October 6. 192 1] 



NATURE 



^11 



are well known for their protracted studies of the 

 subject, which are embodied in the present volume. 

 We could have wished that the different essays 

 and addresses, which form the larger part of the 

 book, had been rewritten in more regular 

 sequence, for this would have saved the reader's 

 time and conduced to more impressive exposi- 

 tion. However, the whole of the work deserves 

 study, and there is something to be said in favour 

 of repetition of the same theme from a new angle. 

 There cannot be said to be anything exactly 

 new in the book, except in the important par- 

 ticular that what others had discussed and re- 

 garded as desirable, in the Cambridgeshire 

 colony described in this book, has been 

 shown to be practicable and competent to 

 bring improved results in the treatment of tuber- 

 culosis. There is, with the possible exception of 

 syphilis, no disease which better illustrates than 

 tuberculosis' the synthesis and inseparability of 

 treatment and prevention. Each patient treated 

 successfully is thereby deprived of the power of 

 infecting others ; and each patient who, apart 

 from cure, is taught during treatment the hygiene 

 of his disease, and made to believe practically 

 that his own recovery, as well as the safety of 

 others, depends on his adopting hygienic pre- 

 cautions in coughing and expectorating, is an 

 added influence towards the extermination of 

 tuberculosis. There is appositeness in the illus- 

 tration, that just as Sir Arthur Pearson said to his 

 blind pupils: "The first thing you have to do is 

 to learn to be blind," so the consumptive must 

 "learn to be a consumptive," and to play the game 

 both for himself and for those about him. It 

 is because so many sanatoria have failed to im- 

 press this lesson, and to make it part of the life 

 of the consumptive, that the loafing habit has 

 been encouraged, and even partial return to indus- 

 trial efficiency has been exceptional. 



Others before the present authors have advocated 

 farm colonies, industrial colonies, after-care asso- 

 ciations, and allied agencies, and much good work 

 has been done. At the Bourn and Papworth 

 colonies a demonstration has been made of the 

 practicability of dealing with all classes of con- 

 sumptives at one institution. This practical 

 application of the vue toute ensemble is especially 

 valuable, particularly so when the views adopted 

 by the authors of this book on the patho- 

 logy of tuberculosis and the essential measures for 

 its prevention are those which offer the greatest 

 prospect of success. We all know that the in- 

 fection of tuberculosis cannot be entirely avoided, 

 but that practical danger arises only when the 

 dosage of infection surpasses the powers of resist- 

 XO. 2710. VOL. 108I 



ance. Hence minimisation of infection and 

 measures for improving general health must go 

 hand in hand. 



The authors speak with authority on the im- 

 portance of preventing the spread of massive 

 infection, of "turning off the tap before we begin 

 to empty the trough." Again: "Small doses of 

 tuberculous virus may be harmless, large doses 

 must be guarded against." They quote Sir 

 Arthur Xewsholme's conclusion that the ad- 

 mission of a large proportion of advanced 

 consumptives to infirmaries has lessened the 

 spread of disease, and add that this " points 

 the way to the next step — the segregation 

 of these middle cases in colonies, where, 

 with the best chance possible of recovery, 

 they aJso cease to be a source of infection to 

 others." It is on this principle that the Cam- 

 bridgeshire Tuberculosis Colony is based. It is 

 an all-round scheme, covering every grade of 

 tuberculosis: "We are satisfied that it is im- 

 possible to keep tuberculous patients in watertight 

 compartments," and therefore early, middle, and 

 advanced cases are treated in separate divisions 

 of the same institution, which comprises the hos- 

 pital at one end of the scale, the village settle- 

 ment at the other, with intermediate rest houses 

 for febrile patients, open-air shelters, hostels, and 

 workshops. Here the patient has a reasonable 

 hope of being made, not into a valetudinarian, but 

 into a useful and productive member of society, 

 who, although he may remain a consumptive, can 

 even enjoy his life. 



This is a hopeful view of the problem. Such 

 institutions have a definite and increasing possi- 

 bility of utility. It would, of course, be a mistake 

 to assume that colonies of this kind cover the 

 whole problem. They could not do so unless 

 they were adopted on a gigantic scale ; for vari- 

 ous reasons a large number of chronic, but in- 

 curable, consumptives will need to be dealt with 

 in urban homes, in hospitals, and in their own 

 homes. A large proportion of partially recovered 

 patients will recover only 75, 50, or 25 per 

 cent, of their full working capacity, and there is 

 need for the further organisation, on a scale com- 

 mensurate with the magnitude of the problem, of 

 provision for them of the three desiderata which 

 are quoted by the authors of this book from an 

 official report in the following words : " If the 

 patient is to have the best possible prospect of 

 recovery, and if his family are to be safeguarded 

 against infection, in many cases he will need 

 (a) improved housing; (6) occupation adapted to 

 his physical capacity, etc. ; (c) the family income 

 will need to be supplemented. These requirements 



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