Tuberculosis

“ The terrible disease tuberculosis is the most serious and deadly enemy which the human body has to face. It kills every year, in the United States, over a hundred and fifty thousand men, women, and children—more lives than were lost in battle in the four years of our Civil War. It is caused by a tiny {157}germ—the tubercle bacillus—so called because it forms little mustard-seed-like lumps, or masses, in the lungs, called tubercles, or "little tubers." ”

“ If separated from a tuberculous father or mother in early infancy we believe that the child [Pg 44] does not acquire tuberculosis. But the main mode of infection is by association in the same house, over a prolonged period, with people who have tuberculosis. Often the patients do not know or will not confess that anybody in the family now has tuberculosis or has died of it. But if we can establish the fact that one of the patient's family has died after having a cough for many years, that he grew very weak, and spit blood, we have established the diagnosis without the name. ”

“ Many a case of tuberculosis suffers chiefly from his fears of the disease or from his discouragement. If we can rid him of his constant dread that the disease will advance or will injure others, if we can give him courage, the natural healing power of his tissues may be all that is needed to bring about the arrest of the disease. On the other hand, even an incipient case of pulmonary tuberculosis may go steadily on from bad to worse, because the patient is constantly fretting and worrying about his own condition, or about the present sufferings of his family. ”

“ All these doubts and difficulties in connection with the diagnosis of tuberculosis in children serve to show that in a way this question may be called a negligible one, negligible, that is to say, as a menace to public health. It is important for the individual that a diagnosis be made, in order to do intensive work in upbuilding his resistance, but he is negligible as a distributor of infection. ”

“ Nowadays the term tuberculosis is applied to everything which constitutes a change in the organism excited by the entrance into it of tubercle bacilli. In statistics, galloping consumption is thus classed with tubercular local infection of a joint, gland, abdominal organ, of a little nodule in the skin of the face, etc. Calcified as well as other remains of previous lesions are classed as tubercular. [Pg 4] We have every reason to praise as a great scientific advance the discovery that in manifestations so varied in their importance to life and health the etiological factor is the same. ”

“ Nothing is more familiar to physicians than the slow progress of tuberculosis of the lymph-glands and bones, on the one hand, and its frequent rapid progress in pulmonary, abdominal, or encephalic organs on the other. It has on this account been rather difficult to persuade many of the etiological identity of scrofula and consumption. In experimental tuberculosis the same truth constantly crops up. Arloing and his followers found that the tubercle bacillus from the lymph-glands of man proved less virulent and deadly than that from the human lungs (Lecons sur la Tuberculose) . ”

“ Tuberculosis is like a concealed enemy, crouched and ready to spring the moment one turns one’s back, and it requires constant vigilance to guard against it. If this fact could be securely drilled into the patients, there would probably be fewer relapses. ”

“ Tuberculosis.—In all communities the white plague, as Oliver Wendell Holmes calls it, takes the first rank as a killing disease. It has been estimated that of it one hundred and twenty thousand people die yearly in this country. In all mortality bills tuberculosis of the lungs, or consumption, heads the list, and when to this198 is added tuberculosis of the other organs, the number swells to such an extent that this disease equals in fatality all the other acute infective diseases combined, if we leave out pneumonia. ”

“ The most important element in any treatment of tuberculosis must be the neutralization of unfavorable suggestions which are weighing upon the patient and preventing him from using even the vital forces that he has for resistance against the disease. The popular impression of tuberculosis, happily waning, is that it is an intensely fatal disease. ”

“ The comparative immunity of the very young does not extend to all forms of tuberculous disease. On the contrary, tuberculosis of the bowels and mesenteric glands (tabes mesenterica) , tuberculous peritonitis and tuberculous meningitis are pre-eminently diseases of childhood. The tables at foot of page show in detail the relative incidence of pulmonary phthisis at different ages, and the steady diminution of the disease in England and Wales since 1850.
Occupation has a marked influence on the prevalence of pulmonary tuberculosis. ”

“ On the contrary, no matter how healthful the surroundings or the salubrity of the atmosphere, for poorly nourished and feeble persons, from whatever cause, there is no immunity from tuberculosis. For no one who even approximately comprehends the universality of microbic life—and of none more than tubercle bacilli—can fail to perceive that, however much we may be able to modify the external relations bearing upon liability to tuberculosis, nevertheless every individual, no matter where his dwelling place, is more or less subject to tubercle bacilli ”

“ We know now that practically every adult above the age of thirty either has or has had tuberculosis. Careful autopsies show us remains of the disease even in the bodies of those who, without any history of tuberculosis, die from other diseases. One out of eight of the population dies of tuberculosis, but the remaining seven are quite capable of resisting the disease and so we find healed lesions at autopsies in this proportion of cases. ”

“ The communicability of tuberculosis has thus been proven and efficient steps taken to prevent its spread. The treatment by abundant fresh air, sunlight and forced nutrition has naturally followed a better understanding of the disease. Seaside and mountain sanitoria, that are now so successfully treating the various forms of bone and gland tuberculosis in children, are but the end products of demonstrations that started in animal experimentation. ”

“ We are beginning to realize that it is true of tuberculosis, so that when one case of advanced and therefore contagious tuberculosis is seen at the dispensary, machinery should automatically and invariably be set in motion to search out possible paths of contagion from that patient to others, just as if he had smallpox. ”

“ Their will to get well must be thoroughly aroused. After all, it must be recalled that tuberculosis is an extremely curable disease. It is now definitely known that more than ninety per cent. of humanity have at some time had a tuberculosis process, that is to say a focus of tuberculosis active within their tissues. Only about one in nine of the deaths in civilized countries is from tuberculosis. That means that at least eight other people who have not died from the disease but from something else have had the affection, yet have recovered from it. ”

“ When Bacillinum acts on tuberculosis the sputum is less abundant, less purulent, less green, and more aērated. It is this which has always struck me most in the action of Bacillinum. It is rarely that a patient satisfied with the remedy fails to remark, "I expectorate less." In cases of dry cough at the beginning of tuberculosis I have noticed that the drug evidently arrests the tubercular process.
I would most severely criticise, as well for myself as for others, cases of so-called "cure of tuberculosis." There certainly are persons in whom the disease does not develop. ”

“ Any person is liable to contract tuberculosis, whether he is well or not. Sickly persons, or those having bad colds, influenza bronchitis or pneumonia or any general weakness are much more liable to contract tuberculosis than a perfectly well or robust person. If you have a cough that hangs on consult at once a reliable physician who has ability to diagnose tuberculosis.
Prevention is possible; it is cheaper and easier than cure.
Any person having tuberculosis can recover from the disease if he takes the proper course in time. ”

“ It is caused by the bacillus tuberculosis, a germ which may attack any tissue of the body, although it most frequently affects the lungs of grown people, and the bones and glands of children. The disease is not inherited, but susceptibility to it appears to be; it is readily communicated from person to person. The germ of tuberculosis is so widely distributed that probably few persons over 30 years of age have not been infected with it at some time, although the infection may have been too slight to be noticed. ”

“ Tuberculosis commonly attacks one organ or part more than another, but it may take the form of an acute general fever, resembling typhoid in its clinical features. "Acute miliary tuberculosis" is a term generally used to indicate disseminated infection of some particular organ—usually the lungs or one of the serous membranes—in which the disease is so severe and rapid that the tubercles have not time to get beyond the miliary state before death occurs. Tuberculosis is exceedingly apt to spread from its original seat and to invade other organs. ”

“ I had been carrying on wholesale injections of tuberculin, and had found that the prevalence of tuberculosis was alarmingly high. On my first visit I had had only time to make sketchy tests, but certainly the disease had gained great headway. Gordon White and I went over the whole population. Lautaua, the religious rebel, blamed the missionaries for the disease. Yet the population had made a satisfactory increase in the past twenty years; and that was hard to understand. There was plenty of malaria, and we were finding acute, unguarded pulmonary tuberculosis. ”

“ We have of late years heard much about the frequency and serious consequences of tuberculosis; it has been dubbed the ‘white plague,’ and so active has been the campaign that a wide-spread understanding of this serious disease has resulted. It may safely be averred that in the urban population at least there are two, and perhaps three, individuals with syphilis to every one with tuberculosis. ”

“ In the treatment of tuberculous lesions, the surgeon also plays his part. Tuberculosis is specially prone to attack the spongy bone-tissue, joints, skin (lupus) and lymphatic glands—especially those of the neck. Recognizing the infective nature of the disease, and knowing that from one focus the germs may be taken by the blood-stream to other parts of the body, and so cause a general tuberculosis, the surgeon is anxious, by removing the primary lesion, to cut short the disease and promote immediate and permanent convalescence. ”

“ Though it is, perhaps, scarcely to be hoped that a time will arrive when tuberculosis will have become, through precautions against infection, as rare as are to-day smallpox and typhus fever, yet it is a most hopeful result of the crusade against tuberculosis that a marked reduction in the mortality, and probably in the incidence of the disease, has been going on in some countries—as, for instance, in England—for forty years. ”

“ It does, however, show that the arrest and the healing of tuberculosis of the lungsis by no means infrequent, and that it occurs among those who are not only prone to become infected, but whose circumstances are least favourable to the arrest of the disease. These facts indicate that the human organism does offer a resistance to the growth of the tubercle bacilli. ”

“ In rare cases distribution by the blood is the principal method of extension, and immense numbers of small foci of disease are produced, the form of disease being known as acute miliary tuberculosis. Although the bacilli are distributed everywhere, certain organs, as the brain and muscles, are usually exempt, because in these the conditions are not favorable to further growth of the bacilli. Tuberculosis, although frequently a very acute disease, is usually one of the best types of a chronic disease and may last for many years. ”

“ It reacts equally well in the healthy, vigorous subject who at one time has had a mild tuberculosis and recovered, in the patient with early phthisis and in the advanced case. In Kraus and Levaditi's Handbuch der Technik und Methodik der Immunitätslehre, 1911, page 205, von Pirquet himself, the grandfather of all the skin tests, says, "A positive skin reaction indicates with certainty that the organism has been infected with tuberculosis. Of the localization, extent and prognosis of tubercular infection, a positive skin reaction gives no conclusion." ”

“ The acute miliary tuberculosis in man, which can be clinically diagnosticated, is to be regarded as a provocative secondary infection, resulting from scrofula of the blood-vessels’ intima when, on the disintegration of cheesy intima tubercles, a great many tubercle bacilli are thrown into the circulation at once. ”

“ That woman left the hospital completely cured, and a year afterwards her health was still perfect. In my opinion this patient never had consumption; she was attacked with pseudo-phymic bronchitis, a complication which is very often found with influenza, and which may very easily be mistaken for tuberculosis; and in spite of the presence in the sputa of Koch's bacillus I would not register it as a case of tuberculosis, because, in contradistinction to that single case, I could mention twenty cases of tuberculosis whose symptoms neither Avian tuberculin nor any other such drug has cured. ”