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The blood in pulmonary tuberculosis
262
THE
BRITISH
JOURNAL
OF TUBERCULOSIS
to the back settlements. T h e y perish under the conditions found in Northern cities. H a d the inheritance been Mendelian, a proportion of them would have inherited the high resisting power of the whites, and a mixed race would have been founded, as in Central and South America. The evidence for the second conclusion is less convincing. At any rate, I think the case is stated too strongly. Doubtless urban dwellers almost daily or hourly inhale or ingest some tubercle bacilli. But dosage plays an important part in infection. In some homes and occupations the liability to receive a dose of bacilli large enough to cause disease is far greater than under other conditions. Moreover, it is in just such homes and occupations that the resisting power of the individual is most lowered--that the innate diathesis is most altered by subsequent acquirement. Environment, therefore, is a considerable factor--obviously so, since an environment in which the average ]Briton can dwell in safety is dangerous to the American negro and deadly to the Red Indian. In the slums of our cities the conditions are dangerous even for the average Briton and deadly for the weaker members of his race. The recent fall in the mortality from phthisis has been so rapid that it cannot be attributed to an improvement in the race, but only to an improvement in the environment. T h e fact that m a n y people who succumb to phthisis when they are approaching middle age escape meningeal and abdominal tuberculosis during infancy and puhnonary tuberculosis during youth is evidence that a fatal dose of bacilli is not, under ordinary circumstances, to be acquired every day by the average individual who is in normal health. Nevertheless, Professor Pearson is well within the mark when he declares that " there is an antisocial disregard for national eugenics in the conduct of medical men who can write to the public press that marriage or even intermarriage of members of tuberculous stocks is of no social detriment, provided they live with a good supply of fresh air." Under such conditions as prevail in England, no amount of air can secure immunity to the members of a susceptible stock. Often, however, it secures life sufficiently prolonged to increase the n u m b e r of sufferers in the next generation. G . ARCHDALL REID, M . B .
THE BLOOD IN PULMONARY TUBERCULOSIS. 1 Dr. R. Kjer-Petersen, in his work on the numerical relations of the leucocytes in pulmonary tuberculosis, has had to meet the difficulty that the ordinary methods of counting the white corpuscles in the blood are very defective, and the normal figures for healthy men and women have not been quite accurately ascertained. According to the author, the number of leucocytes in blood taken on awaking in the morning is fairly constant for healthy men--generally between 4,ooo and 5,ooo in the cubic millimetre--whereas for healthy women it m a y vary between 3,000 and 24,000. T h e counts made during menstrual periods give relatively low i~g.ures; at all events, the highest figures are never found at these tlmes~ T h e author thinks that the daily leucocyte increase is n o t dependent on digestion. F o r ordinary clinical purposes, he recommends that leucocyte-counts 1 ,,Ueber die numerischen Verh~ltnisse der Leukocyten bei der Lungentuberkulose." Von Dr. Med. R. Kjer-Petersen. Pp. 2I 7. Nineteen plates. "vVfirzburg : A. Stuber. I9o6.
REVIEWS
AND
NOTICES
OF
BOOKS
263
be made as early as possible in the day (i.e., on awakening, before the first meal). T h e portion of the book devoted to the leucocyte-counts in cases of p u l m o n a r y tuberculosis occupies i2o of the total 217 pages, and one of the most i m p o r t a n t conclusions arrived at is that there is no invariable relation between the intensity of the p u l m o n a r y disease and the n u m b e r of leucocytes in the circulating blood ; the number, therefore, gives us no more definite information in this respect than does the mere height of the opsonic index. Moreover, the question of mixed infection has, of course, to be considered. Several plates of leucocytecurves in healthy and tuberculous persons are included. F. PARKES WEBER, M.D. THE
THERAPEUTICS
OF
THE
SEA-VOYAGE.
I
This learned work of Dr. Friedrich does not profess to be more than a review of the literature of the subject from revised and verified references. In the preface and the concluding pages the author gives unequivocal proof of the faith which is in him as a champion of seatravel for the sake of health ; but they are the only platform which he has reserved for himself, and he vanishes from the scene to make room for the many authorities whose views are recounted without any editorial comment. These are given in their continuous succession from Oilchrist (1756) to the present day; and, including some earlier writers, the list runs up to 26o names. Chronological sequence, pure and simple, is the elementary plan adopted in the arrangement of this vast material. There is a conspicuous absence of either sections or chapters, and we look in vain for any systematic account of the practical aspects of sea-voyages in connexion with nosology, geography, or season. In presence of this solid bulk of 325 pages, destitute of a "single heading to page or par~raph, we feel as though under sentence to share the author's penalty, and to have to read through the entire series of records, without partiality or selection. Our only chance of escape is a resort to the index; but we are disappointed to find that such important subjects as Hay Fever, Bronchitis, Catarrh, Pneumonia, Malaria, Scrofula, and many others, have failed to be included in the Such-Register. In spite of these serious drawbacks, we heartily welcome the book as a unique historical summary of the subject, and as a mine of information which will prove of the greatest use to the professional student of medical literature. WILLIAM EWART, M.D. ESSAYS
ON
PULMONARY
TUBERCULOSIS3
Dr. Crichton's brochure seeks to give the results of the most recent researches on the underlying condition in pulmonary tuberculosis. He concludes that the disease is due to a paresis of the sympathetic nervous system, as shown by loss of "tone." He discusses first the apparent antagonism between gout--where there is increased blood-pressure-i ,,Die Seereisen zu Heil-und Erholungszwecken, ihre Gesehichte'und Lite,'atur" [" Sea-voyages for Purposes of Cure and Recovery, their History and Literature]." By Sanifiitsrat Dr. Edmund Friedrich, of Dresden. " Berlin : Verlag yon Vogel and Kreienbrink. 19o6. " Pulmonary Tuberculosis : Its Predisposition, Environment, and Treatment." By David Crichton, L.R.C.S.E., L.R.C.P.E., L.F.P.S.G. Pp. 68, Dundee : John Leng and Co., Ltd. z9o7.
THE
BRITISH
JOURNAL
OF TUBERCULOSIS
to the back settlements. T h e y perish under the conditions found in Northern cities. H a d the inheritance been Mendelian, a proportion of them would have inherited the high resisting power of the whites, and a mixed race would have been founded, as in Central and South America. The evidence for the second conclusion is less convincing. At any rate, I think the case is stated too strongly. Doubtless urban dwellers almost daily or hourly inhale or ingest some tubercle bacilli. But dosage plays an important part in infection. In some homes and occupations the liability to receive a dose of bacilli large enough to cause disease is far greater than under other conditions. Moreover, it is in just such homes and occupations that the resisting power of the individual is most lowered--that the innate diathesis is most altered by subsequent acquirement. Environment, therefore, is a considerable factor--obviously so, since an environment in which the average ]Briton can dwell in safety is dangerous to the American negro and deadly to the Red Indian. In the slums of our cities the conditions are dangerous even for the average Briton and deadly for the weaker members of his race. The recent fall in the mortality from phthisis has been so rapid that it cannot be attributed to an improvement in the race, but only to an improvement in the environment. T h e fact that m a n y people who succumb to phthisis when they are approaching middle age escape meningeal and abdominal tuberculosis during infancy and puhnonary tuberculosis during youth is evidence that a fatal dose of bacilli is not, under ordinary circumstances, to be acquired every day by the average individual who is in normal health. Nevertheless, Professor Pearson is well within the mark when he declares that " there is an antisocial disregard for national eugenics in the conduct of medical men who can write to the public press that marriage or even intermarriage of members of tuberculous stocks is of no social detriment, provided they live with a good supply of fresh air." Under such conditions as prevail in England, no amount of air can secure immunity to the members of a susceptible stock. Often, however, it secures life sufficiently prolonged to increase the n u m b e r of sufferers in the next generation. G . ARCHDALL REID, M . B .
THE BLOOD IN PULMONARY TUBERCULOSIS. 1 Dr. R. Kjer-Petersen, in his work on the numerical relations of the leucocytes in pulmonary tuberculosis, has had to meet the difficulty that the ordinary methods of counting the white corpuscles in the blood are very defective, and the normal figures for healthy men and women have not been quite accurately ascertained. According to the author, the number of leucocytes in blood taken on awaking in the morning is fairly constant for healthy men--generally between 4,ooo and 5,ooo in the cubic millimetre--whereas for healthy women it m a y vary between 3,000 and 24,000. T h e counts made during menstrual periods give relatively low i~g.ures; at all events, the highest figures are never found at these tlmes~ T h e author thinks that the daily leucocyte increase is n o t dependent on digestion. F o r ordinary clinical purposes, he recommends that leucocyte-counts 1 ,,Ueber die numerischen Verh~ltnisse der Leukocyten bei der Lungentuberkulose." Von Dr. Med. R. Kjer-Petersen. Pp. 2I 7. Nineteen plates. "vVfirzburg : A. Stuber. I9o6.
REVIEWS
AND
NOTICES
OF
BOOKS
263
be made as early as possible in the day (i.e., on awakening, before the first meal). T h e portion of the book devoted to the leucocyte-counts in cases of p u l m o n a r y tuberculosis occupies i2o of the total 217 pages, and one of the most i m p o r t a n t conclusions arrived at is that there is no invariable relation between the intensity of the p u l m o n a r y disease and the n u m b e r of leucocytes in the circulating blood ; the number, therefore, gives us no more definite information in this respect than does the mere height of the opsonic index. Moreover, the question of mixed infection has, of course, to be considered. Several plates of leucocytecurves in healthy and tuberculous persons are included. F. PARKES WEBER, M.D. THE
THERAPEUTICS
OF
THE
SEA-VOYAGE.
I
This learned work of Dr. Friedrich does not profess to be more than a review of the literature of the subject from revised and verified references. In the preface and the concluding pages the author gives unequivocal proof of the faith which is in him as a champion of seatravel for the sake of health ; but they are the only platform which he has reserved for himself, and he vanishes from the scene to make room for the many authorities whose views are recounted without any editorial comment. These are given in their continuous succession from Oilchrist (1756) to the present day; and, including some earlier writers, the list runs up to 26o names. Chronological sequence, pure and simple, is the elementary plan adopted in the arrangement of this vast material. There is a conspicuous absence of either sections or chapters, and we look in vain for any systematic account of the practical aspects of sea-voyages in connexion with nosology, geography, or season. In presence of this solid bulk of 325 pages, destitute of a "single heading to page or par~raph, we feel as though under sentence to share the author's penalty, and to have to read through the entire series of records, without partiality or selection. Our only chance of escape is a resort to the index; but we are disappointed to find that such important subjects as Hay Fever, Bronchitis, Catarrh, Pneumonia, Malaria, Scrofula, and many others, have failed to be included in the Such-Register. In spite of these serious drawbacks, we heartily welcome the book as a unique historical summary of the subject, and as a mine of information which will prove of the greatest use to the professional student of medical literature. WILLIAM EWART, M.D. ESSAYS
ON
PULMONARY
TUBERCULOSIS3
Dr. Crichton's brochure seeks to give the results of the most recent researches on the underlying condition in pulmonary tuberculosis. He concludes that the disease is due to a paresis of the sympathetic nervous system, as shown by loss of "tone." He discusses first the apparent antagonism between gout--where there is increased blood-pressure-i ,,Die Seereisen zu Heil-und Erholungszwecken, ihre Gesehichte'und Lite,'atur" [" Sea-voyages for Purposes of Cure and Recovery, their History and Literature]." By Sanifiitsrat Dr. Edmund Friedrich, of Dresden. " Berlin : Verlag yon Vogel and Kreienbrink. 19o6. " Pulmonary Tuberculosis : Its Predisposition, Environment, and Treatment." By David Crichton, L.R.C.S.E., L.R.C.P.E., L.F.P.S.G. Pp. 68, Dundee : John Leng and Co., Ltd. z9o7.