653

infectious case. Over the age of 35 the results donot show that sleeping with an infectious case

increases the risk of tuberculosis to the contact.Most of the bed-sharers over 35 are consorts of the

TABLE VII.-Rates per 1000 in each Group.

* Died, all causes, 548 per 1000.t Died, all causes, 120 per 1000.

infectious case-i.e., they are not of the same stock.Hence heredity may again be a factor influencing theresults.

CONJUGAL TUBERCULOSIS.

From among the given series of cases and contacts,I was able to extract 110 married partnerships, onepartner of which either died of tuberculosis or sufferedfrom phthisis with the tubercle bacillus in the phlegm.The following are the details of tuberculosis amongthe consorts :-

Died of phthisis (all sputum-positive) .. 4Living cases of phthisis, sputum-positive .. 5 11" " 11 sputum-negative .. 2Died of other causes........ 2Healthy ............ 97

Total...... 110

This gives a conjugal tuberculosis-rate of exactly10 per cent. This is very high compared with otherpublished data. Fishberg 5 found in 2-5 per cent. of170 couples that both the husband and wife werephthisical. Mongour 6 found in 2-9 per cent. of 440couples that both husband and wife were phthisical.Haupt, quoted by Fishberg,5 found in 7 per cent.of 1553 couples that both husband and wife werephthisical. These authors do not state that the

primary case of tuberculosis in each partnership wassputum-positive. It is obvious that, if sputum-negative cases of phthisis are included in the seriesof primary cases, the conjugal-rate will be muchlower than where all primary cases are sputum-positive. Dickenson,7 in a series of 1635 sputum-positive cases among married patients, found 141instances (8-6 per cent.) of conjugal tuberculosis.

It is interesting to note that among the 110 marriedcouples extracted from the Worcestershire series theconjugal tuberculosis-rate was greater among wivesthan among husbands. Thus in 42 instances thewife was the primary case and of the consorts 3,or 7-1 per cent., developed phthisis ; whereas in 68instances where the husband was the primary case,8 of the consorts, or 11-8 per cent., subsequentlymanifested phthisis.

COMMENT.

While the theory that resistance to tuberculousinfection is closely associated with the allergic statehas been largely used in the foregoing explanationsand reasoning, it is well to remember the limitationsof this theory. Allergy only governs the responseof the body to those tubercle bacilli which gain accessto the tissues. While it may determine whether suchorganisms be destroyed or allowed to live on in’ the

tissues at their point of entrance, it is unlikely thatit governs the number of tubercle bacilli which gainaccess. In all probability the ease with whichtubercle bacilli gain access to the tissues depends onwhat might be termed the " permeability

" of themucous membranes. It is known that the per-meability of mucous membranes is greater in the firstfew days of life, but it seems possible that there maybe great variation of this permeability betweenindividuals even of the same age. If this were thecase, two people exposed for the same length of timeto the same concentration of contagion would notnecessarily receive the same dose of infection. It isalso possible that the permeability of mucous mem-branes may be in part an inherited tendency, and inpart an acquired tendency. Thus phthisical familiesmight have a biological characteristic of more easilypermeable mucous membranes than the normal.The effects of occupation and disease might be toalter the inherited permeability of the mucous

membranes in one direction or the other. Thereseems to be no reason why the resistance due toallergy and the resistance due to impermeable mucousmembranes should be related to one another. This

subject well merits careful investigation. In theabsence of definite knowledge, it is well to bear inmind the possibility that some individuals may beresistant to tuberculosis because they are difficult toinfect, while other individuals may be resistant totuberculosis because the infection, having gainedaccess to the tissues, cannot maintain a footholdagainst the tissue reactions.

REFERENCES.

1. Turner, H. M. : Tubercle, 1931, xii., 145.2. Thomson, R. E. : Family Phthisis, London, 1884.3. Baldwin, E. R., Petroff, S. A., and Gardner, L. U.:

Tuberculosis: Bacteriology, Pathology, and LaboratoryDiagnosis, Philadelphia, 1927.

4. Turner, H. M. : Brit. Jour. Tuberc., July, 1930.5. Fishberg, M. : Pulmonary Tuberculosis, Philadelphia, 1922,

p. 150.6. Mongour: Cong. Intern. de la Tuberculose, Paris, 1905,

i., 413.7. Dickenson, W. H. : Tubercle, 1929, x., 548.

MEDICINE AND THE LAW.

"Establishments for Special Treatment" : theRequirement of Licensing.

Part IV. of the London County Councils (GeneralPowers) Act of 1920 prohibited the carrying on of" establishments for massage or special treatment

"

unless under licence. Under this enactment a

Turkish doctor, holding a diploma from the medicalfaculty of Constantinople, was summoned lastmonth for carrying on an establishment in Regent’sPark’ where high-frequency and solar-ray treatmentwas given. The Act defines " establishment for

massage or special treatment " as meaning anypremises used (or represented as being or intendedto be used) for the reception or treatment of personsrequiring massage, manicure, chiropody, light, electric,vapour or other baths or other similar treatment.-The defendant said he never gave light, electric,vapour or other baths. He understood the word" bath " to imply that the patient was undressedand entered a box or bath for treatment ; this didnot occur at his establishment. He said he used threesolar lamps and two high-frequency instruments forlocal application. The magistrate at MarylebonePolice-court held that these treatments were withinthe prohibition and could not be administered with-out licence. As, however, the defendant appeared

654

to have a bona-fide belief that no licence was required,-the summons was dismissed under the Probation ofOffenders Act on payment of three guineas costs.The compulsory licensing provision does not apply

to establishments carried on by registered medicalpractitioners who comply with certain prescribedformalities, nor to recognised hospitals and infir-maries ; there is also an exception for hairdresserswho give face or scalp massage or manicure treat-ment to female customers. An applicant for a

licence must state his or her name, age, nationality,and technical qualifications as well as the nature ofthe proposed .establishment and the business to becarried on. Some years ago scandals in connexionwith bogus massage establishments were not unknown.The London County Council Act authorises the

licensing authority to make by-laws " for the pre-vention of immorality " in licensed establishments,and for the keeping and inspection of records showingthe persons employed and the general character ofthe business. Authorised officers of the L.C.C. mayenter and inspect premises. An equally importantpoint is that the by-laws may also prescribe thetechnical qualifications to be possessed by personsadministering massage or other curative treatment.The London County Council Act of 1920 was notthe first provision of its kind. There had been, forexample, similar statutory requirements in Part V.of an earlier Act of 1915. The 1920 Act was closelyfollowed in a Local Act obtained by Manchester in1924. The Surrey County Council Act which receivedthe Royal Assent at the end of last July containsprovisions framed on the same lines but with a slightlywider definition of establishments for special treat-ment.

BUCHAREST.

(FROM OUR OWN CORRESPONDENT.)

OATS DIET IN DIABETES.

SOME years ago a German author claimed thatan exclusive diet of oats has value in severe cases ofdiabetes mellitus, and now Dr. Oberth, of Brasov,publishes some further observations on this methodof treatment. He has treated about 100 cases with

varying results. The diet consists of oats given inlarge quantities, in the form of oat flour or flakes,together with albumin and butter, excluding allother carbohydrates and meat. The usual dailyallowance consisted of oats 250 g., albumin (vegetableor from eggs) 100 g., and butter 300 g. This mixturewas made into a soup and given every two hours.Wine or light brandy was occasionally allowed, andalso strong black coffee. Dr. Oberth details a numberof typical cases in which this regime was tried, and saysthat it seemed to give more favourable results thandid other diets recently proposed. He does not, how-ever, advise its adoption without careful preliminarytrial in any particular patient, for he has observedcases in which it made the patient worse. Thetheoretical basis of this diet is under investigation.

BLOOD CHANGE AFTER HEMORRHAGE.

In a recent lecture to the Medical SocietyDr. Niculescu recorded some comparisons of theeffect of haemorrhage upon the composition of theblood in untreated persons, and in those being treatedwith arsenic and iron. He found that haemorrhageproduces more marked effects in the former. The

leucocytes are increased, the change consisting chieflyof an increase of the polymorphonuclears, occasion-

ally of the mononuclear cells. The solids, proteins,and total nitrogen of both blood and serum are

affected to more or less the same extent. The qualitative change in the serum proteins consists in a relativeincrease of serum-albumin. The fibrin is increasedand the coagulation-rate shortened. The blood-ashremains practically unchanged. Haemorrhage duringthe administration of inorganic iron produces lessdeterioration in the blood than when the patient isuntreated, and the administration of organic ironseems even more efficacious in preventing damage.The administration of arsenic alone has little effect

except the number of leucocytes appears to be dimin-ished instead of increased in this group of cases

after haemorrhage. The combined administration ofiron and arsenic was found effective in diminishingthe effects of haemorrhage on the composition of theblood.

THE FATE OF GALL-BLADDER CASES.

A questionaire has recently been circulated to

patients who have been operated on by certain well-known surgeons for gall-bladder disease, excludingcases of carcinoma. The object was to determinethe results and after-effects of the operation. Thestatistics obtained suggest that the relief is generallypermanent and the danger slight. Gall-stones hadbeen deliberately left in one case, since the relationof the biliary ducts was so complex that no radicalprocedure could be attempted. Most of the othercases remained free from symptoms, and only in onecase was - a second operation required. Among 35cases only one mucous and one biliary fistula resulted,and herniae occurred in only two cases where

suppuration had been extensive. Colic, due to

adhesions, was reported by three patients; in two ofthese the appendix was removed, and in one a gastro-enterostomy had been performed. The suggestion ismade that renal colic must be excluded before recurrent

biliary pain colic is diagnosed, since the conditionshave many symptoms in common.

VIENNA.

I (FROM OUR OWN CORRESPONDENT.)

NEW PROFESSORS.

WITHIN the last year six chairs of the Universityof Vienna have become vacant-partly throughdeath or illness, and partly through the age-limit. Every professor attaining the age of 70 is

required by law to resign his position within thenext year. The surgical professors Eiselsberg andHochenegg resigned owing to age ; the gynsecologists,Kermauner and Peham, died within half a yearof each other, and both clinics for materia medicaare vacant through the illness of Wenckebach andOrtner. After protracted negotiations with variousscientists, the two gynaecological clinics have now beengiven to Prof. Georg Wagner, of Berlin, and Prof.William Weibel, of Prague. Both men were studentsat Vienna at the famous old school Scheuta-Chrobak-Wertheim. Ortner’s post has been taken over byProf. Jagie, well known for his researches on bloodand liver function ; Wenckebach’s is still vacant.One of the surgical clinics has been filled by Prof.Wolfgang Denk, hitherto chief of the surgical clinic ofGraz, and a pupil of Eiselsberg. It is expected thatthe other surgical clinic will be accepted by Prof.Paul Clairmont, at present in Zurich, also a pupilof Eiselsberg. The directorship of the institute oforensic medicine, at present nominally held by