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74
Healing by Natural Resolution in Pulmonary Tuberculosis:
Absolute Rest.
The value of Absolute Rest in promoting natural healing of
the lung in racent active cases of pulmonary tuberculosis, is now
no longer questioned. In every new case of pulmonary tuberculosis
seen at the Chest Clinic an initial period of Absolute Rest
in bed is recommended as a routine procedure. The strict
discipline of absolute rest may not be possible in all cases, but a
modified form of rest is always possible. Clinical and radiological
observations of the chest have shown that any fresh tuberculous,
pneumonic or broncho-pneumonic process, with or without
cavitation, may actually heal in a manner comparable to that
observed in lobar pneumonia and broncho-pneumonia. There is,
however, this distinction; the time factor for resolution in a
tuberculous lung lesion is much more prolonged requiring
MONTHS instead of days and weeks of complete BED REST.
In the consideration of the treatment of an early case of pulmonary
tuberculosis that we see both at the Clinic and the
Sanatorium, the following problems arise:—
1. Is this the type of disease which is likely to show a
natural tendency to resolution.
2. Under what conditions is this resolution most likely to
be achieved.
3. What time factor is likely to be required.
It is essential for this treatment to be successful that:—
1. Serial clinical and X-ray investigations be done.
2. The personality of the physician in securing the co-operation
of the patient by a careful explanation before treatment,
of all that is involved, is a sine qua non for success.
Every patient should, in our view, be given an opportunity
of healing by simple methods with careful X-ray control as an
initial measure. By this means, some of our results have proved
to be astonishing. In this type of case, therefore, collapse
therapy by artificial pneumothorax, which may lead to a thoracoplasty
operation later, is not justifiable, and we hold the view
very strongly that if complete and prolonged rest can, unaided,