A Lecture on the Principles of Treatment of Pulmonary Tuberculosis
Authors: C. Riviere
Journal: BMJ (1926)

CONTRARtY to commiloni belief pulmonary tubereculosis is one of the most cuirable of infective diseases.Maiiy of us sittin-g helre have weathered it ill its slighter forms, an'd even the more severe outbreaks are -ery amenable to proper treatment.'Why, then, it must be asked, is the disease responsible 'or so large a death roll?The reasons for this lie far more in human nature and our social con- ditions than in anly failure on the miedical side.Neglect and ignorance delay the diagnosis, anid impatienice and lack of opportunity prevent treatment being carried tlirough to a cure.It has been said by somne that tlhe sanatorium treatmeent of phthisis is a failure, but this is far from true.It is, in fact, a wonderful suiecess; but on accouint of imipatience and lack of opportunity it is rarely, given a chance of carrying a case througlh to the stage of cure.Compare with it the institutional treatment of suirgical tuberculosis-admittedly a triumphant success.Wlhere (hoes the difference mainly lie?Undoubtedly in this -that for these cases, mostly children, the avei'age time of treatment runs into years, till, in fact, " arrest " is really carried into "cure."Among these children inpatience and desire of change do not break off the cure at the critical time as too often happens in adults;nor does the need of w^-age-earning or lack of funds return the half- cured case to the unhealthy conditions out of which the disease arose.Pulmonary tuberculosis is a disease of slow progress and still slower retrogression; it needs for its cure the years that are given to the treatment of surgical tuberculosis, and without them failure must follow, how- ever successful in itself the form of treatment employed.Remember, therefore, at the outset that time is one of the essential elements in its treatment, and that this must be measured in years.Now, what is the first essential in the tr eatment of active inflammation in any organ?You wN-ill answer, without hesitation, "Rest."This is as true of the.lung as else- where, buit lhow are we to apply it?For movement is the essence of the lung's function, and we cannot prevent it.MWe can, however, damp it down by reduicing the need for oxygen through general bodily rest, and this in manv cases sufflices.Let the patient be pult at rest, pr-eferably in bed, as soon as the disease is diagnosed, or even before; it is well that he be impressed at the outset with the fact that he has an inflamed lung, and that the treatment for this is ge.neral bodily rest.Having seen to this, the next question that will be asked is, Should he go into a sanatorium?Sanatorou ium Treaftm ent.The moderni sanatorium-lays itself out to employ all or mnost forms of treatment applicable to pulnionary tubercle, and the principles of sanatorium treatment are roughly the priniciples of the treatment of phthisis.They ar6, in the main, twofold: first, to build up the body's natural resistance to disease by general hygienic measuires, and towards this open air, abundant daylight, and good feedinig especially contribute; and secondly, to increease the specifi& resistance to tuberculosis bv all known measures, of, which the proper applicationln'f-f rest and'erdi;e are tbe'MniosX important.Let us consider open air first, so as to clear the ground for the more important subject of rest and its corollary, exercise.