NA TURE 



475 



THURSDAY, JUNE 8, 1911. 



THE -PERSONAL FACTOR- IN THE WAR 

 AGAINST CONSUMPTION. 

 (i) Pulmonary Tuberculosis and Sanatorium Treat- 

 ment. By Dr. C. Muthu. Pp. vi + 201. (London: 

 Bailliere,, Tindall and Cox, 1910.) Price t,s 6d 

 net. 

 (2) Conquering Consumption. By Dr. Woods Hutch- 

 inson. Pp. 138. (London : Constable and Co., 

 Ltd. • Boston and New York : Houghton Mifflin 

 Company, 1910.) Price ^s. 6d. net. 

 (i) COME twenty years ago the sanatorium treat- 

 '--^ ment of consumptive patients was but in its 

 infancy, and, with the exception of Dr. Walther's 

 disciples who had studied at Nordrach, there 

 were few who understood the real inwardness 

 of this method of treatment. The result was, 

 necessarily perhaps, a somewhat hide-bound method! 

 and although a certain proportion of patients 

 did well, others, even those in the earlier stages of 

 the disease, seemed to be unaffected, favourably, at 

 any rate, by prolonged treatment. Indiscriminate 

 over-feeding, irrational exercise, inattention to details, 

 and imperfect understanding of the general principles 

 upon which the sanatorium treatment is based were 

 accountable for many of the failures. 



During the last ten years a number of physicians, 

 especially young men, have devoted themselves very 

 thoroughly to the study of sanatorium and after 

 sanatorium treatment, and we are now reaping, as 

 the results of the observations and experience of these 

 observers, an extensive literature, some of which has 

 been embodied in what may be called the consump- 

 tives' liturgy. Amongst those who have written such 

 text-books is Dr. C. Muthu, late physician to the 

 Inglewood Sanatorium, Isle of Wight, and at pre- 

 sent physician to the Mendip Hills Sanatorium, Wells, 

 Somerset. Dr. Muthu, who is not only a physician 

 but a philosopher, gives a record of ten years' observa- 

 tions and work in open-air sanatoria. 



As regards the pathology and etiology of tuber- 

 culosis, he has here written many things with which 

 certain, probably the majority of, pathologists and 

 physicians will disagree. This, no doubt, arises from 

 the fact that Dr. Muthu looks at the question from 

 the point of view of his patient, and we may accept 

 it that from the point of view of treatment what is 

 lost thereby is perhaps more than gained in another 

 direction. One gathers from a perusal of this work 

 that Dr. Muthu looks upon the successful treatment 

 of pulmonary tuberculosis as being possible only when 

 an intimate partnership and cooperative movement 

 between physician and patient can be agreed upon 

 and carried out. If the will of the patient be strong 

 the firmness of the doctor is not so important a factor, 

 but in the case of the inexperienced and vacillating 

 patient the personality of the physician and his power 

 of dominating his patient come to be of prime im- 

 portance. The patient must be lifted out of his 

 diseased condition, not only as regards body, but as 

 regards mind. He must not dwell upon its course 

 but upon its cure. 



XO. 2 171, VOL. 86] 



The keynote as to Dr. Muthu's ideas on the path- 

 ology of the disease is given in a statement put 

 in opposition to von Ziemssen's dictum, "no 

 tubercle bacilli, no tuberculosis," Dr. Muthu con- 

 tending that it will be nearer the truth to 

 say, "no soil, no tuberculosis," which one sup- 

 poses should really read, "no suitable soil, no 

 tuberculosis." Dr. Muthu's own statement is perhaps 

 considerably stronger than he really wishes those who 

 read his book to accept, for it is only fair to him to 

 state that he still appears to have some belief in von 

 Ziemssen's dictum. It is, however, the function and 

 the appropriate function, of the sanatorium physician 

 to preach the doctrine that the soil much more than 

 the seed controls the disease, for, after all, it is the 

 cure of the patient that he has to effect. One cannot 

 help feeling, however, that it is a dangerous doctrine 

 to preach that pulmonary tuberculosis is not a con- 

 tagious disease. That the infective material takes 

 long to manifest its presence all will accept, that it 

 is not so infective as the ordinary zymotic diseases 

 may also be taken for granted; but that it is infec- 

 tive, and, under certain conditions, highly infective, 

 should never be ignored. However, those who read 

 the chapters on the predisposing factors, on early 

 diagnosis, and on the prognosis of tuberculosis will 

 be interested whether they agree with the author or 

 not. 



When we come to the principles of open-air treat- 

 ment we are in hearty accordance with almost every 

 word Dr. Muthu writes. His experience is wide, he 

 has entered into his work with enthusiasm, and 

 apparently has recorded his results accurately. The 

 special chapters on treatment are of interest rather 

 to the medical profession than to the general public, 

 and their value can only be fully appreciated by the 

 medical man, as their complete understanding in- 

 volves a knowledge not usually acquired by a layman. 

 Dr. Muthu deals with the social aspect of tuberculosis 

 in the third part of his work, and we can thoroughly 

 recommend this portion to the consideration of all 

 who take an interest in the welfare of their fellows. 

 Dr. Muthu evidently feels deeply, and he certainly 

 expresses himself strongly and clearly. Some may 

 not agree with him on all that he writes, but here 

 again, whether they agree with him or not, they will 

 be interested and often enlightened. The book is well 

 printed and the illustrations are excellent. 



(2) In Dr. Woods Hutchinson's work we have 

 an original and hopeful statement of what the 

 Americans call "a difficult proposition." Dr. Hutch- 

 inson starts out on the assumption that man is '* the 

 toughest, the most resourceful, the most ferocious 

 and dangerous animal that walks upon the face of 

 the irlobe," and he thinks that we have not yet added 

 bactcrha to our conquests simply because we did not 

 know of their existence until about half a century 

 ago. Now he considers that this conquest is only a 

 question of time, especially as the harmful bacteria 

 form such a relatively small proportion of the known 

 microbial organisms. Dr. Woods Hutchinson is a 

 great believer in the tubercle bacillus as the cause 

 of tuberculosis, and he considers that as a cause of 



