Address in medicine / delivered at the seventy-sixth annual meeting of the British Medical Association by James Kingston Fowler.

  • Fowler, James Kingston, Sir, 1852-1934.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Address in medicine / delivered at the seventy-sixth annual meeting of the British Medical Association by James Kingston Fowler. Source: Wellcome Collection.

    18/34 page 14
    the most extreme precautions were taken to eliminate all sources of error depending upon what may be termed “ unconscious bias.” The examinations showed that 95 per cent, of the patients working in the various grades of labour, ranging from walking, carrying baskets loaded with varying weights of earth, and digging, to working as navvies upon the construction of a reservoir, were found to have opsonic indices above the normal at some time during the day. When this system of graduated labour was introduced as an .adjunct to sanatorium treatment, it was not realised that the patients, in addition to the benefits to be expected from the increased functional activity of all the organs and tissues of the body which such labour induces, were at the same time being treated with doses of tuberculin of their own manufacture. Yet, if we accept the theory of auto-infection, no other explanation appears to me so completely in accord with the observed facts; we were in the position of M. Jourdain, who discovered that for 10 years he had been writing prose without knowing it. During the month in which these tests were carried out Dr. Inman was only able to discover two cases in which the amount of work done had exceeded the limits of prudence; in both the slight fever, headache, and loss of appetite induced were accompanied by a negative phase in the opsonic index, which lasted quite a short time, and did no appreciable harm. These facts appear to indicate very clearly that in afebrile cases of pulmonary tuberculosis, when the treatment is supervised with the exact knowledge of the capacity of each individual obtained by Dr. Paterson at Frimley, clinical observation may be trusted, and the continuous control of the opsonic technique is unnecessary. Nevertheless, even in such cases questions as to the true interpretation of certain symptoms do from time to time arise, and resort is necessary to the opsonic index, from which an • immediate answer may be obtained, whereas it might take a month or more to arrive at a decision from observation of the clinical condition alone. As the result of the labour of these patients there is now to be seen at Frimley a reservoir 108 feet long, 58 feet wide, and 134 feet deep, capable of holding half a million gallons of water. Its con- struction necessitated the excavation and removal to a variable distance in baskets or barrows of 4,175 tons of earth. Nearly 1,000 tons of concrete were required for the walls, the whole of
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