The Common Infectious Diseases

PUBLIC HEALTH,

December, 1950

Conclusions I n m y o p i n i o n t h e r e is n o e v i d e n c e whatever that the v i r u s of poliomyelitis h a s ever b e e n d i s t r i b u t e d in a p u b l i c water s u p p l y i n sufficient q u a n t i t y t o cause infecion or that it is capable of s u r v i v i n g i n s u c h quantity, if at all, the purification processes w h i c h h a v e in t h e past b e e n applied to t h e B o a r d ' s water. T h i s o p i n i o n is b a s e d u p o n t h e fact that, despite the o b v i o u s o p p o r t u n i t i e s w h i c h have existed t h r o u g h o u t the years of m a n y of t h e B o a r d ' s sources of s u p p l y b e c o m i n g c o n t a m i n a t e d w i t h the virus, t h e r e has n e v e r b e e n any explosive o u t b r e a k s u c h as m i g h t n o r m a l l y b e e x p e c t e d f r o m water-carriage, or a n y o t h e r type of outb r e a k w h i c h c o u l d e v e n r e m o t e l y h a v e b e e n associated w i t h d i s s e m i n a t i o n b y t h e w a t e r supply. O n a n analogy w i t h o t h e r w a t e r - b o r n e e x c r e m e n t a l diseases, s u c h as t y p h o i d f e v e r a n d dysentery, it is w a r r a n t a b l e to suppose t h a t s u c h a n o u t b r e a k w o u l d have b e e n recognised if the v i r u s were capable of d i s s e m i n a t i o n b y w a t e r a n d resistent to t h e p u r i fication p r o c e s s e s , e v e n h a v i n g r e g a r d to the possibility of some degree of m a s s i m m u n i t y , to the s o m e w h a t p u z z l i n g scatter of cases a n d o t h e r epidemiological features in m a n y outbreaks. I can, therefore, see n o r e a s o n for c h a n g i n g the opinion w h i c h I expressed in m y r e p o r t of May, 1944, to t h e effect t h a t radical c h a n g e s in m e t h o d s of purification w o u l d n o t be justified b e c a u s e t h e r e h a s as yet b e e n n o p r o o f t h a t t h e v i r u s is capable of s u r v i v i n g t h e n a t u r a l a n d artificial purification processes to w h i c h o u r w a t e r s are subjected. C o n s i d e r i n g t h e o p p o r t u n i t i e s w h i c h t h e r a w waters h a v e h a d for m a n y years p a s t of b e c o m i n g c o n t a m i n a t e d b y t h e virus, t h e e v i d e n c e is all to t h e contrary. Nevertheless, t h e p r o b l e m c a n n o t b e s u m m a r i l y dismissed a n d m u s t b e k e p t c o n s t a n t l y u n d e r review i n the light of f u r t h e r c o n t r i b u t i o n s to existing knowledge.

REFERENCES BANKS, tI. S. (1950.) " The Common Infectious Diseases." London : Arnold. BRADLEY, W . H . (1950.) Poliomyelitis, Some Notes on. 3ltkly, Bull. Min. of Hlth. ~ P.H.L.S., 9, 203. CARLSON et al. (t942.) Am. ~. Pub. Hltk., 32, 1125. HARGREAVES, E. R. (1950.) Poliomyelitis in Cornwall in 1949. Brit. reed. J., 1, 879. KEMPF, J. E., et al. (1942.) Am. ~. Pub. Hlth., 32, 1366. KLING, C., et al. (194°.) Acta Med. Scan&, 119,, 217. LENSEN, S. G., et al. (1949.) Am. ~. Pub. Hlth., 89, 1120. PAUL, J. R., TRASK, J. D., and GARD, S. (1940.) .7. Exp. ]~Ied., 71, 765. THOMPSON, W . S . , (1949.) .7. lI3'g., 47, 79. ZtcrllS, J., and PlSZCZEK, E . A . (1948.) Scwnce, 108, 503.

OBITUARY JAMES FRANCIS BLACKETT, M.A., M.D., D.P.H. W e r e c o r d w i t h regret t h e d e a t h after a s h o r t illness on A u g u s t 30th, at t h e age of 69, of D r . J. F. Blackett, M e d i c a l Officer of H e a l t h a n d School M e d i c a l Officer for the C i t y of B a t h f r o m 1920 to 1945. D r . Blackett was a g r a d u a t e f r o m t h e medical schools of Bristol U n i v e r s i t y (where h e was a gold medallist) a n d U n i v e r s i t y College, L o n d o n . He qualified M.B., B.S., L o n d o n , in 1906, a n d p r o c e e d e d M . D . L o n d o n in 1909 a n d Bristol in 1911. H e served in t h e R . A . M . C . in the first world war, t a k i n g t h e D . P . H . in 1917. A f t e r a t e r m as A . M . O . H . , Swansea, h e was a p p o i n t e d in 1920 to the chief post in B a t h w h i c h h e held u n t i l r e t i r e m e n t . H e was a t h o r o u g h l y efficient p u b l i c h e a l t h p r a c t i t i o n e r a n d d i d m u c h for t h e d e v e l o p m e n t of B a t h ' s h e a l t h services, i n c l u d i n g t h e r e c o n s t r u c t i o n of t h e C i t y isolation hospital, of w h i c h h e was m e d i c a l s u p e r i n t e n d e n t . H e h a d m u c h to do w i t h t h e f o u n d a t i o n of t h e B a t h a n d W e s s e x C h i l d r e n ' s O r t h o p a e d i c Hospital. T h e respect in w h i c h h e was held b y t h e profession in his city was s h o w n b y his election as C h a i r m a n of the Bath Division, B . M . A . H i s r e t i r e m e n t was m a r k e d b y a p r e s e n t a t i o n f r o m t h e City Council. H e h a d c o n f e r r e d o n h i m t h e M . A . degree of Bristol U n i v e r s i t y i n I949, his thesis b e i n g " 50 Years of P u b l i c H e a l t h a n d Social M e d i c i n e in a C o u n t y B o r o u g h . " I n t h e Society D r . Blackett was a Fellow f r o m 1919, a n d

23 a P a s t - P r e s i d e n t of the W e s t of E n g l a n d B r a n c h , w h i c h h e also s e r v e d as H o n . T r e a s u r e r for m a n y years. BOOK REVIEWS The Common Infectious Diseases. By H. STANLEY BANKS,M.A., M.D., F.R.C.P., D.P.H. 1949. L o n d o n : Edward Arnold & Co. Pp. 354 ; eight illustrations. Price, 21s. net. Into the 17 chapters of his book Dr. Banks has distilled his vast experience of infectious diseases fortified with the essence of the literature. For a book of its size it is well documented with good references. T h e mind of the teacher is shown in the decision to describe general principles not in separate chapters but in association with particular diseases: air-borne infections, for example, are described in the chapter on measles and the technique of lumbar puncture in that on meningococcal fever. T h i s m e t h o d - - a recognised bedside o n e - - h a s its drawbacks in a textbook : it demands a good index and it endangers the treatment of important subjects. Immunity, for example, is not well done : it is scattered throughout the book and the general principles are omitted. It is difficult to pick out any chapter for special mention. Every one is of a high standard, although Dr. Banks' special interests show themselves throughout the book. He rightly emphasises the importance of pulmonary collapse in whooping cough ; he gives a full account of adrenal syndromes in meningococcal infection, and he still rides his old hobby horse of massive doses of antitoxin in diphtheria. He does not, however, give adequate recognition to the importance of spasm in poliomyelitis. W h e n in his preface he wrote that we are in a period of great activity and rapid change, even he could not have envisaged the changes w h i c h w o u i d occur between the time the book was written and reviewed. T h e three pages describing the specific therapy of typhoid fever cover serotherapy, sulpha-drugs, penicillin and bacteriophage--all of which have been superseded by chloromycetin, which receives passing mention in three lines. In a short time chloromycetin and aureomycin have become established as antibiotics of such wide therapeutic range that they will, no doubt, receive greater attention in future editions. T h e treatment of whooping cough with aerosporon, to which a page is devoted, has now been abandoned because the favourable results recorded in the book have not been confirmed. T h e statement that laboratory tests are seldom required in the diagnosis of smallpox must be disputed. T h e technique of collecting material is now so simple and the complement fixation test (not mentioned in the book) so rapidly and satisfactorily performed that ever':, case of clinical doubt should be tested. In non-epidemic times these doubtful cases constitute a high proportion of those seen; but even the definite sporadic case is worth confirming by laboratory, tests. In the two excellent chapters on acute diarrhoea and infective gastro enteritis of infants a useful and practical account is given of the technique of saline transfusion; but here again progress has been too rapid for a textbook. No mention is made of polythene tubing, a useful new technique for intravenous administration, nor of hyaluronidase, the spreading factor, which is such a considerable advance in hypodermoclysis in infants. Contaminated food and dirty bottles and teats are included among the dietetic instead of the infective causes of infantile diarrhoea on page 326. Nevertheless, Dr. Banks has ahvays been quick to take up new ideas. T h i s book includes many now generally accepted. T h e book is a clear and concise account of the modern practice of fevers. It is sure to be widely used.

Manual of British Water Supply Practice. Compiled by the Institution of Water Engineers. 1950. Cambridge: XV. Heifer & Sons, Ltd. Pp. 910. Price, 50s. This book is an authoritative survey of sound water works practice compiled by a group of professional men, mostly water engineers, but also including doctors, lawyers, cl{emists. biologists, geologists, etc. T h e need for such a book has been felt for many years, and since early in 1948 over 100 men, each a specialist in his own particular field, have been preparing material for this book which covers British Water Supply Practice in all its aspects. No work of such a comprehensive scale has ever been attempted and the result is a triumph for the collaborators, the editorial staff and the publishers. Each topic has had to be limited to fundamental outlines, but appropriate and well-considered references at the end of each chapter indicate to the reader where he can obtain more detailed information on any particular point. Primarily, the manual deals with British practice, b u t f o r e i g n research is referred to and given due weight, and foreign practice where of importance, as in chlorination or bacteriology of water supplies, is given appropriate space. For a book of this type overlapping is inevitable in some degree, but by wide distribution