Remarks on the PRINCIPLES OF TREATMENT IN PULMONARY TUBERCULOSIS

Abstract

It has been seriously suggested that tuberculosis should be regarded as a classic in the teaching of medicine. So many are its manifestations that anyone with a sound general knowledge of tuberculosis would certainly have a solid foundation on which to base his study of other diseases. In the lung it may appear as an acute broncho pneumonia which rapidly proves fatal ; as a subacute infection progressing to a fatal issue by stages of remission and relapse ; as a chronic disease allowing the patient many years of life and even full activity, but exposing him to the risks of periods of ill-health due to such com plications as haemoptysis or pleurisy. Tuberculosis may produce scar tissue in the lungs, which is obvious on post-mortem examination, but which gave rise to no symptoms during life, so that the patient may have died of old age after an active life, during which he was quite unaware of ever having been ill. In this last type of case there is surely no need for treatment, even if by modern methods of examination the lesion in the lung is detected during life. Many people have their lives impaired by prolonged treatment which is quite unnecessary, and vast sums of money are spent owing to the failure to distin guish between infection which requires no treatment and that which if untreated will lead to actual disease. In civilized countries the great majority of people react to tuberculin, but this evidence of infection cannot be taken as an indication for treatment, since comparatively few develop the disease.