Varrier-Jones of Papworth
To be quite candid, this book is rather a hotch-potch. It contains a preface by Lord Horder, an introduction by Sir Humphrey Rolleston, 47 pages of dicta by Varrier-Jones, gathered from numerous papers and addresses, but arranged to be read consecutively in five brief chapters, a table of references, a bibliography, an extract from the British Medical Journal about tuberculosis in London in war-time, a memorial lecture by Wing-Commander Trail on the early diagnosis of pulmonary tuberculosis, some remarks on the rehabilitation of tuberculosis patients, culled from an American
review, and, finally, an unpublished speech and a letter to The Times by Varrier-Jones himself. As regards the dicta, they form, as assembled here, a rather odd mixture of rhetoric and science, with a good many disputable statements, though it is difficult to gather whether some of these represented Varrier-Jones' mature views. A saying of 1938 may be followed by a saying of 1926.
On the basis of this book, for example, Varrier-Jones would appear to have laid a considerably greater responsibility for the spread of pulmonary tuberculosis upon actual sufferers than many of his col- leagues in this field. These would hold that most cases of adult pulmonary tuberculosis are probably due to the lighting-up of a latent childhood-focus by some subsequent illness, prolonged strain, or unfavourable environment, rather than to a de novo infection from a contemporary sufferer. He would also seem, by implication, to -have regarded the presence of a positive sputum in a patient dis- charged from a sanatorium as a menace per se to such a patient's colleagues and co-workers, whereas there are many people whose sputum may occasionally be positive, but who have no other clinical signs, who are engaged in their ordinary avocations with no evidence —given common-sense precautions—that they are a peril to anybody.
But it is not as a pathologist or even a clinician that Varrier- Jones is secure of his place in the history of the war against pulmonary tuberculosis. In spite of the steadily falling mortality and incidence-rates that his lifetime witnessed, the facts as regards the after-history of the established new cases that did occur were sufficiently grim. Sanatoria follow-ups showed a lamentably high number of relapses and early deaths ; and the subsequent wastage from industry of arrested cases—even after a year or eighteen months of treatment—was almost equally discouraging.
It was the salving of these cases—of the industrial worker stricken with the disease—that chiefly fired Varrier-Jones, and led him to envisage and finally establish, in the shape of the Papworth Village Settlement, his own unique contribution to the problem. About' a central hospital for the most advanced cases, and a sanatorium for the less severe, he imagined and achieved a village community of sufferers, not yet fit—and perhaps never likely to be fit—for the rough-and-tumble of ordinary life, but able to work to a certain ex- tent at suitable industries, to enjoy the companionship of their wives and families, and to be at any rate partially self-supporting. A Glamorganshire man by birth, a crusader by temperament, and yet, at the same time, a first-rate administrator, Varrier-Jones, who died in 1941, lived to see the silver jubilee of his dream come true ; and he claimed that Papworth, with its 1,200 inhabitants, was saving- the country L19,000 a year. He would have liked to see a hundred Papworths ; and it may well be that a sojourn in some colony of the Papworth type will become an accepted part, in the future, of the after-treatment of pulmonary tuberculosis. In any case, it is to be hoped that this book, sincerely as it has been com- piled, will be followed by one giving us a picture of Varrier-Jones as a man, and a much more detailed and consecutive account of Papworth as an adventure.
H. H. BASHFORD.
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