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THE INFECTIVITY OF TUBERCULOSIS.
1358 and Goring have suggested that the heredity figure for phthisis is definite and fairly high. Hence full correction must be made for this factor before it is fair to begin to estimate the possible effects of infection. So far as stated, no
met with yellow fever myself or heard of anyone else having seen it there. When yellow fever has been met with in British Guiana it has occurred in Georgetown, the chief seaport, or in the other towns of the coast line. Referring to Dr. Balfour’s paper again, I cannot say that the question of importation from the mainland is negatived in the recent small outbreak of yellow fever at Brighton, near the pitch lake in the south-west of Trinidad, nor can I agree with the remarks attributed to Mr. George-namely, " There is not the slightest evidence that the disease was conveyed here from outside sources." Dr. Balfour expressly states that Case 1, an American, had only been five days in Trinidad, and he had arrived there from the Venezuelan 7fzcci2la7zd five days before being stritek down. It is perfectly clear to my mind, therefore, that he either acquired the disease on the Venezuelan mainland or on his transit from there to Trinidad. Case 2, who was taken ill almost at the same time as Case 1, is not perhaps so easy to explain as he had not been out of Trinidad for one year and seven months. There is no doubt that sporadic cases, of what appears at least to be yellow fever, have cropped up from time to time in endemic yellow fever areas. That all of these have been genuine cases one cannot say definitely, because in many instances no necropsies have been performed nor any careful examinations made. In the light of recent research and improved diagnosis it will be interesting to see if such cases still occur. The finding of bodies, similar to those described by Scott Macfie and Johnston in guinea-pigs and dogs, in monkeys’ blood would be interesting, but would mean nothing. It has yet to be proved that
Pearson
never
such correction is made, and hence the deductions drawn are bound to be misleading. So far the most definite evidence on the point is the results of the various inquiries which have been made into the spread of infection among non-related persons in and such inquiries have shown that sanatoriums, " adults are very little endangered by close contact with open tuberculosis." Apologising for troubling you with the matter, I am, Sir, yours faithfully, MARY H. WILLIAMS. Colwall, Malvern, May 2nd, 1914. To the Editor of THE LANCET.
Sm,-In your annotation in THE LANCET of May 2nd you givean account of the view of Dr, Baldwin, of Saranac Lake, that the risk of infection of adults from cases of open pulmonary tuber. culosis is small, and of the observations of Dr, Lampson, of Minneapolis, who found that an excessively high proportion of other members of the family reacted to tuberculin if one member of the suffered from open pulmonary tuberculosis. I am led to ask, Might not Dr. Baldwin reply that this excess might be due to abnormal susceptibility of these families to tuberculosis infection generally, of which the occurrence of a case of open pulmonary tuberculosis was indication, and not necessarily to infection derived from this case ? I confess I am interested in the question from the point of view of the evidence upon which we must rely in this I am, Sir, yours faithfully, matter. STUDENT. 1914. May 2nd,
family
these bodies are parasites, and, secondly, even if they are that they have anything to do with the cause of yellow fever. Recently looking at guineablood Dr. with C. M. Wenyon here in England pigs’ we have seen bodies very similar to those described by the two observers just mentioned. Before their results can be accepted, therefore, confirmation I do not propose to enter must be forthcoming. into the controversy of Seidelin’s bodies here at this moment. Agramonte, Schilling, Guiteras, and others, all very competent observers, have already done so, and their opinion is certainly them.-I am, Sir, yours faithfully, GEORGE C. Low, M.A. M.D.,
THE FATALITY OF MEASLES. To the Editor of THE LANCET.
SIR,-Anything connected with measles is important to the clinician and health officer, for measles and whooping-cough are the two most deadly and destructive diseases which menace the life and after well-being of the young child. I fear them more than either diphtheria or scarlet fever, of which the general public have such a dread, just measles and whooping-cough so as they regard light-heartedly. I wish both latter diseases were notifiable, for I am sure this would lead to a saving
against
Lecturer, London School of Tropical Medicine.
Bentinck-street, W., May lst, 1914.
THE
INFECTIVITY
OF
TUBERCULOSIS.
To the Editor of THE LANCET.
I I
SIR,-In the annotation in your issue of May 2nd on certain evidence presented in regard to the methods of spread of tuberculosis, you state that "phthisiophobia is to be strongly deprecated," and such an expression of opinion from so weighty a journal as THE LANCET is of high value at the present time. But I would ask to be allowed to draw the attention of your readers to the valueless nature of the evidence on which the conclusions are drawn by Dr. Lampson, to the effect that " the spread of tuberculosis in families having open cases of tuberculosis is greater than is generally believed." The spread of infection is considered in families, or Of such those living in the house with them. persons, the greater number would probably be The researches of members of the same family.
I
of young lives, but authorities are penny wise and pound foolish. In three recent epidemics I have complete notes of 200 cases, of which 75 per cent. were in children of 5 or under, and a like percentage of the cases belonged to the artisan class. The deaths were six, equal to 3 per cent. All died of broncho-pneumonia, and one was aged 2 and the other five were 18 Of the 200 only two suffered months or under. from middle-ear disease, or 1 per cent., and one of the cases dried up completely at the end of 10 days and without impairment of hearing. Four of the 200 cases, aged respectively 6, 3, 2, and 1 years, had " running ears" before, and they are not included. The low percentage of middle-ear disease seems to me worthy of special note, and I believe this happy result as well as the low deathrate is due to our better management of cases of measles during the last 20 years. My own plan is to allow nothing but cold water, aerated water, lemonade, or weak tea for the first
met with yellow fever myself or heard of anyone else having seen it there. When yellow fever has been met with in British Guiana it has occurred in Georgetown, the chief seaport, or in the other towns of the coast line. Referring to Dr. Balfour’s paper again, I cannot say that the question of importation from the mainland is negatived in the recent small outbreak of yellow fever at Brighton, near the pitch lake in the south-west of Trinidad, nor can I agree with the remarks attributed to Mr. George-namely, " There is not the slightest evidence that the disease was conveyed here from outside sources." Dr. Balfour expressly states that Case 1, an American, had only been five days in Trinidad, and he had arrived there from the Venezuelan 7fzcci2la7zd five days before being stritek down. It is perfectly clear to my mind, therefore, that he either acquired the disease on the Venezuelan mainland or on his transit from there to Trinidad. Case 2, who was taken ill almost at the same time as Case 1, is not perhaps so easy to explain as he had not been out of Trinidad for one year and seven months. There is no doubt that sporadic cases, of what appears at least to be yellow fever, have cropped up from time to time in endemic yellow fever areas. That all of these have been genuine cases one cannot say definitely, because in many instances no necropsies have been performed nor any careful examinations made. In the light of recent research and improved diagnosis it will be interesting to see if such cases still occur. The finding of bodies, similar to those described by Scott Macfie and Johnston in guinea-pigs and dogs, in monkeys’ blood would be interesting, but would mean nothing. It has yet to be proved that
Pearson
never
such correction is made, and hence the deductions drawn are bound to be misleading. So far the most definite evidence on the point is the results of the various inquiries which have been made into the spread of infection among non-related persons in and such inquiries have shown that sanatoriums, " adults are very little endangered by close contact with open tuberculosis." Apologising for troubling you with the matter, I am, Sir, yours faithfully, MARY H. WILLIAMS. Colwall, Malvern, May 2nd, 1914. To the Editor of THE LANCET.
Sm,-In your annotation in THE LANCET of May 2nd you givean account of the view of Dr, Baldwin, of Saranac Lake, that the risk of infection of adults from cases of open pulmonary tuber. culosis is small, and of the observations of Dr, Lampson, of Minneapolis, who found that an excessively high proportion of other members of the family reacted to tuberculin if one member of the suffered from open pulmonary tuberculosis. I am led to ask, Might not Dr. Baldwin reply that this excess might be due to abnormal susceptibility of these families to tuberculosis infection generally, of which the occurrence of a case of open pulmonary tuberculosis was indication, and not necessarily to infection derived from this case ? I confess I am interested in the question from the point of view of the evidence upon which we must rely in this I am, Sir, yours faithfully, matter. STUDENT. 1914. May 2nd,
family
these bodies are parasites, and, secondly, even if they are that they have anything to do with the cause of yellow fever. Recently looking at guineablood Dr. with C. M. Wenyon here in England pigs’ we have seen bodies very similar to those described by the two observers just mentioned. Before their results can be accepted, therefore, confirmation I do not propose to enter must be forthcoming. into the controversy of Seidelin’s bodies here at this moment. Agramonte, Schilling, Guiteras, and others, all very competent observers, have already done so, and their opinion is certainly them.-I am, Sir, yours faithfully, GEORGE C. Low, M.A. M.D.,
THE FATALITY OF MEASLES. To the Editor of THE LANCET.
SIR,-Anything connected with measles is important to the clinician and health officer, for measles and whooping-cough are the two most deadly and destructive diseases which menace the life and after well-being of the young child. I fear them more than either diphtheria or scarlet fever, of which the general public have such a dread, just measles and whooping-cough so as they regard light-heartedly. I wish both latter diseases were notifiable, for I am sure this would lead to a saving
against
Lecturer, London School of Tropical Medicine.
Bentinck-street, W., May lst, 1914.
THE
INFECTIVITY
OF
TUBERCULOSIS.
To the Editor of THE LANCET.
I I
SIR,-In the annotation in your issue of May 2nd on certain evidence presented in regard to the methods of spread of tuberculosis, you state that "phthisiophobia is to be strongly deprecated," and such an expression of opinion from so weighty a journal as THE LANCET is of high value at the present time. But I would ask to be allowed to draw the attention of your readers to the valueless nature of the evidence on which the conclusions are drawn by Dr. Lampson, to the effect that " the spread of tuberculosis in families having open cases of tuberculosis is greater than is generally believed." The spread of infection is considered in families, or Of such those living in the house with them. persons, the greater number would probably be The researches of members of the same family.
I
of young lives, but authorities are penny wise and pound foolish. In three recent epidemics I have complete notes of 200 cases, of which 75 per cent. were in children of 5 or under, and a like percentage of the cases belonged to the artisan class. The deaths were six, equal to 3 per cent. All died of broncho-pneumonia, and one was aged 2 and the other five were 18 Of the 200 only two suffered months or under. from middle-ear disease, or 1 per cent., and one of the cases dried up completely at the end of 10 days and without impairment of hearing. Four of the 200 cases, aged respectively 6, 3, 2, and 1 years, had " running ears" before, and they are not included. The low percentage of middle-ear disease seems to me worthy of special note, and I believe this happy result as well as the low deathrate is due to our better management of cases of measles during the last 20 years. My own plan is to allow nothing but cold water, aerated water, lemonade, or weak tea for the first