The leader., 1904-06-18
THE TREATMENT OF
Pulmonary
tuberculosis
BY ROBERT B. PREBLH
Professor Of Medicine, NortAwestern univerulsy

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1t is obviously impossible in the
brief time suitable for an occasion such
as this to enter upon anything like
complete discussion of the treatment
of pulmonary tuberculosis. Each case
presents its peculiar difficulties and
| problems for solution, and must,
therefore, be content with an effort
to sketch what appear to me as the
most essential principles underlying
our attempts to assist nature in ef-
1 fecting cure.
1t is impossible for the physician to
fulfill his higher and broader duty, his
duty to the race, without the conscien-
tious and intelligent assistance Of the
patient. Each case of tuberculosis is q
potential center of radiation. from
which other cases may arise, and the
doctors highest mission Is to prevent
this Fortunately, there is no conflict
between the doctors duty to his pa
tient and that to mankind. 1T Is not
necessary to isolate the patient In In
stitutes for this purpose, nor should
SOURCE of unavoidable danger to his
frierds. Contact with tubereiiar pa
tients can be safely continued for
years, provided only thatrthe suptuml is
properly disposed of. 1t is not neces-5
sary to here discuss the numerous
methods of disposal of the sputum which
have been devised, but wish to draw
| AA
sputnm sprayed from mouth and nose
when sneezing or coughing Is perhaps
of even greater danger than that expec-
torated into cup or cloth. This should
be explained to the patient, and the
mouth ana hose should be carefully
covered whenever the patient sneezes
or coughs. sT Isl zgsY
II is perfectly evident that no pa
tient will properly destroy his sputum
unleas the reasons for such trouble are
explained to him, and such explanation
mustbepreceded by afrank statement of
the nature of his disease. The neces-
sity of the proper disposal Of the
sputHm 10 now admitted by all, and
10 doubt were every case Of tubercu-
losis recognized as soon as the tubercle
bacili appear in the sputum, and every
bit OF sputum properly destroyed, tu-
berculosis would soon disappear from
the Torld.
In taking up the treatment of this
diseass we should keep clearly before
us the limits of possibility in order that
we iaay not attempt the impossible I
believe fully that the drug has not vet
been found which has any direct inf1u-
ence upon the bacilli and that all efforts
to directly destroy the bacillt destroy
the patient; in other words, am con-
WINGED that all of the antiseptics which
have been used with this idea in mind.
and do not recall one which has not
been used for this purpose, do more
harm, than good. 90 not consider that
eff7lts to discover such drug are ab-
sol 1tely hopeless, but it appears to me
mere likely that something may be
found which will neutralize the toxines,
as the diphtheria antitoxine does the
to4ine of the diphtheria bacillus, and
thus enable the host to resist the in
f1iences of the l1nwelcome guest. 1t
algo appeals to me as likely that such
a boiy when found will be a biological
product of either the human or bovine
/ variety of the tubercle bacillus. There
hays been and still are in use number
of these bodies, but even after the pas
] sage of years no one of them has been
abba to establish itself in the confidence
of the profession. Because of the
chronic course of this disease any meth
cd must be slow in it's establishment,
but sufficient time has elapsed to try and
/ find wanting a considerable number of
these biological products.
There is scarcely drug in the
pharmacppeia, scarcely method, physi-
cal, electrical, hydropathic or mechan-
i ical, which has not been tried again and
again in the treatment of pulmonary tu-
kerculosis, and yet out of all this careful
and conscientious effort no drug or meth
cd has emerged triumphant. The only
thing upon which all are now agreed is
that the patient must be supplied with
all the necessaries of life in liberal
quantities and of the best qualities.
That the energies of his body must be
conserved and strengthened in every
way, in order that the heanng power
Inherent IN us all may bring about a
cure. Drugs and other therapeutic
uleaRa are to be employed to combat
Individual symptoms as they arise, but
the disease itself must be left to ma
ture.
Tho first and most essential thing is
70 supply the patient with good, pure
air. / believe that, when it is possible,
the patient should be removed to some
one of the health resorts, where the cli-
InatiS conditions have proven favorable
TO these cases, but, unfortunately, a
very large percentage of tuhercular pa
tients are not able to stand the ex-
pense of such change. One of the
most important new facts In the treat
ment of this disease is that the patient
can be supplied at home with the neees-
sary air. Nothing was more hopeless
than these cases so long as it was be-
lieved that change of climate was
absolutely essential. We realize now
that much can be done in the way of
supplying an abundance of air, even in
so crowded and otherwise undesir-
able a place as Chicago. If 1t can
be done there, it can be done any
where. This is not possible in all
parts of the city. but there are, fortu-
nately, many places available to those
Of even the sienderest means, where an
abundance CT fresh air can be sup
piled. Theie are many outlying dis
tricts easily reached by single car
fare where the necessary open space
can be obtaiaed, and IL the family re-
fuses to remove to such a neighbor-
hood, and persists in remaining in a
crowded, i'll ventilated fat, the case is
practically hopeless.
The family should take either some
fiat or house where there is a back
yard, in which tent. or, still better, a
hoard shark may he erected for the d.