THE TREATMENT OF PULMONARY BY WILLIAM F. WAUGH, A.M., M.D., the Chicago Summer School of Medicine. Ir is questionable if any disease that affects mankind is as well worth studying as tuberculosis. It is the most fatal of all maladies, the most widely disseminated, and, I may add, one in which the physician can best display his skill in the science and art of medical practice. There is a wide variety in the symptoms and in the types of the attacks. Pulmonary tuberculosis may progress with irregularity for many years or it may prove fatal in four days. I shall, however, confine myself, at present, to some remarks upon the treatment. With the public there exists a totally mistaken conception of what can be accomplished by climate. It is generally believed that there is something specific in the air of some localities: the air is too rare or too dense, too dry, too hot or too cold, or too pure for the tubercle bacillus to thrive. So patients have been sent to Asheville, Florida, Texas, California, Arizona, Colorado, Minnesota, to oceanic islands in the tropics, to the Mammoth Cave: in fact, the whole world has been ransacked for locations in which the bacillus will die and the patient live. The history of these resorts is strikingly uniform. The first reports are enthusiastic, the next glowing, then, in succession, confident, comparative, questionable, defensive, apologetic, and finally every claim for them is acknowledged to be baseless. And yet these reports are all, in the main, true. When the first consumptive goes to any climate that suits his case, where the pure air invigorates him or where he is able to spend much time out of the house, he improves. Hope does much; the fact that he breathes an atmosphere uncontaminated by emanations from any other case does more, and he recovers. Of those who follow him, it may be said that the more favorable subjects recover, the doomed ones die; and, as the place becomes more known and popular, the latter predominate, and the death-rate mounts. Meanwhile, each new-comer assists in polluting the place with his bacilli-laden sputa, and in time it becomes a very hotbed of tuberculosis, more deadly than the localities from which the patients originally came. From the Atlantic coast westward there has been a steady march of the "onelungers," and a steady recession of the line at which tuberculosis did not exist. First it was said that tubercle was unknown in the Alleghenies; next, that it did not exist in the Mississippi Valley; then the prairies were the goal, and finally the mountains. were scaled, for the bacilli grew scarcer as the sea-level became more remote. In all seemed to remark that, where the bacillus these perfectly true observations no one was scarce, population was scarcer; and, as the country filled up with inhabitants, pulmonary consumption increased in fre quency. The pure, cold air of Minnesota or of the Rockies will cure some cases to whom it is well suited and kill the rest; the damp, heavy air of the tropical shores will prolong the life of some and hasten the death of others. But, apart from the invigorating effect upon the general system and the relief of certain symptoms, such as cough, the only good effect that can legitimately be expected from any climate is the avoidance of reinfection by breathing air charged with tubercle bacilli, streptococci, and other micro-organisms. Beyond this there is nothing specific in any climate, nothing directly germicidal, even in the aromatic emanations from the pines of the Carolinas. In fact, unless in certain exceptional conditions, the tuberculous patient will do better at home, under skilled treatment, than he will in any other locality. |