THE SHIBBOLETHS OF TUBERCULOSIS.*
WIEETHER it be the author's intention or not, this book will probably be widely read by the public, and it is necessary that the reviewer should keep this fact constantly in mind in any criticism he may make. It is obvious if any real progress is to be made in the control of disease the assistance of the public is essential, for without such assistance the most learned, far- seeing and self-sacrificing body of medical men will be powerless to carry out much-needed reforms. The education of the public must, however, be a slow process and needs to be very carefully conducted if the would-be reformer is to avoid many serious pitfalls and not make chaos worse confounded. It is worse than useless to appeal to a Caesar ignorant of almost the very elements of the subject, on which he is asked to give a decision. Reading Dr. Peterson's cleverly written and highly interesting book on tuberculosis, one cannot avoid asking oneself the ques- tion whether, in spite of all the good and useful things it con- tains, it is not likely to do more harm than good, to confuse and lead into error the very public it seeks to educate. We have stated that we are not sure whether the author desired that the Public should read his book, but really there can be no doubt that it is to the general public ho desires to appeal. He can have but a poor opinion of the general practitioner in the bulk. rue portrait of the general practitioner presented in this volume Tite Shibboleths of Tuberadosis. Sr Marcus Paterson. Men. London: '°4 Mumr.V. Ms. 6d. aet.3 seems to be arrived at by inverting the process adopted by the golfer when speaking of " his game." The golfer by " his game " means an imaginary round of golf composed of the best scores lie has ever obtained for each hole, whereas Dr. Paterson's general practitioner is a composite picture of almost all the most ignorant specimens of this genus he has ever met. This practitioner does not know that in a case of consumption there may be no tubercle bacilli in tho expectoration, does not know that the bacilli may be coughed up and yet not be found at the first or even at several subsequent examinations, believes that a reaction following a subcutaneous injection of tuberculin is evidence of active tuberculosis, that the cutaneous test also is a proof of activity, in fact is an ignorant ass who does not read and is incapable of thinking. As a matter of fact, quite the opposite is the case; much of the best work—aye, and the best thinking— is done by general practitioners, and, not infrequently, when they have gone astray, they have been following the bleatinge of consultants—a statement not made with any intention of disparaging a body of very efficient physicians.
Dr. Paterson is an enthusiastic believer in treatment by auto- inoculation ; that is to say, a system by which, as a result of graduated exercise or work, the patient drives from the centre of disease increasing amounts of the tuberculosis poisons in the system whereby in response' the immunity of the patient is gradually increased, the disease reduced to inactivity and in favourable cases overcome. The treatment is a fairly lengthy one, requires very careful, skilled super vision and must be carried out in a large, well-equipped institution. Nevertheless, if the success claimed for it by the author—a claim which we believe to be justified—can be generally attained, then, in spite of theao drawbacks, its more extensive application is to be advocated. But this question is bound up with the greater question of the value of the tuberculin treatment introduced by Robert Koch, concerning which opinions in the medical profession are still much divided, for auto-inoculation is simply tuberculin treat- ment, only, instead of injecting a preparation prepared from tubercle bacilli grown outside the body, the patient, so to speak, injects into his system a tuberculin manufactured in his body-- prima fade, one more likely to arouse suitable responses. As great success as Dr. Paterson claims for auto-inoculation has been claimed for Koch's tuberculin treatment, nevertheless many very capable experts remain unconvinced of the latter's efficacy and have discontinued its use. Is it surprising that the general practitioner is confused by all this controversy and hesitates to adopt methods so potent for good or evil, crying, "A plague o' both your houses" ? But to the author's exposition of his views on treatment no exception can be taken ; he knows the subject on which he is writing thoroughly, and, whether his views be accepted or not, we are glad to have them put so clearly before SM. But on other aspects of the problem of tuberculosis we believe the author's views to be both wrong and dangerous. We would refer especially to the third so-called shibboleth, " That persons who have or have had tuberculosis should not marry." Although in practice such marriages cannot well be prevented, and although it is true that the children of well- trained consumptives may grow up quite healthy, to regard this statement as o shibboleth seems dangerously mistaken. It is the fashion among certain medical men to consider the seed all important and to disregard the soil. But the seed or germ is not the disease, which is indeed the reaction of the coil or body to the seed. Germs may be present as in " carriers," and yet there may neither be disease nor ever has been disease in that individual. No amount of statistics will over convince the present writer that the marriage of two people, one or both of whom may be subject to tuberculous disease, is not likely to result in the birth of children whose tissues are more than averagely susceptible to the inroads of the tubercle bacillus, The marriage of such people, while tuberculosis is so widespread, should certainly be discouraged.
The view that the supposed beneficial effects of climate should be regarded as a shibboleth also needs combating. Dr. Paterson makes great play with the figures of tuberculous disease among the indigenous populations of localities recommended as eminently suitable for the treatment of consumptives, and it is well that the flimsy basis of these claims should be exposed. But if it be true that many health resorts have obtained reputa- tions for curative influences to which they are not justly entitled, this fact hardly disposes of the whole question of the climatic treatment of tuberculosis, which needs much further investigation. At the lowest climatic influences are probably as potent as good feeding and suitable hygienic surroundings in promoting the well-being of the consumptive, while there is some evidence to show that the Incidence of tuberculosis in any population Is closely connected with climatic conditions. Professor Roget In his book Altitude and Health has pointed out that in Switzerland the great majority of the population live under far from favourable conditions, inhabiting as they do misty valleys, and claims that the beneficial effects of altitude are not obtained at heights less than 5,000 feet above sea-level.
In spite of what we regard as the defects of this book, it must be admitted that Dr. Paterson has made a most interesting contribution to the question of the treatment of the consump- tive. The author expresses his opinions with vigour and has a very large practical experience of his subject, but to describe an opponent's opinions as shibboleths is hardly the highest art of controversy.
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