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The present position of the Treatment of Pulmonary
Tuberculosis in the light of recent advances.
The problem of the treatment of pulmonary tuberculosis
remains a twofold one, the disease producing two distinct manifestations:—
(1) The general constitutional disturbance, due to absorption
of bacterial products into the systemic circulation.
(2) The local inflammatory lesion in the lung.
Despite all the recent advances, nothing has arisen to replace
an old established form of treatment, especially of factor (1),
namely, the Sanatorium treatment, where every patient is treated
under the best possible conditions with constant medical, nursing
and dietetic supervision. The more recent therapeutic measures,
valuable as they undoubtedly are, only serve as an adjunct
to Sanatorium treatment. Moreover, during the last decade,
with the remarkable progress in radiography, the value of certain
important features of the Sanatorium regime have been doubly
emphasised.
Healing by Resolution in the soft exudative (non-fibrotic)
type of disease has been clearly indicated by serial radiography.
Complete immobilisation of the patient by Absolute Rest—an
important aspect of Sanatorium treatment—is one of the very
best methods of securing such healing. This result has tended to
concentrate our attention, in selected cases, to the great value of
Prolonged Rest as an important feature of treatment. Many
patients accordingly undergo prolonged immobilisation with considerable
benefit.
If, however, serial radiographs show no signs of healing,
Collapse Therapy is considered where conditions are favourable.
Artificial Pneumothorax is undertaken and refills subsequently
continued at the Clinic for several years. Unfortunately, the
efficacy of this treatment is frequently hampered by
(a) Pleural Adhesions preventing satisfactory collapse (often
a contra-selective collapse).
(b) Pleural Effusions which occur in about 50% of cases.