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The eradication of bovine tuberculosis
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NOTICES OF BOOKS. THE
ERADICATION
OF
BOVINE
TUBERCULOSIS.
DR JORDAN, in his r e c e n t l y issued m o n o g r a p h , has p e r f o r m e d a m o s t v a l u a b l e s e r v i c e in s h o w i n g t h e p o s s i b i l i t i e s of an e r a d i c a t i o n s c h e m e carried out u n d e r o r d i n a r y f a r m c o n d i t i o n s and w i t h a m i n i m u m of assistance. 1 T h e a r e a s e l e c t e d for the s c h e m e was in A y r s h i r e , c o v e r ing a p p r o x i m a t e l y n i n e s q u a r e m i l e s a n d c o n t a i n i n g t h i r t y - s e v e n farms. T h e a v e r a g e n u m b e r of m i l k i n g c o w s w a s t w e n t y - s i x p e r herd. A l l the f a r m e r s in this a r e a w e r e i n v i t e d to p a r t i c i p a t e in a s c h e m e to e r a d i c a t e t u b e r c u l o s i s f r o m t h e i r herds. T h e a s s i s t a n c e g i v e n t o o k the f o r m of t h e p r o v i s i o n of free t u b e r c u l i n and free t e s t i n g and a d v i c e on m e t h o d s of isolation, d i s i n f e c t i o n , a n d on t h e r e a r i n g of y o u n g stock. N o other d i r e c t i n c e n t i v e s w e r e offered. T h e r e a c t o r s w e r e not slaughtered, no c o m p e n s a t i o n was paid, and a p p a r e n t l y no r e s t r i c t i o n s w e r e p l a c e d in t h e w a y o f free sale or o t h e r m e t h o d of disposal of r e a c t i n g a n i m a l s . T h e s c h e m e was on B a n g ' s lines, a n J v a r i o u s m e t h o d s w e r e utilized to s e p a r a t e r e a c t o r s from n o n r e a c t o r s , from r e m o v a l to s e p a r a t e p r e m i s e s to h o u s i n g at different e n d s of one building w i t h such p r e c a u t i o n s as w e r e possible to p r e v e n t i n f e c t i o n from the t u b e r c u l o u s a n i m a l s to those free f r o m t u b e r c u l o s i s . Special care was t a k e n to k e e p y o u n g stock free f r o m infection. T h e retestings w i t h t u b e r c u l i n w e r e c a r r i e d o u t at s i x - m o n t h l y intervals. V e r y few a n i m a l s w e r e b r o u g h t into t h e herds, b u t w h e r e this was done the e n t r a n t s w e r e t e s t e d b e f o r e e n t e r i n g the area. T h e experim e n t l a s t e d for t h r e e years, and the r e s u l t s a c h i e v e d are set out in s e v e r a l tables and also d i s c u s s e d in d e t a i l for e a c h herd. I f we t a k e the gross figures at t h e first test t h e r e w e r e 385 r e a c t o r s (26"1 per cent.) out of 1,475 a n i m a l s tested, a n d at t h e s e v e n t h test 211 r e a c t o r s (i2" 3 per cent.) o u t of 1,635 a n i m a l s . T h e a u t h o r d i v i d e s t h e herds into f o u r g r o u p s w i t h t h e f o l l o w i n g findings : Group. ]] I
Initial Number of Reactors.
--i .
I
2 3 4
I
,
.
o
.
.
.
.
.
1-25 (average 8 per cent.) : 25-50 ( ,, 405 ) i I 50"75( , 55 .6 . . . . ) I
Number o) Herds.
Condition at End of Seventh Test.
98
All free.
8 5
Average of 21 "6 per cent. ,. 29"0 . . . .
W h i l e t h e s e results s h o w s u b s t a n t i a l p r o g r e s s , l o o k e d at from a n o t h e r a s p e c t ~chey a p p e a r less satisfactory. D i r e c t i n g a t t e n t i o n o n l y to the h e r d s w h i c h at the i n c e p t i o n c o n t a i n e d m o r e t h a n IO per cent. of reactors, we find that t h e r e w e r e fifteen s u c h h e r d s w h i c h w e r e g i v e n the full s e v e n tests. W i t h t h e s e herds t h e r e s u l t s s h o w e d : C o m p l e t e e r a d i c a t i o n , 5 ; r e d u c t i o n to u n d e r i o p e r cent. reactors, o ; r e d u c t i o n to l o - 2 o per cent. r e a c t o r s , 2 ; r e d u c t i o n to 2o-3o p e r cent., 5 ; reduc1 ,, The Eradication of Bovine Tuberculosis." By L. Jordan, Ph.D.. M.R.C.V.S. Special Report Series, No. 184 . of the Medical Research Council. Pp. lO4 . London : H.M. Stationery Office 1933. Price 2s. net.
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tion, but reactors still over 3° per cent., I ; actual increase in the number of reactors, 2. It is of interest to note that of the five herds entirely free, in one the herd could not be cleared until the owner sold all his reactors, in a second the herd was only cleared when all the stock was sold and fresh introduced, and in a third good results were only achieved when all reactors were cleared out of the main byre. In view of the heavy infection of our dairy herds, herds with over io per cent. of reactors are the ones of interest, and the figures show that the results obtained were decidedly unsatisfactory for a majority of the herds. In other words, while the system employed can give excellent results with herds nearly free from tuberculosis, the experiment has not demonstrated its practical utility to eliminate bovine tuberculosis as applied to the average highly infected herd. This is in accord with experience elsewhere, where it has been found that any system of leaving the reactors on the farm is not good enough to effect anything in the nature of an eradication of bovine tuberculosis. A reduction in the number of infected animals can be obtained, but unless there is continuous unremitting care subsequently the percentage of reactors is liable to rapidly increase again. To have been able to demonstrate the considerable results shown with such simple methods is, however, a great achievement, particularly as some of the factors operating seem to have been rather adverse. It is important to make clear that the experiment has not demonstrated that the proper way to deal with bovine tuberculosis in this country is along the lines followed with the very incomplete separation of reactors, but it does emphasize that the eradication of bovine tuberculosis is a perfectly feasible proposition, and that there is nothing insuperable in the way of starting eradication schemes now. The author draws attention to the general improvement shown in the herds and in the appreciation of stock--both points of great importance. He has to record that there was no increased demand for milk from the tuberculosis.free herds. In this review of the report only the experimental work done has been discussed, but it should be mentioned that it also contains an immense mass of useful information and a valuable discussion upon the value of the different procedures now in operation to influence bovine tuberculosis and the infection of the milk supply. For example, the author examined samples of milk (once only) from 636 reactors but without any clinical symptoms of tuber c-uI0sis, and nine of them (1"4 per cent ) contained tubercle bacilli, a point on which information has long been required. The effectiveness or otherwise of existing legislation is often discussed, and the author points out : " The Tuberculosis Order, even when supplemented by clinical inspection of cattle under the Milk and Dairies Act, can do little towards reducing the percentage of tubercular animals in dairy herds . . . . These results provide clear evidence that neither the Tuberculosis Order nor routine clinical inspection is effective as a safeguard against the tubercular infection of milk destined for human consumption." The report also includes a valuable discussion upon the interpretation and reliability of the double intradermal test, and notes upon the measures taken in various countries to combat bovine tuberculosis. The whole report is of great value, and should be read by everyone iw, erested in the elimination of bovine tuberculosis and in the prevention of human tuberculosis of bovine origin. W. G. SAVAGE, M.D.
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MENINGITIS.
Dr. T. A. Jousset has written an interesting little m o n o g r a p h on the p r o b l e m s of t u b e r c u l o u s meningitis. She has carried out a series of pathological studies in the laboratories of the Salp~tri~re, the results of which tend to throw some light on the cause of death and the reasons for the high m o r t a l i t y in this affection. Cerebral compression was found to p l a y a relatively secondary r61e in the m e c h a n i s m of death. Of prime importance is the very. early i m p l i c a t i o n of ganglion-cells, proceeding to necrotic changes m the brain-stem. T h e a u t h o r has t a b u l a t e d a list of seventy-four cases of t u b e r c u l o u s meningitis, collected from the literature, which have not ended fatally. T h e i r own series contains the r e m a r k a b l e n u m b e r of fifteen cases, in all of which tubercle bacilli were isolated in the cerebrospinal fluid. E a c h of these cases was treated with injections of " a l l e r g i n e " - - a p h o s p h a t i d e x t r a c t of special tubercle bacilli, selected on account of their properties of solubility. F u l l details as to the method of p r e p a r a t i o n of allergine and the t e c h n i q u e of its e m p l o y m e n t are given in this book. I t is obvious that a c o m m u n i c a t i o n of this i m p o r t a n c e will be a v i d l y studied, and further confirmation will be eagerly a w a i t e d at the hands of other investigators. 1 MACDONALD CRITCHLEY, M.D., F . R . C . P . CAVITATION
IN THE
TUBERCULOUS
LUNG.
In G e r m a n y a s w e l l as in E n g l a n d attention has r e c e n t l y been focussed on the origin and t r e a t m e n t of cavities in the lung. Dr. A l e x a n d e r ' s booklet m a y be looked on as an a u t h o r i t a t i v e treatise on this interesting subject. '2 I n addition to the theories of c a v i t y formation which are current in E n g l a n d , some annular shadows, characterized by the a b s e n c e of increased t r a n s l u c e n c y within the ring, are looked on as being due to pre-cavernous demarcation, a condition in which a tuberculous focus is assumed to be surrounded by a zone of cellular infiltration sufficiently dense to cast a shadow on the film. T h i s theory is made use of to account for the frequent and rapid d i s a p p e a r a n c e of these shadows, but no p o s t - m o r t e m evidence of the occurrence of such a condition is put forward. I n the section dealing with diagnosis the author refers to the uncertainty of physical signs and the s u p e r i o r i t y of radiology, not only in the diagnosis, but also in the determination of the exact situation and size of a cavity. A s r e g a r d s treatment, all early cavities are looked on as a contra-indication to either tuberculin or gold t h e r a p y until such time as there is definite evidence of the b e g i n n i n g of a healing process. L i g h t t r e a t m e n t is considered d a n g e r o u s for a still longer period. Most attention is given to the various forms of collapse therapy. E a r l y (round) cavities give the best results with p n e u m o t h o r a x treatment, adhesions being infrequent in this t y p e of lesion, but as spontaneous healing is also common, Dr. A l e x a n d e r r e c o m m e n d s a p r e l i m i n a r y period of general rest controlled by serial X - r a y films. I f after two to three weeks the disease is still in a highly a c t i v e condition p n e u m o t h o r a x is 1 ,, I~tude et
Traitement
de
la M~ningite T u b e r c u l e u s e . "
B y Th~r~se A.
Jousset. Preface by Dr. Andr~ Jousset. Pp. i52, with io figs. and graphs. Paris : Masson et Cie., 12o, Boulevard Saint Germain. I933. Price 3o fr. " Die TuberculSse Kaverne." By Harms Alexander. Tuberkulose-Bibliothek No. 5I. PP. 47, with 72 illustrations. Leipzig : Johann Ambrosius Barth. 1933.
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best; in other cases six to eight weeks' general treatment should be given and pneumothorax carried out unless there is evidence of spontaneous healing. Phrenic evulsion also gives good results in these soft-walled cavities, but the author deprecates the practice of preferring this operation to pneumothorax, as the former causes permanent and considerable reduction in functional activity. Old fibrotic cavities are usually surrounded by too many adhesions for pnenmothorax to be effective, but there is no harm in making the attempt. I f cauterization is impossible, partial or total thoracoplasty is better than the continuation of a useless partial pneumothorax. Single thick-walled apical cavities rarely respond favourably to phrenic evulsion, but it is in this type of case that apicolysis gives its best results. T h e text is profusely illustrated by radiograms excellently reproduced.
ANDEEW TUBERCULOSIS
MORLAND,
AND THE
M.D., M.R.C.P.
CHILD.
" The brightest beacon that has ever lighted the path of the tuberculosis worker is the new knowledge and the larger understanding of tuberculosis in childhood." So says Professor J. Arthur Myers in his new work on tuberculosis and the childJ Dr. William P. Shepard, in his sympathetic Introduction, claims that " a new vision of possibilities in tuberculosis control is revealed in this volume." Certainly the author urges with reason that tuberculosis be stopped at its source, namely, the tuberculous person or animal, that apparently" healthy " carriers of the disease be sought out and isolated, and that special attention be given to known contacts. In sixteen chapters Dr. Myers elaborates his programme, setting forth in concise, convincing and effective manner essential facts, governing principles and practical measures. There are chapters on Portals of E n t r y of the Tubercle Bacillus, the Finding of Tuberculous Children, Control at Different Ages and under Varying Conditions, Disposal of Cases, Strongholds of Tuberculosis, and Prevention among Non-Tuberculous Children. The concluding chapter describes a scheme for the solution of the problem. " The tuberculosis programme for the future does not include any new or startling procedure nor any revolutionary ideas, rather it consists of an intelligent understanding of the facts at hand, and the employment of these facts as a tried and true foundation for future actions. These include a widespread testing of children in order to screen out those who require special supervision and treatment before symptoms appear, the greatest possible use of the hospital facilities and research projects, even greater stress on the known strongholds of tuberculosis, and a wholehearted continuance of the present educational campaign, so that the essential facts of the disease will be household knowledge throughout the length and breadth of the land." Of course Dr. Myers has addressed his monograph primarily to American readers, but it is a work which should be studied by medical advisers, particularly medical officers of health, tuberculosis officers, school medical officers, and all who, as 1 ,, T h e Child and the T u b e r c u l o s i s P r o b l e m . " By J. A r t h u r Myers, P h . D . , M.D., F.A C . P . , Professor of Preventive Medicine, U n i v e r s i t y of M i n n e s o t a ; Chief of Medical Staff, L y m a n h u r s t School for "Tuberculosis Children. W i t h an Introduction by William P. S h e p a r d , M.D., F . A . P . t I . A . , W e l f a r e Director, W e s t e r n Division, Metropolitan Life I n s u r a n c e C o m p a n y . Pp xvi + 23o, with 2I illustrations. C h a p t e r s u m m a r i e s . L o n d o n : BailIi6re, Tindall a n d Cox. 1932. Price I7s. 6d.
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members of the medical and educational professions, come in contact with children and have to plan and advise regarding their welfare. The work is indeed one which will appeal to all interested in the tuberculosis problem. The work is well planned, effectively produced with instructive illustrations, and has a select bibliography. TUBERCULOSIS CONTROL. Professor Goldberg has produced a comprehensive guide to procedures in tuberculosis control, which is to be commended to the consideration of all interested in the organization and administration of tuberculosis schemes and the care of tuberculous patients. 1 The volume consists of forty-three chapters grouped in three sections, the third of which is devoted to considerations relating to the sanatorium. The author analyzes and criticizes methods, procedures, and institutions, evaluating them mainly in terms of control. It is shown that tuberculosis gives rise to a multiplicity of problems of-prevention and treatment varying with race, age and many other factors, making it difficult to estimate and interpret results. Professor Goldberg for over twenty years has been actively engaged in tuberculosis work, and for four years of this time acted as director of the municipal tuberculosis organization of the city of Chicago, including its dispensaries and sanatorium. His book covers a wide range, and furnishes statistics and other data regarding tuberculosis as met with in the United States of America. While appealing primarily to those dealing with the tuberculosis movement in the United States it will be of interest and service to tuberculosis officers and others engaged in tuberculosis work in this country. The sections dealing with legislation indicate under what statutory powers a tuberculosis service is carried on in America. There are suggestive sections on Home Treatment and Heliotherapy. In the sanatorium section is an elaborate exposition as to diet, with tables giving basic dietaries. A special chapter is devoted to undergraduate instruction on tuberculosis. The article on sanatorium planning by Mr. Kinder provides a short account in which location and exposure and orientation receive chief consideration. The volume concludes with chapters on the General Hospital and Tuberculosis and t h e Follow-up of Tuberculous Patients. The whole work is one which all responsible for the control of tuberculosis will do well to study critically and in its entirety. The volume is illustrated with maps, charts and figures, and there is a select bibliography. M A N U A L S F O R M E D I C A L A D V I S E R S A N D W O R K S OF REFERENCE. Drs. Pescher and Hervy have provided a manual in a semimedical, semi-popular style dealing with the mechanism of respiration and the physical methods by which the ventilation of the lungs may be 1 ,, Procedures in Tuberculosis Control for the Dispensary, Home, and Sanatorium." By Benjamin Goldberg, M.D., F.A.C.P., F.A.P.H.A,, Associate P r o lessor of Medicine, University of Illinois. With a chapter on Sanatorium Planning by Thomas 13. Kinder, of New York City, and an Introduction by David J. Davis, M.D., Ph.D., Dean o{ the College of Medicine, University of Illinois, Chicago. Pp. 373, with 54 illustrations. Philadelphia, U.S.A. : F. A. Davis Company. i933~ Price $4.o0. VOL. XXVIII. 3
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improved. 1 I n addition to breathing exercises, m u c h importance is attached to the " spiroscope " invented by one of the authors, and providing a simple m e a n s of breathing against pressure. I t is unfortunate that a method of proved, although limited, value should suffer from such exaggerated claims as are made in this book, a n d medical readers are not likely to be impressed by the account of a family in which one child having died of tuberculous meningitis, another was sav~ed from contracting this disease by breathing exercises. Similarly, the claim that in the same way the age of a hundred years m a y be reached can hardly expect serious consideration.
ANDREW
MORLAND,
M.D., M.R.C.P.
Dr. A n d r e w Morland has added a compact little work on P u l m o n a r y Tuberculosis to the series of " Pocket Monographs on Practical Medicine."2 It is addressed to general practitioners, who, as the author says in his preface, " in spite of the spread of specialization, remain the most i m p o r t a n t branch of the profession dealing with the individual tuberculous patient." Dr. Morland rightly claims that " for the best results to be obtained, proper co-operation between the general practitioner, the consultant, the tuberculosis officer, and the s a n a t o r i u m physician is necessary." Dr. Morland has accomplished a difficult task with rare skill in c o n d e n s i n g essentials regarding tuberculosis of the lungs into I i o pages, emphasizing principal points in diagnosis, and describing such t r e a t m e n t as will be of service to the busy doctor. Attention is directed to the importance of u n d e r s t a n d i n g the psychological outlook of the c o n s u m p t i v e patient. T h e r e is a sensible chapter on After-Care. T h e little book closes with a selected bibliography. N a c k t k u l t u r , or the practice of nakedness, is attracting attention and adherents not only in G e r m a n y and America b u t to some extent in this country. T h e physiological and psychological as well as the aesthetic aspects of the n e w ' c u l t d e m a n d the serious consideration of medical advisers and others who can approach the subject without bias and in a scientific spirit. " O n G o i n g N a k e d " is a new work by an A m e r m a n w o m a n who has practised N a c k t k u l t u r both privately and publicly, and now sets forth picturesquely in detail and with some h u m o u r the routine of nudist organizations in G e r m a n y , Scandinavia, F r a n c e and other countries, a T h e authoress appears to have made personal observations in various lands and to have participated in the naked life there practised. T h e volume contains chapters on the Personalities of Nudists, N u d i s t Organizations and Literature, and the Implications of Nakedness. T h e concluding chapters seeks to anticipate the future of this strange cult. There is a Directory of N u d i s t Clubs. T h e publishers have thought welt to issue this volume in a silver-coloured wrapper reproducing a photograph of a young woman in a state of nudity. T h e work, although scarcely scientific in i ,, La R~dducation Respiratoire." By J. Pescher and Jean Hervy. Pp. i34 , with 2 figs. Paris : G. Doin et Cie, 8, Place de l'Oddon, z933. Price 26 francs. " Palmonary Tuberculosis in General Practice." By Andrew Morland, M.D., M.R.C.P., Resident Physician, Mundesley Sanatorium. Pp. ix+z~3. London: John Bale, Sons, and Danielsson, Ltd., 83, Great Titcbfield Street, W.z. z933. Price 2s. 6d. a ,, On Going Naked." By .]an Gay. With Decorations by Zhenya. Pp. i76. With illustrations. London : Noel Douglas, ~8-3o, Little Russell Street, -W.C.i. z933. Price 7s. 6d.
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its presentation, provides m a t t e r which medical men and women interested in personal hygiene and public health and called to advise in regard to N a e k t k u l t u r should be a c q u a i n t e d with. T u b e r c u l o s i s has for long figured in fiction, and some few books have described the residence of patients at D a v o s and other health centres where c o n s u m p t i v e s congregate, but the n u m b e r of stories of life in a s a n a t o r i u m is limited. Mr. D a v i d E s d a i l e has succeeded in writing a novel which presents vivid pictures of personalities undergoing institutional treatment. 1 T h e a u t h o r has manifestly a first-hand acquaintance with sanatorium routine and the w a y s of doctors, nurses, a n d others who direct, control, and g e n e r a l l y enliven the period of residence under open-air conditions. M e d i c a l superintendents will do well to read this book, for it gives a picture of s a n a t o r i u m procedure as at least one patient has viewed it. Dr. C. H. A u t y has compiled a helpful m a n u a l on I n h a l a t i o n T h e r a p y which the medical practitioner will find of practical service. 2 T h e a p p a r a t u s is described and illustrated, a n d methods of t r e a t m e n t are described. T h e concluding section deals with diseases, including certain affections of the respiratory system, in which inhalation has proved useful. Dr. F r e d e r i c k W . P r i c e and those who have collaborated with him in the production of the most popular of modern t e x t b o o k s of medicine are to be c o n g r a t u l a t e d on the a p p e a r a n c e of a new and fourth editionY T h i s notable work for students and practitioners of medicine was first published in i922 , and after the issue of five s e p a r a t e impressions reached its second edition in I926 and its third edition in I929. And now within the short space of four years a t h o r o u g h l y revised and strikingly u p t o date fourth edition has appeared. Such a rapid d e v e l o p m e n t indicates the widespread a p p r o v a l which has been a c c o r d e d to this c o m p r e h e n s i v e and exceptionally complete treatise. T h e w o r k has undergone careful revision, and is likely to m a i n t a i n its position as the most a u t h o r i t a t i v e and serviceable of present-day textbooks on the principles and practice of medicine. As would be expected of those responsible for the issue of a m e m b e r of the series of Oxford M e d i c a l Publications, the v o l u m e is a d m i r a b l y produced, being effectively p r i n t e d on good thin paper, and supplied with a p a r t i c u l a r l y complete and helpful index. T h e new volume presents a n u m b e r of alterations in classification, general arrangement, and nomenclature. U n d e r General Infectious Diseases are two new S u b - S e c t i o n s on R i c k e t t s i a Diseases and Diseases due to F i l t r a b l e Viruses, to one of which certain articles from the Sub-Sections on B a c t e r i a l Diseases and Infectious D i s e a s e s of D o u b t f n l or U n k n o w n A~tiology have been transferred. Other c o m m u n i c a t i o n s have undergone rearrangement. T h e r e are n u m e r o u s articles, m a n y have been largely or wholly re-written, and much new m a t t e r has been added. i ,, Eat, Drink, and Be Merry." By David Esdaile. Pp. 28i. London : Longmarts, Green and Co. I933. Price 7s. 6d. "Modern Inhalation Therapy for the General Practitioner." By C. H. Auty, M R C.S., L.R.C.P. Medical Officer No. 2 District, Willesden. Pp. vii+66. London: William Heinemann (Medical Books), Ltd., 99, Great Russell Street, W . C . i . I933. Price3 s.6d. 3 ,, A Textbook of the Practice of Medicine." By various Authors. t~dited by Frederick W. Price, M.D., F.R:S.E. Fourth edition. Pp. xlv+I995, with io6 illustrations. London : Humphrey Milford, Oxford University Press, Amen House, Warwick Square, E.C. 4- I933. Price36s.
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T h e r e are a n u m b e r of fresh illustrations. T h e L i s t of Contributors includes no less than twenty-seven, all connected with L o n d o n ' s great hospitals and medical schools. T h e sections dealing with T u b e r c u l o u s Disease are to be found in several parts of the book, and generally arranged according to the special system under consideration. T h e r e is an excellent introductory article p r o v i d e d by L o r d H o r d e r in the section dealing with G e n e r a l I n f e c t i o u s Diseases. T h e account of P u l m o n a r y Tuberculosis, covering twenty-four pages, has been p r e p a r e d by Drs. R. A. Young and G. E. B e a u m o n t . Dr. H a r o l d B a r w e l l writes on T u b e r c u l o s i s of the L a r y n x ; and other sections deal with tuberculosis as met with in other parts of the body. T h i s brief e n u m e r a t i o n will, we believe, be sufficient to indicate t h a t the work is not only a necessity for every medical practitioner, but one which no student desirous of fully equipping himself for e x a m i n a t i o n can afford to be without. Considering the c o m p r e h e n s i v e c h a r a c t e r of this great onevolume textbook of medicine, it is issued at a price which must be considered r e m a r k a b l y low. A m o n g the m a n y fine volumes which have been issued this season there is one which will r e m a i n in the forefront as an ideal gift-book for doctors and patients. " T h e P a g e a n t of T o w e r H i l l , " p r e p a r e d by the founder of Toc H and D r . L e f t w i c h , provides a w o n d e r f u l tonic for all. L o r d W a k e f i e l d , who has preserved Toc H for all time as a British possession, in his s y m p a t h e t i c c o m m e n d a t i o n with rare vision anticipates the speedy coming of the t i m e when T o w e r Hill will regain its own and become again " t h e P l e a s a n c e proudly held between the Crown and the City of L o n d o n " - - " a noble space s u p r e m e as a promenade, the pride of h o m e - c o m i n g sons and daughters of the E m p i r e , the a d m i r a t i o n of the foreign visitor, a p u b l i c p a r k set with grass and trees, bounded upon t h e east by the historic City W a l l and on the south by the T o w e r itself. H e r e will be h e a r d music and the sound of children's voices from p l a y g r o u n d s on the r i v e r beach." T h i s is the glorious picture which L o r d W a k e f i e l d envisages, and which is revealed in " T h e P a g e a n t of T o w e r Hill. ''t B u t the " n e g l e c t e d H i l l " awaits the coming of a g r e a t restoration, a n d the h a n d s o m e volume which lies before us will hasten the desired achievement. An A d v i s o r y Body, of which L o r d W a k e f i e l d is President, has a l r e a d y laid the foundation of the great City project to provide the historic T o w e r Hill as an open space in its ancient setting for all time. T h e beloved " T u b b y " and his colleague, Dr. Leftwieh, librarian of C u s t o m s House, have produced a c a p t i v a t i n g historic story of this ever notable section of L o n d o n ; and with its splendid series of pictures and m a p s it is w o r t h y of the s u b j e c t and the s c h e m e it seeks to establish as an accomplished fact. Mr. R. H . M o t t r a m ' s c h a r m i n g history of and descriptive h a n d b o o k to E n g l a n d ' s eastern province will a p p e a l to m a n y of our readers who are interested in Norfolk and a d j a c e n t counties. 2 T h e work is a p p r o 1 " T h e Pageant of Tower Hill." By the Rev. P. 13. Clayton, C.H., M.C., P.S.A., Vicar of All Hallows, Barking-by-the-Tower, Pounder Padre of Toc H ; and B. R. Leftwich, M.B.E., F.R.Hist.S. "With a commendation by the Right Hon. Lord Wakefield ~af Hythe, C.B.E., LL.D. Pp. xiv+328 , with a coloured frontispiece, numerous illustrations and maps. London: Longmans, Green and Co. I933. Price i2s. 6d. 2 ,. East Anglia: England's Eastern Province." By R. H. Mottram. Pp. xv-~ 358. London: Chapman and Hall, Ltd., iI, Henrietta Street, W.C. 2. I933.~ Price 8s. 6d.
NOTICES
OF
BOOKS
37
priately dedicated to Russell J a m e s Colman, L o r d - L i e u t e n a n t of Norfolk. I n seven a p p e a l i n g c h a p t e r s the wonderful part of E a s t Anglia, its celebrated men and w o m e n ; its palaces, castles, churches, ancient houses, and other outstanding b u i l d i n g s ; its i~dustries, excursion possibilities, and health centres receive picturesque consideration. S e v e r a l i m p o r t a n t hospitals, s a n a t o r i a and other institutions are to be found in this eastern area, and along the coast-line are a n u m b e r of popular health stations. T h e geographical features of the country are effectively portrayed. T h e a u t h o r has devoted m u c h time and t a k e n considerable trouble to m a k e his book worthy of its subject. T h e illustrations, reproductions cf paintings, d r a w i n g s and engravings by well-known artists add greatly to the a t t r a c t i v e n e s s and value of this notable and a d m i r a b l y produced book. Mr. H a r r y Batsford and Mr. Charles F r y have p r o d u c e d a perfectly delightful picture book with p i c t u r e s q u e text, which will a p p e a l to true Scots and all real lovers of Scotland. 1 T h i s s u r v e y of Scottish scenery, with its informing and r e v e a l i n g descriptions of highlands and islands, lowlands and uplands, which s o effectively a c c o m p a n i e s the most beautiful p h o t o g r a p h s of S c o t l a n d which we have ever seen, is a work to possess and peruse at leisure. Such a volume as this is an exposition of the influ~mces which have gone to the m a k i n g of national history, c h a r a c t e r and literature. Truly, as Mr. B u c h a n says in his s y m p a t h e t i c Foreword, " the face of S c o t l a n d does not p e r m i t of facile generalizations, and it is easier for pictures than for words to reveal its infinite variety." T h e volume contains i15 p h o t o g r a p h s : an unrivalled panor a m a of S c o t t i s h s c e n e r y - - m o u n t a i n s , hills, moors, lochs, rivers, islands and fretted coastline. T h e r e is a fine section on Scottish buildings, and illustrations of old towns, villages, castles, a b b e y s and ancient houses. T h e coloured frontispiece of a scene in S u t h e r l a n d is from a water-colour by Mr. W . Russell Flint, R.A. T h e publishers have produced the book in w o r t h y form. I t is an ideal gift-book for anyone who proposes to go N o r t h in search of health or for the recuperation of mind and body which comes from a Scottish holiday. W e particularly c o m m e n d this h a n d s o m e v o l u m e to the notice of doctors, m a n y of whom in the British Isles come of Scottish stock and have enjoyed a medical training in the U n i v e r s i t i e s of Scotland. T h e famous firm of B a r t h o l o m e w , g e o g r a p h i c a l editors, printers and publishers have issued a new and revised edition of their wonderful Pocket Atlas. 1 It contains I2o coloured m a p s and 8o pages of a W o r l d Gazetteer. This inexpensive, informing, a t t r a c t i v e little work is a truly m a r v e l l o u s reference book which everyone who reads a n e w s p a p e r should possess. I t is a pocket companion which n o b o d y can afford to be without. i ,,The Face of Scotland." By Harry Batsford and Charles Fry, with a Foreword by John Buchan. Illustrated with drawings by Brian Cook and from photographs. P p x+ II7. London : B. T. Batsford Ltd., I5, North Audley Street, W . i . I933. Price 7s. 6d. Bartholomew's Pocket Atlas of the World and Gazetteer. New and revised edition. Edinburgh: John Bartholomew and Son, Ltd., 12, Duncan Street. Price 2s. 6d.
OF
BOOKS
29
NOTICES OF BOOKS. THE
ERADICATION
OF
BOVINE
TUBERCULOSIS.
DR JORDAN, in his r e c e n t l y issued m o n o g r a p h , has p e r f o r m e d a m o s t v a l u a b l e s e r v i c e in s h o w i n g t h e p o s s i b i l i t i e s of an e r a d i c a t i o n s c h e m e carried out u n d e r o r d i n a r y f a r m c o n d i t i o n s and w i t h a m i n i m u m of assistance. 1 T h e a r e a s e l e c t e d for the s c h e m e was in A y r s h i r e , c o v e r ing a p p r o x i m a t e l y n i n e s q u a r e m i l e s a n d c o n t a i n i n g t h i r t y - s e v e n farms. T h e a v e r a g e n u m b e r of m i l k i n g c o w s w a s t w e n t y - s i x p e r herd. A l l the f a r m e r s in this a r e a w e r e i n v i t e d to p a r t i c i p a t e in a s c h e m e to e r a d i c a t e t u b e r c u l o s i s f r o m t h e i r herds. T h e a s s i s t a n c e g i v e n t o o k the f o r m of t h e p r o v i s i o n of free t u b e r c u l i n and free t e s t i n g and a d v i c e on m e t h o d s of isolation, d i s i n f e c t i o n , a n d on t h e r e a r i n g of y o u n g stock. N o other d i r e c t i n c e n t i v e s w e r e offered. T h e r e a c t o r s w e r e not slaughtered, no c o m p e n s a t i o n was paid, and a p p a r e n t l y no r e s t r i c t i o n s w e r e p l a c e d in t h e w a y o f free sale or o t h e r m e t h o d of disposal of r e a c t i n g a n i m a l s . T h e s c h e m e was on B a n g ' s lines, a n J v a r i o u s m e t h o d s w e r e utilized to s e p a r a t e r e a c t o r s from n o n r e a c t o r s , from r e m o v a l to s e p a r a t e p r e m i s e s to h o u s i n g at different e n d s of one building w i t h such p r e c a u t i o n s as w e r e possible to p r e v e n t i n f e c t i o n from the t u b e r c u l o u s a n i m a l s to those free f r o m t u b e r c u l o s i s . Special care was t a k e n to k e e p y o u n g stock free f r o m infection. T h e retestings w i t h t u b e r c u l i n w e r e c a r r i e d o u t at s i x - m o n t h l y intervals. V e r y few a n i m a l s w e r e b r o u g h t into t h e herds, b u t w h e r e this was done the e n t r a n t s w e r e t e s t e d b e f o r e e n t e r i n g the area. T h e experim e n t l a s t e d for t h r e e years, and the r e s u l t s a c h i e v e d are set out in s e v e r a l tables and also d i s c u s s e d in d e t a i l for e a c h herd. I f we t a k e the gross figures at t h e first test t h e r e w e r e 385 r e a c t o r s (26"1 per cent.) out of 1,475 a n i m a l s tested, a n d at t h e s e v e n t h test 211 r e a c t o r s (i2" 3 per cent.) o u t of 1,635 a n i m a l s . T h e a u t h o r d i v i d e s t h e herds into f o u r g r o u p s w i t h t h e f o l l o w i n g findings : Group. ]] I
Initial Number of Reactors.
--i .
I
2 3 4
I
,
.
o
.
.
.
.
.
1-25 (average 8 per cent.) : 25-50 ( ,, 405 ) i I 50"75( , 55 .6 . . . . ) I
Number o) Herds.
Condition at End of Seventh Test.
98
All free.
8 5
Average of 21 "6 per cent. ,. 29"0 . . . .
W h i l e t h e s e results s h o w s u b s t a n t i a l p r o g r e s s , l o o k e d at from a n o t h e r a s p e c t ~chey a p p e a r less satisfactory. D i r e c t i n g a t t e n t i o n o n l y to the h e r d s w h i c h at the i n c e p t i o n c o n t a i n e d m o r e t h a n IO per cent. of reactors, we find that t h e r e w e r e fifteen s u c h h e r d s w h i c h w e r e g i v e n the full s e v e n tests. W i t h t h e s e herds t h e r e s u l t s s h o w e d : C o m p l e t e e r a d i c a t i o n , 5 ; r e d u c t i o n to u n d e r i o p e r cent. reactors, o ; r e d u c t i o n to l o - 2 o per cent. r e a c t o r s , 2 ; r e d u c t i o n to 2o-3o p e r cent., 5 ; reduc1 ,, The Eradication of Bovine Tuberculosis." By L. Jordan, Ph.D.. M.R.C.V.S. Special Report Series, No. 184 . of the Medical Research Council. Pp. lO4 . London : H.M. Stationery Office 1933. Price 2s. net.
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tion, but reactors still over 3° per cent., I ; actual increase in the number of reactors, 2. It is of interest to note that of the five herds entirely free, in one the herd could not be cleared until the owner sold all his reactors, in a second the herd was only cleared when all the stock was sold and fresh introduced, and in a third good results were only achieved when all reactors were cleared out of the main byre. In view of the heavy infection of our dairy herds, herds with over io per cent. of reactors are the ones of interest, and the figures show that the results obtained were decidedly unsatisfactory for a majority of the herds. In other words, while the system employed can give excellent results with herds nearly free from tuberculosis, the experiment has not demonstrated its practical utility to eliminate bovine tuberculosis as applied to the average highly infected herd. This is in accord with experience elsewhere, where it has been found that any system of leaving the reactors on the farm is not good enough to effect anything in the nature of an eradication of bovine tuberculosis. A reduction in the number of infected animals can be obtained, but unless there is continuous unremitting care subsequently the percentage of reactors is liable to rapidly increase again. To have been able to demonstrate the considerable results shown with such simple methods is, however, a great achievement, particularly as some of the factors operating seem to have been rather adverse. It is important to make clear that the experiment has not demonstrated that the proper way to deal with bovine tuberculosis in this country is along the lines followed with the very incomplete separation of reactors, but it does emphasize that the eradication of bovine tuberculosis is a perfectly feasible proposition, and that there is nothing insuperable in the way of starting eradication schemes now. The author draws attention to the general improvement shown in the herds and in the appreciation of stock--both points of great importance. He has to record that there was no increased demand for milk from the tuberculosis.free herds. In this review of the report only the experimental work done has been discussed, but it should be mentioned that it also contains an immense mass of useful information and a valuable discussion upon the value of the different procedures now in operation to influence bovine tuberculosis and the infection of the milk supply. For example, the author examined samples of milk (once only) from 636 reactors but without any clinical symptoms of tuber c-uI0sis, and nine of them (1"4 per cent ) contained tubercle bacilli, a point on which information has long been required. The effectiveness or otherwise of existing legislation is often discussed, and the author points out : " The Tuberculosis Order, even when supplemented by clinical inspection of cattle under the Milk and Dairies Act, can do little towards reducing the percentage of tubercular animals in dairy herds . . . . These results provide clear evidence that neither the Tuberculosis Order nor routine clinical inspection is effective as a safeguard against the tubercular infection of milk destined for human consumption." The report also includes a valuable discussion upon the interpretation and reliability of the double intradermal test, and notes upon the measures taken in various countries to combat bovine tuberculosis. The whole report is of great value, and should be read by everyone iw, erested in the elimination of bovine tuberculosis and in the prevention of human tuberculosis of bovine origin. W. G. SAVAGE, M.D.
NOTICES TUBERCULOUS
OF
BOOKS
31
MENINGITIS.
Dr. T. A. Jousset has written an interesting little m o n o g r a p h on the p r o b l e m s of t u b e r c u l o u s meningitis. She has carried out a series of pathological studies in the laboratories of the Salp~tri~re, the results of which tend to throw some light on the cause of death and the reasons for the high m o r t a l i t y in this affection. Cerebral compression was found to p l a y a relatively secondary r61e in the m e c h a n i s m of death. Of prime importance is the very. early i m p l i c a t i o n of ganglion-cells, proceeding to necrotic changes m the brain-stem. T h e a u t h o r has t a b u l a t e d a list of seventy-four cases of t u b e r c u l o u s meningitis, collected from the literature, which have not ended fatally. T h e i r own series contains the r e m a r k a b l e n u m b e r of fifteen cases, in all of which tubercle bacilli were isolated in the cerebrospinal fluid. E a c h of these cases was treated with injections of " a l l e r g i n e " - - a p h o s p h a t i d e x t r a c t of special tubercle bacilli, selected on account of their properties of solubility. F u l l details as to the method of p r e p a r a t i o n of allergine and the t e c h n i q u e of its e m p l o y m e n t are given in this book. I t is obvious that a c o m m u n i c a t i o n of this i m p o r t a n c e will be a v i d l y studied, and further confirmation will be eagerly a w a i t e d at the hands of other investigators. 1 MACDONALD CRITCHLEY, M.D., F . R . C . P . CAVITATION
IN THE
TUBERCULOUS
LUNG.
In G e r m a n y a s w e l l as in E n g l a n d attention has r e c e n t l y been focussed on the origin and t r e a t m e n t of cavities in the lung. Dr. A l e x a n d e r ' s booklet m a y be looked on as an a u t h o r i t a t i v e treatise on this interesting subject. '2 I n addition to the theories of c a v i t y formation which are current in E n g l a n d , some annular shadows, characterized by the a b s e n c e of increased t r a n s l u c e n c y within the ring, are looked on as being due to pre-cavernous demarcation, a condition in which a tuberculous focus is assumed to be surrounded by a zone of cellular infiltration sufficiently dense to cast a shadow on the film. T h i s theory is made use of to account for the frequent and rapid d i s a p p e a r a n c e of these shadows, but no p o s t - m o r t e m evidence of the occurrence of such a condition is put forward. I n the section dealing with diagnosis the author refers to the uncertainty of physical signs and the s u p e r i o r i t y of radiology, not only in the diagnosis, but also in the determination of the exact situation and size of a cavity. A s r e g a r d s treatment, all early cavities are looked on as a contra-indication to either tuberculin or gold t h e r a p y until such time as there is definite evidence of the b e g i n n i n g of a healing process. L i g h t t r e a t m e n t is considered d a n g e r o u s for a still longer period. Most attention is given to the various forms of collapse therapy. E a r l y (round) cavities give the best results with p n e u m o t h o r a x treatment, adhesions being infrequent in this t y p e of lesion, but as spontaneous healing is also common, Dr. A l e x a n d e r r e c o m m e n d s a p r e l i m i n a r y period of general rest controlled by serial X - r a y films. I f after two to three weeks the disease is still in a highly a c t i v e condition p n e u m o t h o r a x is 1 ,, I~tude et
Traitement
de
la M~ningite T u b e r c u l e u s e . "
B y Th~r~se A.
Jousset. Preface by Dr. Andr~ Jousset. Pp. i52, with io figs. and graphs. Paris : Masson et Cie., 12o, Boulevard Saint Germain. I933. Price 3o fr. " Die TuberculSse Kaverne." By Harms Alexander. Tuberkulose-Bibliothek No. 5I. PP. 47, with 72 illustrations. Leipzig : Johann Ambrosius Barth. 1933.
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best; in other cases six to eight weeks' general treatment should be given and pneumothorax carried out unless there is evidence of spontaneous healing. Phrenic evulsion also gives good results in these soft-walled cavities, but the author deprecates the practice of preferring this operation to pneumothorax, as the former causes permanent and considerable reduction in functional activity. Old fibrotic cavities are usually surrounded by too many adhesions for pnenmothorax to be effective, but there is no harm in making the attempt. I f cauterization is impossible, partial or total thoracoplasty is better than the continuation of a useless partial pneumothorax. Single thick-walled apical cavities rarely respond favourably to phrenic evulsion, but it is in this type of case that apicolysis gives its best results. T h e text is profusely illustrated by radiograms excellently reproduced.
ANDEEW TUBERCULOSIS
MORLAND,
AND THE
M.D., M.R.C.P.
CHILD.
" The brightest beacon that has ever lighted the path of the tuberculosis worker is the new knowledge and the larger understanding of tuberculosis in childhood." So says Professor J. Arthur Myers in his new work on tuberculosis and the childJ Dr. William P. Shepard, in his sympathetic Introduction, claims that " a new vision of possibilities in tuberculosis control is revealed in this volume." Certainly the author urges with reason that tuberculosis be stopped at its source, namely, the tuberculous person or animal, that apparently" healthy " carriers of the disease be sought out and isolated, and that special attention be given to known contacts. In sixteen chapters Dr. Myers elaborates his programme, setting forth in concise, convincing and effective manner essential facts, governing principles and practical measures. There are chapters on Portals of E n t r y of the Tubercle Bacillus, the Finding of Tuberculous Children, Control at Different Ages and under Varying Conditions, Disposal of Cases, Strongholds of Tuberculosis, and Prevention among Non-Tuberculous Children. The concluding chapter describes a scheme for the solution of the problem. " The tuberculosis programme for the future does not include any new or startling procedure nor any revolutionary ideas, rather it consists of an intelligent understanding of the facts at hand, and the employment of these facts as a tried and true foundation for future actions. These include a widespread testing of children in order to screen out those who require special supervision and treatment before symptoms appear, the greatest possible use of the hospital facilities and research projects, even greater stress on the known strongholds of tuberculosis, and a wholehearted continuance of the present educational campaign, so that the essential facts of the disease will be household knowledge throughout the length and breadth of the land." Of course Dr. Myers has addressed his monograph primarily to American readers, but it is a work which should be studied by medical advisers, particularly medical officers of health, tuberculosis officers, school medical officers, and all who, as 1 ,, T h e Child and the T u b e r c u l o s i s P r o b l e m . " By J. A r t h u r Myers, P h . D . , M.D., F.A C . P . , Professor of Preventive Medicine, U n i v e r s i t y of M i n n e s o t a ; Chief of Medical Staff, L y m a n h u r s t School for "Tuberculosis Children. W i t h an Introduction by William P. S h e p a r d , M.D., F . A . P . t I . A . , W e l f a r e Director, W e s t e r n Division, Metropolitan Life I n s u r a n c e C o m p a n y . Pp xvi + 23o, with 2I illustrations. C h a p t e r s u m m a r i e s . L o n d o n : BailIi6re, Tindall a n d Cox. 1932. Price I7s. 6d.
NOTICES
OF BOOKS
33
members of the medical and educational professions, come in contact with children and have to plan and advise regarding their welfare. The work is indeed one which will appeal to all interested in the tuberculosis problem. The work is well planned, effectively produced with instructive illustrations, and has a select bibliography. TUBERCULOSIS CONTROL. Professor Goldberg has produced a comprehensive guide to procedures in tuberculosis control, which is to be commended to the consideration of all interested in the organization and administration of tuberculosis schemes and the care of tuberculous patients. 1 The volume consists of forty-three chapters grouped in three sections, the third of which is devoted to considerations relating to the sanatorium. The author analyzes and criticizes methods, procedures, and institutions, evaluating them mainly in terms of control. It is shown that tuberculosis gives rise to a multiplicity of problems of-prevention and treatment varying with race, age and many other factors, making it difficult to estimate and interpret results. Professor Goldberg for over twenty years has been actively engaged in tuberculosis work, and for four years of this time acted as director of the municipal tuberculosis organization of the city of Chicago, including its dispensaries and sanatorium. His book covers a wide range, and furnishes statistics and other data regarding tuberculosis as met with in the United States of America. While appealing primarily to those dealing with the tuberculosis movement in the United States it will be of interest and service to tuberculosis officers and others engaged in tuberculosis work in this country. The sections dealing with legislation indicate under what statutory powers a tuberculosis service is carried on in America. There are suggestive sections on Home Treatment and Heliotherapy. In the sanatorium section is an elaborate exposition as to diet, with tables giving basic dietaries. A special chapter is devoted to undergraduate instruction on tuberculosis. The article on sanatorium planning by Mr. Kinder provides a short account in which location and exposure and orientation receive chief consideration. The volume concludes with chapters on the General Hospital and Tuberculosis and t h e Follow-up of Tuberculous Patients. The whole work is one which all responsible for the control of tuberculosis will do well to study critically and in its entirety. The volume is illustrated with maps, charts and figures, and there is a select bibliography. M A N U A L S F O R M E D I C A L A D V I S E R S A N D W O R K S OF REFERENCE. Drs. Pescher and Hervy have provided a manual in a semimedical, semi-popular style dealing with the mechanism of respiration and the physical methods by which the ventilation of the lungs may be 1 ,, Procedures in Tuberculosis Control for the Dispensary, Home, and Sanatorium." By Benjamin Goldberg, M.D., F.A.C.P., F.A.P.H.A,, Associate P r o lessor of Medicine, University of Illinois. With a chapter on Sanatorium Planning by Thomas 13. Kinder, of New York City, and an Introduction by David J. Davis, M.D., Ph.D., Dean o{ the College of Medicine, University of Illinois, Chicago. Pp. 373, with 54 illustrations. Philadelphia, U.S.A. : F. A. Davis Company. i933~ Price $4.o0. VOL. XXVIII. 3
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improved. 1 I n addition to breathing exercises, m u c h importance is attached to the " spiroscope " invented by one of the authors, and providing a simple m e a n s of breathing against pressure. I t is unfortunate that a method of proved, although limited, value should suffer from such exaggerated claims as are made in this book, a n d medical readers are not likely to be impressed by the account of a family in which one child having died of tuberculous meningitis, another was sav~ed from contracting this disease by breathing exercises. Similarly, the claim that in the same way the age of a hundred years m a y be reached can hardly expect serious consideration.
ANDREW
MORLAND,
M.D., M.R.C.P.
Dr. A n d r e w Morland has added a compact little work on P u l m o n a r y Tuberculosis to the series of " Pocket Monographs on Practical Medicine."2 It is addressed to general practitioners, who, as the author says in his preface, " in spite of the spread of specialization, remain the most i m p o r t a n t branch of the profession dealing with the individual tuberculous patient." Dr. Morland rightly claims that " for the best results to be obtained, proper co-operation between the general practitioner, the consultant, the tuberculosis officer, and the s a n a t o r i u m physician is necessary." Dr. Morland has accomplished a difficult task with rare skill in c o n d e n s i n g essentials regarding tuberculosis of the lungs into I i o pages, emphasizing principal points in diagnosis, and describing such t r e a t m e n t as will be of service to the busy doctor. Attention is directed to the importance of u n d e r s t a n d i n g the psychological outlook of the c o n s u m p t i v e patient. T h e r e is a sensible chapter on After-Care. T h e little book closes with a selected bibliography. N a c k t k u l t u r , or the practice of nakedness, is attracting attention and adherents not only in G e r m a n y and America b u t to some extent in this country. T h e physiological and psychological as well as the aesthetic aspects of the n e w ' c u l t d e m a n d the serious consideration of medical advisers and others who can approach the subject without bias and in a scientific spirit. " O n G o i n g N a k e d " is a new work by an A m e r m a n w o m a n who has practised N a c k t k u l t u r both privately and publicly, and now sets forth picturesquely in detail and with some h u m o u r the routine of nudist organizations in G e r m a n y , Scandinavia, F r a n c e and other countries, a T h e authoress appears to have made personal observations in various lands and to have participated in the naked life there practised. T h e volume contains chapters on the Personalities of Nudists, N u d i s t Organizations and Literature, and the Implications of Nakedness. T h e concluding chapters seeks to anticipate the future of this strange cult. There is a Directory of N u d i s t Clubs. T h e publishers have thought welt to issue this volume in a silver-coloured wrapper reproducing a photograph of a young woman in a state of nudity. T h e work, although scarcely scientific in i ,, La R~dducation Respiratoire." By J. Pescher and Jean Hervy. Pp. i34 , with 2 figs. Paris : G. Doin et Cie, 8, Place de l'Oddon, z933. Price 26 francs. " Palmonary Tuberculosis in General Practice." By Andrew Morland, M.D., M.R.C.P., Resident Physician, Mundesley Sanatorium. Pp. ix+z~3. London: John Bale, Sons, and Danielsson, Ltd., 83, Great Titcbfield Street, W.z. z933. Price 2s. 6d. a ,, On Going Naked." By .]an Gay. With Decorations by Zhenya. Pp. i76. With illustrations. London : Noel Douglas, ~8-3o, Little Russell Street, -W.C.i. z933. Price 7s. 6d.
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its presentation, provides m a t t e r which medical men and women interested in personal hygiene and public health and called to advise in regard to N a e k t k u l t u r should be a c q u a i n t e d with. T u b e r c u l o s i s has for long figured in fiction, and some few books have described the residence of patients at D a v o s and other health centres where c o n s u m p t i v e s congregate, but the n u m b e r of stories of life in a s a n a t o r i u m is limited. Mr. D a v i d E s d a i l e has succeeded in writing a novel which presents vivid pictures of personalities undergoing institutional treatment. 1 T h e a u t h o r has manifestly a first-hand acquaintance with sanatorium routine and the w a y s of doctors, nurses, a n d others who direct, control, and g e n e r a l l y enliven the period of residence under open-air conditions. M e d i c a l superintendents will do well to read this book, for it gives a picture of s a n a t o r i u m procedure as at least one patient has viewed it. Dr. C. H. A u t y has compiled a helpful m a n u a l on I n h a l a t i o n T h e r a p y which the medical practitioner will find of practical service. 2 T h e a p p a r a t u s is described and illustrated, a n d methods of t r e a t m e n t are described. T h e concluding section deals with diseases, including certain affections of the respiratory system, in which inhalation has proved useful. Dr. F r e d e r i c k W . P r i c e and those who have collaborated with him in the production of the most popular of modern t e x t b o o k s of medicine are to be c o n g r a t u l a t e d on the a p p e a r a n c e of a new and fourth editionY T h i s notable work for students and practitioners of medicine was first published in i922 , and after the issue of five s e p a r a t e impressions reached its second edition in I926 and its third edition in I929. And now within the short space of four years a t h o r o u g h l y revised and strikingly u p t o date fourth edition has appeared. Such a rapid d e v e l o p m e n t indicates the widespread a p p r o v a l which has been a c c o r d e d to this c o m p r e h e n s i v e and exceptionally complete treatise. T h e w o r k has undergone careful revision, and is likely to m a i n t a i n its position as the most a u t h o r i t a t i v e and serviceable of present-day textbooks on the principles and practice of medicine. As would be expected of those responsible for the issue of a m e m b e r of the series of Oxford M e d i c a l Publications, the v o l u m e is a d m i r a b l y produced, being effectively p r i n t e d on good thin paper, and supplied with a p a r t i c u l a r l y complete and helpful index. T h e new volume presents a n u m b e r of alterations in classification, general arrangement, and nomenclature. U n d e r General Infectious Diseases are two new S u b - S e c t i o n s on R i c k e t t s i a Diseases and Diseases due to F i l t r a b l e Viruses, to one of which certain articles from the Sub-Sections on B a c t e r i a l Diseases and Infectious D i s e a s e s of D o u b t f n l or U n k n o w n A~tiology have been transferred. Other c o m m u n i c a t i o n s have undergone rearrangement. T h e r e are n u m e r o u s articles, m a n y have been largely or wholly re-written, and much new m a t t e r has been added. i ,, Eat, Drink, and Be Merry." By David Esdaile. Pp. 28i. London : Longmarts, Green and Co. I933. Price 7s. 6d. "Modern Inhalation Therapy for the General Practitioner." By C. H. Auty, M R C.S., L.R.C.P. Medical Officer No. 2 District, Willesden. Pp. vii+66. London: William Heinemann (Medical Books), Ltd., 99, Great Russell Street, W . C . i . I933. Price3 s.6d. 3 ,, A Textbook of the Practice of Medicine." By various Authors. t~dited by Frederick W. Price, M.D., F.R:S.E. Fourth edition. Pp. xlv+I995, with io6 illustrations. London : Humphrey Milford, Oxford University Press, Amen House, Warwick Square, E.C. 4- I933. Price36s.
36
THE
BRITISH
JOURNAL
OF
TUBERCULOSIS
T h e r e are a n u m b e r of fresh illustrations. T h e L i s t of Contributors includes no less than twenty-seven, all connected with L o n d o n ' s great hospitals and medical schools. T h e sections dealing with T u b e r c u l o u s Disease are to be found in several parts of the book, and generally arranged according to the special system under consideration. T h e r e is an excellent introductory article p r o v i d e d by L o r d H o r d e r in the section dealing with G e n e r a l I n f e c t i o u s Diseases. T h e account of P u l m o n a r y Tuberculosis, covering twenty-four pages, has been p r e p a r e d by Drs. R. A. Young and G. E. B e a u m o n t . Dr. H a r o l d B a r w e l l writes on T u b e r c u l o s i s of the L a r y n x ; and other sections deal with tuberculosis as met with in other parts of the body. T h i s brief e n u m e r a t i o n will, we believe, be sufficient to indicate t h a t the work is not only a necessity for every medical practitioner, but one which no student desirous of fully equipping himself for e x a m i n a t i o n can afford to be without. Considering the c o m p r e h e n s i v e c h a r a c t e r of this great onevolume textbook of medicine, it is issued at a price which must be considered r e m a r k a b l y low. A m o n g the m a n y fine volumes which have been issued this season there is one which will r e m a i n in the forefront as an ideal gift-book for doctors and patients. " T h e P a g e a n t of T o w e r H i l l , " p r e p a r e d by the founder of Toc H and D r . L e f t w i c h , provides a w o n d e r f u l tonic for all. L o r d W a k e f i e l d , who has preserved Toc H for all time as a British possession, in his s y m p a t h e t i c c o m m e n d a t i o n with rare vision anticipates the speedy coming of the t i m e when T o w e r Hill will regain its own and become again " t h e P l e a s a n c e proudly held between the Crown and the City of L o n d o n " - - " a noble space s u p r e m e as a promenade, the pride of h o m e - c o m i n g sons and daughters of the E m p i r e , the a d m i r a t i o n of the foreign visitor, a p u b l i c p a r k set with grass and trees, bounded upon t h e east by the historic City W a l l and on the south by the T o w e r itself. H e r e will be h e a r d music and the sound of children's voices from p l a y g r o u n d s on the r i v e r beach." T h i s is the glorious picture which L o r d W a k e f i e l d envisages, and which is revealed in " T h e P a g e a n t of T o w e r Hill. ''t B u t the " n e g l e c t e d H i l l " awaits the coming of a g r e a t restoration, a n d the h a n d s o m e volume which lies before us will hasten the desired achievement. An A d v i s o r y Body, of which L o r d W a k e f i e l d is President, has a l r e a d y laid the foundation of the great City project to provide the historic T o w e r Hill as an open space in its ancient setting for all time. T h e beloved " T u b b y " and his colleague, Dr. Leftwieh, librarian of C u s t o m s House, have produced a c a p t i v a t i n g historic story of this ever notable section of L o n d o n ; and with its splendid series of pictures and m a p s it is w o r t h y of the s u b j e c t and the s c h e m e it seeks to establish as an accomplished fact. Mr. R. H . M o t t r a m ' s c h a r m i n g history of and descriptive h a n d b o o k to E n g l a n d ' s eastern province will a p p e a l to m a n y of our readers who are interested in Norfolk and a d j a c e n t counties. 2 T h e work is a p p r o 1 " T h e Pageant of Tower Hill." By the Rev. P. 13. Clayton, C.H., M.C., P.S.A., Vicar of All Hallows, Barking-by-the-Tower, Pounder Padre of Toc H ; and B. R. Leftwich, M.B.E., F.R.Hist.S. "With a commendation by the Right Hon. Lord Wakefield ~af Hythe, C.B.E., LL.D. Pp. xiv+328 , with a coloured frontispiece, numerous illustrations and maps. London: Longmans, Green and Co. I933. Price i2s. 6d. 2 ,. East Anglia: England's Eastern Province." By R. H. Mottram. Pp. xv-~ 358. London: Chapman and Hall, Ltd., iI, Henrietta Street, W.C. 2. I933.~ Price 8s. 6d.
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priately dedicated to Russell J a m e s Colman, L o r d - L i e u t e n a n t of Norfolk. I n seven a p p e a l i n g c h a p t e r s the wonderful part of E a s t Anglia, its celebrated men and w o m e n ; its palaces, castles, churches, ancient houses, and other outstanding b u i l d i n g s ; its i~dustries, excursion possibilities, and health centres receive picturesque consideration. S e v e r a l i m p o r t a n t hospitals, s a n a t o r i a and other institutions are to be found in this eastern area, and along the coast-line are a n u m b e r of popular health stations. T h e geographical features of the country are effectively portrayed. T h e a u t h o r has devoted m u c h time and t a k e n considerable trouble to m a k e his book worthy of its subject. T h e illustrations, reproductions cf paintings, d r a w i n g s and engravings by well-known artists add greatly to the a t t r a c t i v e n e s s and value of this notable and a d m i r a b l y produced book. Mr. H a r r y Batsford and Mr. Charles F r y have p r o d u c e d a perfectly delightful picture book with p i c t u r e s q u e text, which will a p p e a l to true Scots and all real lovers of Scotland. 1 T h i s s u r v e y of Scottish scenery, with its informing and r e v e a l i n g descriptions of highlands and islands, lowlands and uplands, which s o effectively a c c o m p a n i e s the most beautiful p h o t o g r a p h s of S c o t l a n d which we have ever seen, is a work to possess and peruse at leisure. Such a volume as this is an exposition of the influ~mces which have gone to the m a k i n g of national history, c h a r a c t e r and literature. Truly, as Mr. B u c h a n says in his s y m p a t h e t i c Foreword, " the face of S c o t l a n d does not p e r m i t of facile generalizations, and it is easier for pictures than for words to reveal its infinite variety." T h e volume contains i15 p h o t o g r a p h s : an unrivalled panor a m a of S c o t t i s h s c e n e r y - - m o u n t a i n s , hills, moors, lochs, rivers, islands and fretted coastline. T h e r e is a fine section on Scottish buildings, and illustrations of old towns, villages, castles, a b b e y s and ancient houses. T h e coloured frontispiece of a scene in S u t h e r l a n d is from a water-colour by Mr. W . Russell Flint, R.A. T h e publishers have produced the book in w o r t h y form. I t is an ideal gift-book for anyone who proposes to go N o r t h in search of health or for the recuperation of mind and body which comes from a Scottish holiday. W e particularly c o m m e n d this h a n d s o m e v o l u m e to the notice of doctors, m a n y of whom in the British Isles come of Scottish stock and have enjoyed a medical training in the U n i v e r s i t i e s of Scotland. T h e famous firm of B a r t h o l o m e w , g e o g r a p h i c a l editors, printers and publishers have issued a new and revised edition of their wonderful Pocket Atlas. 1 It contains I2o coloured m a p s and 8o pages of a W o r l d Gazetteer. This inexpensive, informing, a t t r a c t i v e little work is a truly m a r v e l l o u s reference book which everyone who reads a n e w s p a p e r should possess. I t is a pocket companion which n o b o d y can afford to be without. i ,,The Face of Scotland." By Harry Batsford and Charles Fry, with a Foreword by John Buchan. Illustrated with drawings by Brian Cook and from photographs. P p x+ II7. London : B. T. Batsford Ltd., I5, North Audley Street, W . i . I933. Price 7s. 6d. Bartholomew's Pocket Atlas of the World and Gazetteer. New and revised edition. Edinburgh: John Bartholomew and Son, Ltd., 12, Duncan Street. Price 2s. 6d.