Medical Disorders during Pregnancy

with prevention are of great practical value. There are special chapters on bovine tuberculosis in man, mass miniature radiography and immunization against tuberculosis. Looking into the book in more detail one finds that the author has spared no pains to support his argument by a full survey of the literature on the aspects of the subject dealt with in the respective chapters. This extensive bibliography at the end of each chapter makes the book very valuable for reference. The author has also been able, from his own wide experience, to make authoritative statements on debatable subjects. On the influence of race and heredity he favours the existence of familial susceptibility or resistance, but thinks it present in only a small proportion of persons of European stock. He stresses the need for diagnoses in the preclinical stage of the disease before the development of cavitation or apical infiltration which are signs of late advanced tuberculosis. An open mind is kept on the vexed question of endogenous and exogenous infection. The subject is fully discussed under the four headingstuberculosis in contacts, in specially exposed persons, in persons specially subjected to overcrowding and in the study of the results of measures taken to control infection. The general conclusion is that super infection is a factor of considerable importance in determining the clinical history subsequent to the primary infection. The chapter on food and tuberculosis is well worth careful study, and although no final conclusions are reached a high protein diet is favoured and research is suggested on the value of such a diet in the presence of a positive N balance and on its influence on the blood protein pattern in cases of active tuberculosis. It is interesting to note that when discussing the influence of environment on the development of active disease it is stated that ' Provision of an adequate food supply is far the most important of living conditions in relation to tuberculosis, because the almost universal latent infection will manifest itself as disease in proportion to the severity of malnutrition. Other living conditions are important either as contributory causes of malnutrition or as factors which predispose to infection.' These are probably two of the most important sentences in the book. Mass radiography is dealt with by Dr. J. Ritchie in a short chapter that contains much information of practical value. It is good to be reminded that accuracy rather than speed should be the paramount consideration, and it is comforting to read that in mass radiography the emphasis ' has again been placed-where it rightly rests-on the prevention of tuberculosis.' The linking up of tuberculin testing, B.C.G. vaccination and mass radiography is also favoured. Immunization against tuberculosis is given a chapter to itself, which is rather sketchy and incomplete. More could have been said on the administrative side of B.C.G. vaccination as a preventive measure and the need or otherwise of segregation of persons suitable for vaccination. In a book of this type it would be unusual if there were no omissions. One would have liked to have seen more reference to education as a means of prevention, to the control of tuberculosis among food handlers and to the risks that healthy children run of contracting the disease in schools and other institutions, but a work that covers every aspect of the cause and prevention of tuberculosis would comprise many volumes, and it is remarkable how much information Dr. Clarke has included in this volume of 288 pages, which has been well indexed and excellently produced. The book should be read by all chest physicians and medical officers of health as well as postgraduate students of phthisiology. F.H.