needs and tastes of the time, and it can perhaps only claim a place in these selected pieces of ‘curiosa’ because one cannot easily imagine such a poem being written for such an occasion today. A few examples wil1 suffice ‘The blight that eateth to the rose’s heart The lightning’s flash, that masks the falling stroke Such types but dimly paint thee as thou art, Thou “smiler”, with the knife beneath the cloak! Where flowers are fairest, there thy finger soweth Weeds of the grave, by night-dews darkly fed; And, where the fruit seems richest, rankly groweth Thy harvest - for the garners of the dead! Some of the lines refer to consumption attacking both the rich and the poor ‘Through the loud laughter of the gay saloon!’ “_ * * ‘Oh, spoiler! - whom the palace cannot turn From hollow knocking at its gilded gate,’ And in a poem avowedly written to enlist active help, and financial support for the new hospital, we find such lines as ‘Yet wealth may lul1 the pain it cannot chase Or sooth the stricken, til1 their hopes revive: And sickness cometh with a milder grace Where love brings honey from a golden hive’ Poetry continued to play a part in the anti-tuberculosis movement for some time, and the first
issue of the journal
’Tuherculosis.
Thr
Journa/
of’ tlw
National
AssocYatiorr
for
IIW Pwwnrion
q/
contained a poem by Canon Hardwicke Drummond Rawnsley, well-known in Cumberland literary and poetical circles ot‘ hih day: and one who in addition to taking an active part in the anti-tuberculosi\ movement. was ah one of the founders of the National Trust. Part of the poem runs ‘Nat to make smooth the pathway to the grave For 70,000 stricken ones we meet Not from the grasp of long-drawn death to save And give back hope and health that is so sweet. Not for the rich alone, but for the poer, Doomed heretofore, a patient hideous band Today new knowledge opens wide the door Of help and heart to bless our native land’ Consumprion
The October consumptive’,
and othrr
Fotm.~ of’ Tuhermlosis
‘, Londen.
Oc~robrv~, 1899,
1903 issue of the same journal contained the Canon’s which reveals a change of style. Part of it ran ‘1 worked in the warehouse “packing-room”. Plenty of dust for a microbe there! And the pal1 of the city’s pitiless gloom Blessed the bacillus, but plagued the air.
poem ‘The cry of the poor
1 had a friend with a flush in his check, With a bit of a cough and a bit of a spit; I went off work at the end of the week, And the doctor said, “My friend, you are hit. ” :; :k ‘But the end for you, it is not in sight, For death by bacillus has slow degrees, ~ A cough by day and a sweat by night, And the lung turned leisurely into cheese. :: * * “But doctor,” 1 said, is it must, is it must? Is there not one ray of hope for me? Must 1 pass in my prime to the graveyard dust? I’ve a wife whom 1 love, and children three”. Then the doctor sadly shook his head, “There is one way only to ‘scape the ban: Good air, good feeding, good rest,” he said; “They are not at the cal1 of the working man!” The good Canon continued to produce poems in the above vein, and the January 1904 number reproduced one written to commemorate the founding of the King Edward Vl1 Sanatorium at Midhurst, which had originally been published in the Westminster Gazette of November 4th, 1903. Part of this ran ‘The Bourne of Ease! How oft to Eastbourne Hill Shall the dark city’s victims hither bring Desire of life to which al1 mortals cling, And here shall fee1 sweet Sussex sunshine fill Lungs unaccustomed to the live air’s thrill! Here, saved from slow-drawn Death’s o’ershadowing, Shall bless the giver, magnify the King.’
CURIOSITIES
OF
TUBERCULOSIS
161
It is, of course, easy to laugh at some of the above lines, and one thinks of Oscar Wilde% comment on Dickens’s description of the death of little Nell: that one would need to have a heart of stone to read it and not laugh. But there were many men and women such as the Canon, who were moved by the plight of the afflicted and less fortunate among them, and who were not in the least embarrassed at showing their emotions, whether in prose or verse. In fact, the poems give USseveral hints that the Canon, in common with other well-informed and well-intentioned interested laymen of his day had a good grasp of such aspects of tuberculosis as the influence of poverty and bad working conditions, the tubercle bacillus, symptoms of the disease and sanatoria. A recent advertisement for rifampicin reproduced the cover of a song entitled ‘T-B Blues’, words and music by Jimmie Rodgers (America’s blue yodeller) with ukelele guitar and banjo chorus. The caption tells USthat ‘The helplessness of the fight against pulmonary tuberculosis was plaintively recorded by the “Father of Country Music” Jimmie Rodgers, in 1931 - two years before he lapsed into a coma and died’. Part of the words were ‘l’ve been fighting like a lion; looks like I’m going to lose. I’m fighting like a lion; looks like Pm going to lose, ‘Cause there ain’t nobody ever whipped the TB blues’ This shows something of the continuity of man’s struggle against tuberculosis, and that ar late-as the 1930’s it was sufficiently identifiable to the genera1 public when alluded to in a popular song. The last book in my selection is - ‘Observations chie$y on pulmonary disease in India and an essay on the use of the stethoscope’ by W. E. E. Conwell, B.L., B.S., D.M.P. Surgeon on the Madras Establishment, and member qf the London College: Corresponding member of the London Medico-Botanica1 Society: and of the Imperia1 Vaccine lnstitution,for British India. Principal Surgeon to the Hospita1 established at Wallahjabad, for the native sick and wounded jirom the Burmese War. Subsequently Surgeon of the Genera1 Hospita1 at Penang. OfJiciating Surgeon of the Madras Troops employed to the Eastward; and oficiating superintending Surgeon of Prince of Waless Island, Sìngapore and Malacca. Malacca: Printed at the Mìssion Press. A.D. M.D. CCCXXIX.
The above work, which must be fairly rare, commands our attention and deserves our interest on several counts 1. lt was almost certainly the first separate work on chest diseases (and the stethoscope) published in the East Indies. 2. Tt provides further evidente of the great influence of Laennec, and of how his pupils carried his teachings to distant parts of the world. From Conwell’s preliminary observations we learn that ‘By submitting to the Profession generally, detailed statements of pulmonary disease in India ; 1 fulfil my promise to that effect made at the request of my excellent and learned master : the late M. Laennec, of Paris’. We know that Conwell obtained the Paris M.D., in 1824, but here we have direct evidente of the great Laennec actually stimulating one of his pupils to undertake a specific piece of research. 3. The work is bibliographically interesting, being printed at what must have been one of the earliest presses in the Malay peninsula. Also of interest is its typography and unusual format. 4. The work perhaps qualifies for inclusion in this collection of ‘curiosities’ because of the author’s admission that he originally underestimated the importante of pulmonary disease in India, but his subsequent researches made him revise his opinion. Such examples of admission of error are not al1 that common in literature. In conclusion one should perhaps mention certain aspects of the history of tuberculosis which 1 have excluded from this paper. Such things as the supposed benefits to be derived from horseriding, swinging, the drinking of asses, mares, or women’s milk cannot, 1 think, be really considered curieus, because they were rationalized by the views of their time. Even many of the extraordinary concoctions made from mice boiled in salt and oil, boiled crocodile, ashes of the dunp of a hare,
162
13IS ti 0 P
snails. and elephant’s blood al1 seemed logica1 to earlier generations, or were at least hallowed h! long tradition. which began publication in 1907. The early volumes of the British Journal of Tuberculosis. contain many references to items of eyuipment which formed part ot the anti-tuberculoais armamentarium in the fìrst two decades of this century. Such things as elaborate face-masks. foot-warmers, and truncheons with built in whistles for emergency use for patients sleeping in often isolated revolving huts or chalets in sanatoria, now raise a smile: but in their day they had a propelplace and contemporary readers saw nothing amusing in them. In Gerald Webb’s excellent little history of tuberculosis, published in 1936. we read ‘Cato, the Elder . . . was the great exponent of cabbage for phthisis, and a lukewarm bath ot urine for a person who had eaten cabbage was considered the infallible cure’ (p. 143) One is left wondering how this prescription or suggestion was actually implemented. How long did the consumptive patient have to wait before the cabbage-consuming party produced enough urine to make it w-orth his while to take a bath? The periodical literature of tuberculosis and chest diseases is a chapter in itself. and well illustratea the interest which this important disease and branch of medicine has aroused over the years. Since in 1862-63 the fìrst periodical in the field appeared. appropriately enough named ‘Thr Stethoscope (it only ran for four numbers) journals have proliferated, devoted not only to tuberculosis in its widest sense, but als» to such specific aspects as prevention and control, tuberculosi: in children. thoracic surgery, mass radiography bronchoscopy, and sanatoria. I sometimes think it curieus Lx that one can trace an almost logica1 progression in titles, evinced by such examples as - Thomas Poumon ~ Lung nnd Heart - Chest and 1~s Bronrhes. So Far we have not yet reached the stage where we have one journal for the right lung and one for the left organ, but one cannot help but feel that the mid-nineteenth century medical press. which greeted with dismay and derision the advent of ‘The Stethoscope’ in 1862 and warned that it would lead to a deplorable state of affairs. might well if they could speak to US from the grave, say -- ‘1 told YOLI so’. In conclusion I would mention one boek, which. whenever I pass the section on sanatoria in its title is ~- ‘La pratiyuc the library and notice it never l’ails to amuse me. By L. Guinard. des snnatoriwm’. Paris. 1925. It is a large book of 446 pages. and is, in fact, a mine of information on all aspects of sanatoria at the period. One of the many topics it deals with is the provision of libraries for patients. After a somewhat unpromising beginning - in fact the very first rule is ‘Les bibliothèques doivent toujours être fermées’ (which might almost have been written by a librarian) it goer on to say among other things -~ ‘L’introduction des brochures, imprimés, journaux. illustrations, etc., portant atteinte a la morale par leur trop grande Iégèreté ou leur obscénité, est absolument interdite. .
Al1 the works 1 have quoted from are in the Library of the Cardiothoracic Institute at Brompton, with the exception of ‘Phthisiologia. A poem . . .*, London. 1798, which would appear to be a very rare work. 1 know only of copies in the Manchester University Medical Library and the National Library of Medicine, Bethesda, Md. Conwell’s ‘Observations . . .., Malacca, 1829, is not such a rare item, and copies are in the libraries of the Royal Society of Medicine: the Royal College of Physiciani of London: and the Wellcome Institute of the History of Medicine.
OCCASIONAL SOME CURIOSITIES
SURVEY
OF THE LITERATURE
OF TUBERCULOSIS
By P. J. BISHOP from the Lihrary, Cardiothoracic Institrcte, Brompton Hospital, London
The word ‘curiosity’ is used in the above title in the sense of meaning anything curieus, rare, or strange. The word ‘curieus’ has had several meanings over the centuries, until it has gradually come to connote anything deserving or exciting curiosity; strange; singular; or queer. The older literature of tuberculosis (and diseases of the chest) naturally contains much that to modern observers appears ‘curieus’; but this paper is not so much concerned with these, but rather with items that were already curieus at the time of their appearance and which stood out from the genera1 pattern or trend because of their curiosity. Sometimes they stand out because the views expressed were far removed from the usual, accepted, orthodox views which prevailed at the time, sometimes because of their authors, and sometimes because of the form in which they were presented or published to the world. 1 am not concerned here with listing some of the many older works, with their quaint titles, incredibly detailed title-pages, and fulsomly flattering dedications; for these were not curiosities in their day, but rather the reflection of the accepted customs and tastes of the times. Although many of them are historically, and therefore inevitably, far removed from the present day, they were not regarded as being curieus in their own time. But undoubtedly many publications, both books and articles in periodicals, have been published on many aspects of tuberculosis which can be regarded as curieus by any standards. Some works could perhaps qualify for the title because of their pioneering influence, their innovative nature, or because of the catalytic effect they had on the contemporary literature; but again, I am not concerned here with these. In addition many publications can be considered bibliographic curiosities, because of their rarity or other factors; but these are outside the scope of my paper. 1 must emphasize that my choice of ‘curiosities’ has of necessity been selective. and also a strictly personal one. My examples of ‘curiosa’ could be placed in several categories, although like most attempts at classification, one cannot always place them neatly into a particular bracket. If, however, one were to attempt a classification, one category would be works of curieus title. The first example 1 have chosen is - *The young stethoscopist, or the student’s aid to aumdtation’, by Henry Z. Bowditch. M.D., New York and Boston, 1846. This work is generally regarded as being a classic among early American works on chest disease. The author Henry Ingersoll Bowditch (1808-92) studied medicine at Harvard and served as a house officer at the famous Massachusetts Genera1 Hospital. In 1832 he went to Paris, where he studied under such great figures as Andral, Chomel, and Louis. He was a particular admirer of Louis, and became bis friend as wel1 as his disciple. Dr. Saul Jarcho, in his introduction to the modern reprint of Bowditch’s work published in 1964, speaks very highly of it. It is plain that the book filled a real need, for students often found the large-scale and elaborate works of Laennec and others a little too much for them, and we know that such smaller, practica1 manuals on al1 aspects of medicine have always been popular. Bowditch’s introduction - ‘To the student of auscultation’ - starts with directness and simplicity: ‘For you 1 have prepared this book on physical diagnosis. In its preparation 1 have endeavoured to be concise, yet clear and comprehensive’. To my mind the most interesting thing about the work is that it makes use of wooden monaural stethoscopes to form the initial historiated letter at the beginnings of chapters. The use of stethoF
HI s Ii 0 1’
1.54
in this manner is. to the best of my knowledge. unique. A few of them are reproduced herc (Fig. 1). The great Laennec, who is known to have shown many acts of kindness to his pupils, although he is said to have been somewhat sparing in his praise, would doubtless have approved of such a work, and one suspects that he would have also approved of the title: while his artistic sense and feeling for style would have been gratified by the introduction of such drawings into a werk of practica1 utility. My next example is taken from the literature concerned with the evils of mouth-breathing. Such works tend to have somewhat arresting titles, but one strongly admonitory in tone was ‘S’/rli/ t’ou~’lnouth and saw your l(fC’, b_vGrorgr Catlin. the 6th edition of which was published at Londen ;n 1875. Catlin (1796-1872) was a well-known American ethnologist and traveller, and author of several works on the North American Indian. He lived among them for many years, and left us many drawings and paintings illustrating their life and customs. Like the works of many artists, his drawings are very distinctive (Figs. 2-3). Catlin’s work is perhaps typical of many such works of a polemic nature, in so far as they reveal a sort of ‘bee in the bonnet’ syndrome, which usually manifests itself in the inevitable book. lt is quite p1ai.n that he thought mouth-breathing the root cause of almost all man’s ills ‘Destructive irritation of the nervous system and inflammation of the lungs, with their consescopes
118
Tnx YoUNo
STETBOSCOPIST.
PALPATIONOF VEINS. DLSEASE of the veins is never recognised by palpation alonr, but this method affords generally similar result3 to those given in the last section.
-
AUSCULTATION OF VEINS. A~ELY is there any sound produced in the veins; but in certain cases, for example, in chlorotic females : in hssmorrhagic, and in anhsmic patients; in ah, in fact, who, from aoy cause, have less fibrine than usual in the blood, a sound called bruif ds Diable ar Devil’s noise, is heard (311). It was named by Bouillaud and resembles the sound produced by a toy. It is similar to the bellows murmur of the arteries, except that it is continuous. It becomes, in very marked cases, musical in its character, remioding one of FIG.
1
A page from Bowditch’s ‘The Young Stethoscopist’,
1846.
sIsoln3xI38n.L
do
s3111s01xfl3
IS6
li I S H 0 1’
quences, are the immediate results of this unnatural habil: and its continued and more remotc effects, consumption of the lungs and death. Besides this frequent and most fatal of all diseaseh, bronchitis, quinsey, croup, asthma, and other diseases of the respiratory organs. as wel1 as dyspepsia, gout of the stomach. rickets, diarrhoea. diseases of the liver, the heart. the sp;nr. and the whole of the nervous system, from the brain to the toes, may chiefly be attributed 10 this deadly and unnatural habit. . . .’ (P. 31) An example of a work I personally find curieus is - ‘The injfuence @atrong, prewlent. ruin-beurin,? winds on the prevalente qf’phthisis ‘, by Wiffiam Cordon, London, 1910. In spite of the well-known interest in climate and tuberculosis, clearly shown by the very large number of books and papers on the subject, this book always strikes me as a good example of the thorough approach interested people often brought to the topic. The histories of tuberculosis in general, and individual sanatoria in particular, clearly demonstrate that the founders of such institutions gave conriderable thought to the choice of site; often critically examining many possibilities before deciding on a particular locality. Dr. Gordon was Physician to the Royal Devon and Exeter Hospital. In his book he examined the influence of winds on phthisis mortality in Devonshire as a whole; on the female phthisis mortality in Okehampton rural district during the ten years 1890-1899: on the female phthisis mortality in Exeter streets during the ten years 1892-1901; the same in twenty-three parishes of North Devon d uring the forty-five years 1860-1904; and finally on the prevalente of phthisis in various parts of the world. He tells US in his first chapter that when he began his investigations, his views were at the time those generally held - ‘that the house should be protected from northerly and easterly winds, and well open to the South and west’. He was astonished to find that the ideally situated districts, well open to South and west, were just those in which the phthisis mortality was highest. In 1913 he gave the Samuel Hyde Memorial Lectures, before the Section of Balneology and Climatology of the Royal Society of Medicine, his title being - ‘The pluce of climatologv in medicine’, London, 1913. In 1920 Marcus Sinclair Paterson (1870-1932) the first Superintendent of the Brompton Hospita1 sanatorium at Frimley, and a man who had a considerable influence on the tuberculosis world of his day, published a work with a very curieus title - ‘The shibboleths of tuberculosis’, London, 1920. On the verso of the title page Paterson reproduced two definitions of the Hebrew word ‘shibboleth’: Shibboleth : ‘A catch phrase or cry to which the members of a party adhere after any signifìcance or meaning which it may have imparted has disappeared’ Ency. Brit. ‘Christians were ready to insist on that insensate shibboleth : Except ye be circumcised, ye cannot be saved’ H. J. Reynolds: John the Baptist If one consults the Shorter Oxford English Dictionary, one finds several defìnitions given 1. The Hebrew word used by Jephthah as a test-word by which to distinguish the fleeing Ephraimites (who could not pronounce the ‘sh’) from his own men the Gileadites. 2. (trans.) A word used as a test for detecting foreigners, or prrsons from another district, by their pronunciation. 3. loosely. A custom, habit, mode of dress, or the like, which distinguishes a particular class or set of persons. 3. fig. A catchword or formula adopted by a party or sect, by which their adherents or followers may be discerned, or those not their followers may be excluded. -Paterson discussed in his book fifty-nine shibboleths, and it seems to me that he was rather enlarging or extending the meaning of the word to describe certain generally accepted opinions or dogmas concerning tuberculosis, for which he thought there was no real ground for their acceptance. The following three samples illustrate some of his targets -
CURIOSITIES
OF TUBERCULOSIS
157
X111. ‘Once tubercu!ous, always tuberculeus’. This saying would be plainer if it were written, ‘once a patient has had pulmonary tuberculosis, he is never allowed to suffer from any other disease’. (P. 73) XLII. That sucking ice is good as an antidote for haemoptysis. ‘Ice applied direct to a bleeding surface does, as we are al1 aware control haemorrhage. In the case of haemoptysis, the blood is issuing from the lungs. The water from the melting ice goes to the stomach. The ice cannot have any effect on the bleeding point in the lung, unless the whole of the circulating blood is reduced in temperature by its action, which is, of course, impossible’ (Pp. 155-156) XLVI. That it is good practice to open a tuberculeus empyema. ‘It may be wel1 to do so, but 1 have seen too many such operations at Brompton ever to be induced to submit to draining tuberculeus pus from my chest. . . . It follows, of course. that 1 would not entertain the idea of an Estlander’s operation in a case due to tuberculosis’ (P. 162) LVII. That good housing wil1eradicate tuberculosis. ‘Good housing alone wil1 do no such thing. A perfect abode wil1 not prevent a man being infected outside of it, nor wil1 it afterwards prevent him from contaminating others within his domicile. It is a very narrow view to take, that any one thing wil1 eradicate tuberculosis. . . . Tuberculosis wil1 not be wiped out by any single measure - neither by Sanatoria, Tuberculosis Institutes, Health visitors, Education, Housing, nor Tuberculin. Tt wil1 demand a mobilisation of al1 forces. medical as wel1 as social, and even then it wil1 prove a great and difficult problem’ (Pp. 208211) Paterson’s work as a whole is very readable, and probably contains much that is stil1 true today. It is one of the relatively few which stand out from the rest, not only because of the somewhat iconoclastic nature of the views expressed, but also because of its very unusual title. Many readers wil1 doubtless remember the wide publicity given in the 1930’s to Umckaloabo in the treatment of pulmonary and surgical tuberculosis. The story of this substance, which had nothing, apart from its rather euphonious name to recommend it, goes back to 1897, when Charles H. Stevens, a seventeen-year old Birmingham mechanic, was found to have tuberculosis. and was advised to go to South Africa. In Bloemfontein he made the acquaintance of a witchdoctor, who was said to possess a remedy for lung diseases, prepared from certain roots. After two months treatment Stevens felt better and soon after his return to England was apparently pronounced cured by his doctor. He returned to South Africa, took part in the Boer War, attaining the rank of Major, and later set up in business. He revived his interest in Umckaloabo, and tried to interest medical men and various societies, but they al1 refused to take any interest. In 1904 he founded a company to promote his product under the name of Sacco. A friend in London (England) offered al1 doctors in the U.K. free samples so they could give it a trial. Only a few replied, and most of them wished to remain anonymous. Meanwhile, back at the Cape, Stevens had twice been fined for illegally practising medicine. By 1905 the London papers had got hold of the story, and the popular journal ‘Truth’ investigated the whole matter. In 1907 Stevens himself returned to London, where he founded the ‘Stevens Co.’ to trade in Umckaloabo, which he called ‘a vegetable germicide’. In 1909 the British Medical Association published its ‘Secret remedies: what theJ>tost and what they contain’. Their analytical chemist found the formula was approximately Rectified spirits of wine, 23.7 parts by measure Glycerine, 1.8 parts by measure Decoction of Krameria (1 in 3) to 100 parts by measure, or else it can be made with tincture of Krameria. The estimated tost of ingredients for 2: fluid oz., was lid. It sold for 5/-. The really curieus thing about the whole affair was perhaps that at least four separate books were published on ‘Stevens cure’. The first in English was probably - +The treatment of pulmonary
c Y~U‘Ituherculosis with umckulouho. It~tr~~al medicution (Stesens ’cuw). Historictrl. mentul researches. clinicul ohservutions. results ‘, 1~~.Adrien Sechehu,~~e.Trunsluted, fiwn the Frenclr London, 1928. The author of this work was a Doctor of Medicine of the Universities of Geneva and Lisbon, who had earlier written a work on the use of x-rays in the localisation of foreign bodies for which he had received the Prize of the Faculty of Medicine of the University of Geveva, and an honourable mention from the Academy of Medicine of Paris. He disclaimed any personal acquainatance with Major Stevens, although he did say he had corresponded with him. He gave a detailed account of the two lawsuits which had taken place over umckaloabo: the result of the second being that Stevens had to pay the defendant’s costs (about ff2,OOO). Sechehaye admitted that it was impossible for him to give a botanica1 description of the ‘umckaloabo’ plant. as he had never succeeded in getting a specimen from Stevens, and in fact had never seen it.
und surgical
The second book on the subject was ‘Tuherculosis. Its treutment und cure nVth the help of Umckulouho (Stevens) bjy un English ph.vsiciun M. R.C.S. (Eng), L. R.C. P. (Land., 1893) ‘. Londun. 1931. I do not know the identity of this ‘English Physician’. The third book was - ‘The treutment qf’tuherculous qjfections with Ilmckulouho. I~.~tructsf~om u com~nmicution made in Lausanne with some neM_ohservutions qf putients und complementur!~ b), Adrien Sechehaj,e. London. 1938. Therefore, no less remurks, ,fòllowed hy u ,f&fLom physicians’. than three books in English were published on this subject, al1 of them by B. Fraser 8~ Co., London -plus of course the original French version published in Switzerland. Stevens himself continued to manufacture and market the ‘drug’ from his private house, and later published a shilling booklet with the arresting title - ‘The doom of’ 150,000 people in Greut Brituin’. Coming nearer to our own times, in 1944 James Ernest Helme Roberts (1881-1948) pioneer thoracic surgeon at the Brompton Hospital, gave the Presidential Address to the Tuberculosis Association (later the BTA). He chose for his title ~ ‘Whur is the right time, pleusr. A surgeon’., unswer’. Published in the British Journal of Tuberculosis, 1944, 38, 105, it is a good example of an attention-catching title, sometimes found in such addresses. The point at issue was, what is the right time for certain surgical interventions. It may well be that as we move into a world of computerised indexing. such titles as the above. and those old favourites ‘new wine in old bottles’ and even ‘old wine in new bottles’, wil1 tend to disdppear. One advantage of such titles is that they tend to stick in the mind. It is gratifying to record that the paper by Roberts was adequately indexed in the Quarterly Cumulative Index Medicus of the day under ~ Tuberculosis, pulmonary, surgical therapy. Poetry has always had a place in medicine ~ the most famous example and one of the great First classics in medical literature being Girolamo Fracastoro’s ‘Syphili.v, sive morbus gallicus’. published at Verona in 1530, it has appeared in over a hundred editions. In our own time Sir Zachary Cope has given US ‘The diugnosis ?f’ the ucute ubdomen in rh.vme’. NO such wel1 known example exists in the literature of tuberculosis, although there are many references to consumption in poetry. Some of these are fairly well-known. but most of them are incidental. and merely provide further evidente. if it were needed, of the great part this disease has played in the history of mankind and medicine. Specilic examples of poems wholely devoted to the theme are less numerous. Richard Morton’s famous ‘Phthisiologiu’ is well known to students of the history of tuberculosis and is generally regarded as being one of the first important and influential works on the subject. First published in 1689, it went through several editions. But there is another work, far less known, which has the same general title - ‘Phthisiologiu. A poem miscelluneously descriptive und didacticul; in.four parts. To which ure prejìxed certuin preliminury, and phvsico-medicul observutions und admonitions’, London, 1798. The work bears no clue as to the author’s name. The poem contains several interesting lines, although it is rather turgid in tone. 1 wil1 confine myself to reproducing a few examples - leaving a detailed examination of the work as a whole until a later date -
CURIOSITIES
OF TUBERCULOSIS
159
‘Phthisis, my theme, thou slow destructive force! That canst so oft’ health’s property divorce Hectic - Consumption - or what name avow’d, The world thy deathly power has allow’d. That blastest fertile youth’s expanding bloom, And bring’st it prostrate to it’s finite doorn. ‘Gainst whom so little human art avails, When thy dire grasp the system frail assails, Tis thee, within the mental eye 1 see, Thou murd’rous cat’rer, for our destiny’ Several references are made to the value of travel or sea-voyages, which so long formed a part of the ‘treatment’ of the disease ‘Ere the disease is ripen’d in the frame, Or bodes the symptoms of the Phthisic same, Left be your winters on your native isle, For climes whose sway to gentle sense beguile’. The poem ends with ‘Whilst the tongue fault’ring, scarce to sound gives birth, As vision fades, upon the orb of earth. The low sigh’d whisper, seems a wish to tell, That breaths to al1 - here left, a last Farewell’. On June llth, 1844, a bazaar in aid of the building fund of the proposed new Hospita1 for Consumption, later built at Brompton, was held in the grounds of the Chelsea Hospital. On sale was a poem entitled - ‘Consurnption’, by a Mrs. T. K. Hervey, which sold for half-a-crown, and the profits from which went to the Hospital. Although the poem can perhaps be considered a fairly typical example of the style of poetry which appealed to our Victorian ancestors, it does contain some quite felicitous lines, and wel1 illustrates the knowledge people had of the disease at the time. In fact it was eminently suited to the needs and tastes of the time, and it can perhaps only claim a place in these selected pieces of ‘curiosa’ because one cannot easily imagine such a poem being written for such an occasion today. A few examples wil1 suffice ‘The blight that eateth to the rose’s heart The lightning’s flash, that masks the falling stroke Such types but dimly paint thee as thou art, Thou “smiler”, with the knife beneath the cloak! Where flowers are fairest, there thy finger soweth Weeds of the grave, by night-dews darkly fed; And, where the fruit seems richest, rankly groweth Thy harvest - for the garners of the dead! Some of the lines refer to consumption attacking both the rich and the poor ‘Through the loud laughter of the gay saloon!’ “_ * * ‘Oh, spoiler! - whom the palace cannot turn From hollow knocking at its gilded gate,’ And in a poem avowedly written to enlist active help, and financial support for the new hospital, we find such lines as ‘Yet wealth may lul1 the pain it cannot chase Or sooth the stricken, til1 their hopes revive: And sickness cometh with a milder grace Where love brings honey from a golden hive’ Poetry continued to play a part in the anti-tuberculosis movement for some time, and the first
issue of the journal
’Tuherculosis.
Thr
Journa/
of’ tlw
National
AssocYatiorr
for
IIW Pwwnrion
q/
contained a poem by Canon Hardwicke Drummond Rawnsley, well-known in Cumberland literary and poetical circles ot‘ hih day: and one who in addition to taking an active part in the anti-tuberculosi\ movement. was ah one of the founders of the National Trust. Part of the poem runs ‘Nat to make smooth the pathway to the grave For 70,000 stricken ones we meet Not from the grasp of long-drawn death to save And give back hope and health that is so sweet. Not for the rich alone, but for the poer, Doomed heretofore, a patient hideous band Today new knowledge opens wide the door Of help and heart to bless our native land’ Consumprion
The October consumptive’,
and othrr
Fotm.~ of’ Tuhermlosis
‘, Londen.
Oc~robrv~, 1899,
1903 issue of the same journal contained the Canon’s which reveals a change of style. Part of it ran ‘1 worked in the warehouse “packing-room”. Plenty of dust for a microbe there! And the pal1 of the city’s pitiless gloom Blessed the bacillus, but plagued the air.
poem ‘The cry of the poor
1 had a friend with a flush in his check, With a bit of a cough and a bit of a spit; I went off work at the end of the week, And the doctor said, “My friend, you are hit. ” :; :k ‘But the end for you, it is not in sight, For death by bacillus has slow degrees, ~ A cough by day and a sweat by night, And the lung turned leisurely into cheese. :: * * “But doctor,” 1 said, is it must, is it must? Is there not one ray of hope for me? Must 1 pass in my prime to the graveyard dust? I’ve a wife whom 1 love, and children three”. Then the doctor sadly shook his head, “There is one way only to ‘scape the ban: Good air, good feeding, good rest,” he said; “They are not at the cal1 of the working man!” The good Canon continued to produce poems in the above vein, and the January 1904 number reproduced one written to commemorate the founding of the King Edward Vl1 Sanatorium at Midhurst, which had originally been published in the Westminster Gazette of November 4th, 1903. Part of this ran ‘The Bourne of Ease! How oft to Eastbourne Hill Shall the dark city’s victims hither bring Desire of life to which al1 mortals cling, And here shall fee1 sweet Sussex sunshine fill Lungs unaccustomed to the live air’s thrill! Here, saved from slow-drawn Death’s o’ershadowing, Shall bless the giver, magnify the King.’
CURIOSITIES
OF
TUBERCULOSIS
161
It is, of course, easy to laugh at some of the above lines, and one thinks of Oscar Wilde% comment on Dickens’s description of the death of little Nell: that one would need to have a heart of stone to read it and not laugh. But there were many men and women such as the Canon, who were moved by the plight of the afflicted and less fortunate among them, and who were not in the least embarrassed at showing their emotions, whether in prose or verse. In fact, the poems give USseveral hints that the Canon, in common with other well-informed and well-intentioned interested laymen of his day had a good grasp of such aspects of tuberculosis as the influence of poverty and bad working conditions, the tubercle bacillus, symptoms of the disease and sanatoria. A recent advertisement for rifampicin reproduced the cover of a song entitled ‘T-B Blues’, words and music by Jimmie Rodgers (America’s blue yodeller) with ukelele guitar and banjo chorus. The caption tells USthat ‘The helplessness of the fight against pulmonary tuberculosis was plaintively recorded by the “Father of Country Music” Jimmie Rodgers, in 1931 - two years before he lapsed into a coma and died’. Part of the words were ‘l’ve been fighting like a lion; looks like I’m going to lose. I’m fighting like a lion; looks like Pm going to lose, ‘Cause there ain’t nobody ever whipped the TB blues’ This shows something of the continuity of man’s struggle against tuberculosis, and that ar late-as the 1930’s it was sufficiently identifiable to the genera1 public when alluded to in a popular song. The last book in my selection is - ‘Observations chie$y on pulmonary disease in India and an essay on the use of the stethoscope’ by W. E. E. Conwell, B.L., B.S., D.M.P. Surgeon on the Madras Establishment, and member qf the London College: Corresponding member of the London Medico-Botanica1 Society: and of the Imperia1 Vaccine lnstitution,for British India. Principal Surgeon to the Hospita1 established at Wallahjabad, for the native sick and wounded jirom the Burmese War. Subsequently Surgeon of the Genera1 Hospita1 at Penang. OfJiciating Surgeon of the Madras Troops employed to the Eastward; and oficiating superintending Surgeon of Prince of Waless Island, Sìngapore and Malacca. Malacca: Printed at the Mìssion Press. A.D. M.D. CCCXXIX.
The above work, which must be fairly rare, commands our attention and deserves our interest on several counts 1. lt was almost certainly the first separate work on chest diseases (and the stethoscope) published in the East Indies. 2. Tt provides further evidente of the great influence of Laennec, and of how his pupils carried his teachings to distant parts of the world. From Conwell’s preliminary observations we learn that ‘By submitting to the Profession generally, detailed statements of pulmonary disease in India ; 1 fulfil my promise to that effect made at the request of my excellent and learned master : the late M. Laennec, of Paris’. We know that Conwell obtained the Paris M.D., in 1824, but here we have direct evidente of the great Laennec actually stimulating one of his pupils to undertake a specific piece of research. 3. The work is bibliographically interesting, being printed at what must have been one of the earliest presses in the Malay peninsula. Also of interest is its typography and unusual format. 4. The work perhaps qualifies for inclusion in this collection of ‘curiosities’ because of the author’s admission that he originally underestimated the importante of pulmonary disease in India, but his subsequent researches made him revise his opinion. Such examples of admission of error are not al1 that common in literature. In conclusion one should perhaps mention certain aspects of the history of tuberculosis which 1 have excluded from this paper. Such things as the supposed benefits to be derived from horseriding, swinging, the drinking of asses, mares, or women’s milk cannot, 1 think, be really considered curieus, because they were rationalized by the views of their time. Even many of the extraordinary concoctions made from mice boiled in salt and oil, boiled crocodile, ashes of the dunp of a hare,
162
13IS ti 0 P
snails. and elephant’s blood al1 seemed logica1 to earlier generations, or were at least hallowed h! long tradition. which began publication in 1907. The early volumes of the British Journal of Tuberculosis. contain many references to items of eyuipment which formed part ot the anti-tuberculoais armamentarium in the fìrst two decades of this century. Such things as elaborate face-masks. foot-warmers, and truncheons with built in whistles for emergency use for patients sleeping in often isolated revolving huts or chalets in sanatoria, now raise a smile: but in their day they had a propelplace and contemporary readers saw nothing amusing in them. In Gerald Webb’s excellent little history of tuberculosis, published in 1936. we read ‘Cato, the Elder . . . was the great exponent of cabbage for phthisis, and a lukewarm bath ot urine for a person who had eaten cabbage was considered the infallible cure’ (p. 143) One is left wondering how this prescription or suggestion was actually implemented. How long did the consumptive patient have to wait before the cabbage-consuming party produced enough urine to make it w-orth his while to take a bath? The periodical literature of tuberculosis and chest diseases is a chapter in itself. and well illustratea the interest which this important disease and branch of medicine has aroused over the years. Since in 1862-63 the fìrst periodical in the field appeared. appropriately enough named ‘Thr Stethoscope (it only ran for four numbers) journals have proliferated, devoted not only to tuberculosis in its widest sense, but als» to such specific aspects as prevention and control, tuberculosi: in children. thoracic surgery, mass radiography bronchoscopy, and sanatoria. I sometimes think it curieus Lx that one can trace an almost logica1 progression in titles, evinced by such examples as - Thomas Poumon ~ Lung nnd Heart - Chest and 1~s Bronrhes. So Far we have not yet reached the stage where we have one journal for the right lung and one for the left organ, but one cannot help but feel that the mid-nineteenth century medical press. which greeted with dismay and derision the advent of ‘The Stethoscope’ in 1862 and warned that it would lead to a deplorable state of affairs. might well if they could speak to US from the grave, say -- ‘1 told YOLI so’. In conclusion I would mention one boek, which. whenever I pass the section on sanatoria in its title is ~- ‘La pratiyuc the library and notice it never l’ails to amuse me. By L. Guinard. des snnatoriwm’. Paris. 1925. It is a large book of 446 pages. and is, in fact, a mine of information on all aspects of sanatoria at the period. One of the many topics it deals with is the provision of libraries for patients. After a somewhat unpromising beginning - in fact the very first rule is ‘Les bibliothèques doivent toujours être fermées’ (which might almost have been written by a librarian) it goer on to say among other things -~ ‘L’introduction des brochures, imprimés, journaux. illustrations, etc., portant atteinte a la morale par leur trop grande Iégèreté ou leur obscénité, est absolument interdite. .
Al1 the works 1 have quoted from are in the Library of the Cardiothoracic Institute at Brompton, with the exception of ‘Phthisiologia. A poem . . .*, London. 1798, which would appear to be a very rare work. 1 know only of copies in the Manchester University Medical Library and the National Library of Medicine, Bethesda, Md. Conwell’s ‘Observations . . .., Malacca, 1829, is not such a rare item, and copies are in the libraries of the Royal Society of Medicine: the Royal College of Physiciani of London: and the Wellcome Institute of the History of Medicine.