Postgrad Med J: first published as 10.1136/pgmj.16.174.142 on 1 April 1940. Downloaded from 142 POST-GRADUATE MEDICAL JOURNAL April, 1940

extending to rather less than ten pages, deal A HISTORY OF with undulant fever, relapsing fever, melioidosis, TROPICAL MEDICINE. dengue, amcebic dysentery, and ankylostomiasis. Tropical diseases connected with food, like By H. HAROLD SCOTT, C.M.G., M.D., F.R.C.P. beri-beri, epidemic dropsy, pellagra and scurvy, (London), D.P.H. Two- Volumes, Pp. xix+ are given considerable attention in 81 pages. 1165, with 13 plates and numerous maps and Poisonous foods are dealt with in 14 pages. In- charts. Edward Arnold & Co., London. 1939. teresting chapters then follow on the Suez canal, Price 50s. Od. net. the Panama canal, and the slave trade. The This book is based on the Fitzpatrick Lectures second volume closes with brief biographies of delivered before the Royal College of Physicians fifteen men who have helped to advance our of London 1937-38. knowledge of the diseases he has discussed. In the preface the author draws attention to The book is furnished with a somewhat limited the fact that here and there, scattered in medical bibliography, an index of authors, and a subject works dealing with diseases in the tropics, we find index, all very valuable assets to a work of this a few notes on the history of these diseases but, kind. speaking in any sense other'than the narrowest, Anyone who has read this book must have there is no history of the rise and development of been impressed by the painstaking qualities of tropical medicine-a subject of absorbing interest. Dr. Scott's work. Each chapter is a mine of For this reason, Dr. Scott found no difficulty in information culled from very many sources, some selecting the subject of his lectures but he seems of them not easily accessible. This information to have been more puzzled in choosing a title for is collected conveniently together under the them. He points out that there is no definition various diseases which have been treated and is of the term "Tropical Medicine". If on the one thus made available for ready reference. Towards hand we take a narrow interpretation of the term the end of almost every chapter is tabled a to mean diseases restricted to the tropics, then chronological list of events which have marked there are very few. On the other hand, if we important steps in the evolution of our knowledge extend the limits to diseases met with in warm disease under discussion. climates, then we must include nearly all the ills of the particular that flesh is heir to. does not detract from the value of the book It by copyright. He goes on to say that it is not his aim to if we remark that some of the chapters appear give a history of diseases of warm climates but a to be lop-sided, while others are unduly pruned. history of tropical medicine in the generally Some indication of this has been given above in accepted connotation of the term. He explains the number of pages devoted to the discussion that the history that he means to deal with is the of the separate diseases. In a work of this kind rise and development of tropical medicine within it is almost inevitable that some diseases should a period of a hundred to a hundred and fifty be overlooked, but it is noteworthy that apart years. from ankylostomiasis no other helminthic infec- tion has been treated. Passing reference, to be As a preliminary to his main task he considers sure, has been made to such widespread diseases it expedient to describe, from the medical aspect, as schistosomiasis filariasis and guinea-worm dis- the state of some of the countries when they ease, but their history is not discussed. We think http://pmj.bmj.com/ came under European rule. "This will show," that a special chapter might have been devoted he says, "the nature of the problems that arose to the progress of our knowledge of parasitology, and the conditions under which their solution including in this term entomology, protozoology had to be undertaken." He tells how improve- and helminthology. The history of tropical ments have been brought about, usually first medicine owes much to the development of these with a view to safeguarding the health of officials branches of science. Some reference to these and European traders and later undertaking also sciences has been made in the book under the the treatment of natives, by which two purposes separate diseases, but no systematic endeavour were simultaneously to of accomplished-benefit has been attempted to show how the study on September 28, 2021 by guest. Protected the health and well-being of the native and parasitology has developed hand in hand with further protection of the white man from native- our knowledge of the diseases of the tropics. borne infection. We wish here to call particular attention to Following an instructive introduction, to which the following remarks made in the Introduction we shall refer anon, he proceeds to review the to the book. "We must not forget," Dr. Scott part played by the Navy, the Mercantile Marine, says, "that of the diseases called 'tropical' some and the Army in advancing our knowledge of at least were in times past rampant in temperate tropical disease. He next refers very briefly to climates; leprosy, cholera, plague are instances. Dominion and Colonial development in Africa, It is important also for us to bear in mind, the Federated Malay States, Hong Kong, when we begin to congratulate ourselves on the Mauritius, the West Indies. A special chapter is discoveries of their causes, that without any devoted to India, Australia and New Zealand. specific being found against plague, against The history of malaria and blackwater fever is leprosy, against sweating sickness, they are now discussed in the next two chapters, covering some practically unknown among us in England. They 165 pages. Yellow fever is then considered in disappeared, but not because they were driven 174 pages, trypanosomiasis in 93 pages, leish- out by marvellous discoveries in medicine; they maniasis in 21 pages, leprosy in 78, cholera in 52 faded away before the general amelioration of and plague in 65 pages. Shorter chapters, each our state of living as a result of improvements Postgrad Med J: first published as 10.1136/pgmj.16.174.142 on 1 April 1940. Downloaded from April, 1940 BOOK REVIEWS 143 in sanitation, improvements in housing, drainage, fellows," while to-day, owing to the production refuse disposal, in education and elevation of the and export of rubber and tin and the economic standard of living for the generality of the exploitation of the country, "thousands of acres people. Leprosy, malaria, and plague were have been wrested from the jungle; thousands lessening before the causa causans had become of people now live in peace and plenty; a railway known." Surely, then, we would be correct in stretches from end to end of the land; roads describing these diseases, not as tropical diseases second to none bear motors of every kind; while but as diseases associated with a culture and chiefs who had never entered each other's country customs which may be called mediaeval or except with sword in hand meet in harmony. primitive. These diseases disappeared when this British administration has brought wealth and culture and its customs vanished. We might prosperity to a degree to which can be found no even make bold to suggest an answer to the parallel. And with wealth has come health. puzzle which confronted Dr. Scott in selecting rom hundreds of square miles malaria, which a title for his book by proposing one which we formerly exacted a heavy toll from Malay and believe more truly connotes the facts. It would foreigner alike, has been driven out." be something to this effect-"The evolution of our After reading the fascinating biographies of knowledge of mediieval diseases as now en- some fifteen heroes who have made a name for countered in the tropics." But we suppose the themselves by working in the tropics, we must popular, though incorrect, use of the term acknowledge our indebtedness to the many other "tropical diseases" must be respected. workers who have shed light upon the diseases Although we have learned, within the past which prevail in the tropics. We cannot do forty years, much about the cause, the cure and this more fittingly than quote Dr. Scott, who the manner in which malaria is spread, "yet" says of them, "Looking back on the lives of those says Dr. Scott, "malaria in warm climates is as who have devoted themselves to the study of bad, as rife, as prevalent as ever and nearly as tropical medicine, we find a few have reaped fatal as it was a quarter of a century ago." He honours for the work they have done, but many then adds, "It was Sir Malcolm Watson, primus there are who toil unrecognised--'Others there inter pares, who laid such stress on the need to be that have no memorial'. Such men labour, go deeper than merely finding the mode of trans- surrounded by squalor and disease, separated mission, the vector and the conditions under from home comforts, from encouragement, human which it lives so that it can be fought. He sympathy and companionship, preserving in maintains that we must go further back and silence their lofty ideals, shrinking from by copyright. raise the living conditions of the natives; if that publicity, their daily prayer, 'Lord give us work is done, as in England, so abroad, we may have and strength to do the work'. But, at their better hope and expectation that 'tropical dis- death, unhonoured and unsung, they gain, may eases' so called may disappear there as they have we hope, all the honour, the reverence paid to the done in temperate climates." This aspect of Dr. Unknown Warrior, and in the knowledge of duty Scott's history of diseases has perhaps been done the joys and recompense such as the world inadequately dealt with although it is obvious cannot give." throughout the book that he has not forgotten the primitive culture and customs of the people who suffer from the diseases he describes. The opening chapters of his work, dealing with the CARBON MONOXIDE http://pmj.bmj.com/ social and economic state of the countries in which the diseases occur, have been introduced ASPHYXIA. without doubt to give a general background for By CECIL K. DRIKKER, M.D., D.Sc. Oxford the discussion of the diseases themselves. University Press. 1939. Price 25s. Od. We are pleased to note that Dr. Scott has not The author deals with the problems of carbon forgotten that the problem of the prevention, not monoxide from the many aspects that it has to say the extermination, of the diseases he acquired in modern times. The physiology of discusses is largely an economic one. "In respiration is treated adequately to make the modern times," he says, on page 93, "as opposed subject understandable to the layman. The on September 28, 2021 by guest. Protected to those of fifty or more years ago, the chief author then develops his theme and clearly obstacle is not ignorance but finance. Sanitary explains the physiology and pathology of carbon improvements on a large scale are costly, while monoxide poisoning. Two chapters are devoted the demands on the small revenues of a strug- to consideration of the general problems of gling colony are many. Health is not a cheap carbon monoxide production that arise in every- commodity and the primary cost is but a part; day life, which clearly indicate the many possible there is the ever recurring cost of upkeep which causes of poisoning from this gas. Rational cannot be relegated to the future." It is often treatment, based on the previous discussion, is said that health means wealth, in another sense fully described and well illustrated. A chapter wealth is necessary to obtain health. A striking on methods of determination of carbon monoxide example of this truth is revealed in a description in the air and in the body is included and an of the past and present conditions in the Feder- excellent bibliography, which should be useful ated Malay States. Sir Malcolm Watson has to other workers on these problems. The book described the condition of this dependency in should not only prove of value to the specialist the days gone by as "a land deep in the gloom and the advanced student, but the inclusion of of an evergreen forest whose darkness covered historical material and clearly described experi- even darker deeds, for man fought with man and mental evidence makes it interesting and in- almost every man's hand was against his structive reading for the lay public.