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TUBERCULOSIS

AND ITS COMPLICATIONS

WITH SPECIAL REFERENCE TO DIAGNOSIS AND TREATMENT
FOR GENERAL PRACTITIONERS AND STUDENTS

BY

SHERMAN G. BONNEY, A.M., M.D.

PROFESSOR OF MEDICINE, DENVER AND GROSS COLLEGE OF MEDICINE, MEDICAL DEPARTMENT
OF THE UNIVERSITY OF DENVER

VISITING PHYSICIAN TO ST. LUKE'S HOSPITAL

CONSULTANT TO THE DENVER COUNTY HOSPITAL

DIRECTOR OF THE NATIONAL ASSOCIATION FOR THE STUDY AND PREVENTION OF TUBERCULOSIS
MEMBER OF THE AMERICAN CLIMATOLOGICAL ASSOCIATION

EX-PRESIDENT OF THE DENVER CLINICAL AND PATHOLOGICAL SOCIETY, ETC.

WITH 189 ORIGINAL ILLUSTRATIONS, INCLUDING
COLORS AND 60 X-RAY PHOTOGRAPHS

20 IN

PHILADELPHIA AND LONDON

W. B. SAUNDERS COMPANY

1908

Copyright, 1908, by W. B. Saunders Company

PRINTED IN AMERICA

PRESS OF

W. B. SAUNDERS COMPANY

PHILADELPHIA

ΤΟ

THE MEMORY OF MY FATHER

Calvin F. Bonney, M. D.

WHO FOR NEARLY HALF A CENTURY SUSTAINED

THE HIGH IDEALS OF THE GENERAL PRACTITIONER

PREFACE

It is quite impossible to present an exhaustive treatise upon all phases of pulmonary tuberculosis, and in submitting this volume for the criticism of reviewers, I have no apology to make for its limitations and imperfections. All physicians who have had a large experience in the management of pulmonary invalids are forced to the conclusion that there is not so comprehensive a knowledge of the disease as fully to conserve the interests of society. Despite the many excellent contributions upon the general subject, there is perhaps a justification for publishing the following pages, which embody largely the results of personal experience. This book is not designed for the benefit of skilled specialists in the treatment of pulmonary affections, but for the use of general practitioners whose opportunities for clinical study may have been somewhat limited. Its preparation, conducted during the course of an active practice, has consumed a vast amount of time, and the work has been delayed by many unavoidable interruptions.

It has been my desire that the book should be devoted essentially to the clinical aspects of pulmonary tuberculosis, and an effort has, therefore, been made to emphasize practical considerations. To this end I have endeavored, through the various lights and shadows of every-day observation, to portray different phases of the disease in such a manner as to accentuate important points without obscuring other detail. In the interests of clearness and force, brief illustrative cases are introduced in the text, but comparatively little space is devoted to the consideration of alluring theories. In presenting certain aspects of pulmonary tuberculosis it has been necessary to make use of the contributions of innumerable scientific workers. To those whose labors in the realm of experimental research, histologic study, or clinical observation have added to the sum-total of our present knowledge, I have endeavored to give due credit in the text. If suitable recognition has not been accorded in any instance, such omission is purely unintentional. In several paragraphs relative to the physiologic effects of climate, I have made free use of material contained in Huggard's "Handbook Upon Climatic Treatment," and wish to express my obligation.

It is with some hesitation that I venture, in the last chapter of the book, to report my clinical observations concerning the practical application of vaccine therapy to cases of pulmonary tuberculosis. Some doubts have existed in my mind as to the propriety of introducing more than passing mention of this phase of specific medication. It is apparent that such a subject, even though of engrossing interest and probable value, must be adjudged upon the basis of continuous conservative investigation. While it is recognized that errors inevitably occur in the interpretation of clinical findings, such a study relative to the actual efficiency of newer therapeutic measures must remain an important feature of scientific progress. The evolution of complete

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