TUBERCULOSIS.
Definition.—An infective disease, caused by the bacillus tuberculosis, the lesions of which are characterized by nodular bodies called tubercles or diffuse infiltrations of tuberculous tissue which undergo caseation or sclerosis and may finally ulcerate, or in some situations calcify.[…]
Clinical Forms.
[…] Pulmonary form.—Symptoms.—From the outset the pulmonary symptoms are marked. The patient may have had a cough for months or for years without much impairment of health, or he may be known to be the subject of chronic pulmonary tuberculosis. In other instances, particularly in children, the disease follows measles and whooping-cough, and is of a distinctly broncho-pneumonic type. The disease begins with the symptoms of diffuse bronchitis. The cough is marked, the expectoration muco-purulent, occasionally rusty. Hæmoptysis has been noted in a few instances. From the outset dyspnœa is a striking feature and may be out of proportion to the intensity of the physical signs. In adults, the respirations may be as hurried as in acute pneumonia, reaching from fifty to sixty; in children, as high as eighty or more. There is more less cyanosis of the lips and finger-tips, and the cheeks are suffused. Apart from emphysema and the later stages of severe pneumonia I know of no other pulmonary condition in which the cyanosis is so marked. The physical signs are those of bronchitis…Toward the close the râles may be larger and more mucous. The temperature rises to 102° or 103°, and may present the inverse type. The pulse is rapid and feeble. In the very acute cases the spleen is always enlarged. The disease may prove fatal in ten or twelve days, or may be protracted for weeks or even months.
Treatment
[...] General Measures.—There are three indications—first, to place the patient in surroundings most favorable for the maintenance of a maximum degree of nutrition; second, to take such measures as, in a local or general way, influence the tuberculous processes; third, to alleviate symptoms.
The question of environment is of first importance in the treatment of tuberculosis. It is illustrated in an interesting and practical way by an experiment of Trudeau, showing that inoculated rabbits, confined in a dark, damp place, rapidly succumb, while others, allowed to run wild, either recover or show slight lesions. It is the same in human tuberculosis. A patient confined to the house—particularly in the close, overheated, stuffy dwellings of the poor, or treated in a hospital ward—is in a position analogous to the rabbit confined to a hutch in the cellar; whereas a patient living in the fresh air and sunshine for the greater part of the day has chances comparable to those of the rabbit running wild.
In the majority of cases the treatment has to be carried out at home and often under adverse conditions. Still, much can be done if the patient is kept out of doors in the fresh air the greater part of each day. In pulmonary tuberculosis neither the cough, the fever, the night-sweats, nor the haemoptysis contra-indicates this rule. Only when the weather is blustering or rainy should the patient remain in the house. It is remarkable how quickly improvement in many instances follows this fresh-air treatment. In cities the patient can be wrapped up and placed on a sofa or in a reclining-chair on the balcony or even in the yard.
The climatic treatment of tuberculosis is simply a modification of this plan. The requirements of a suitable climate are a pure atmosphere, an equable temperature not subject to rapid variations, and a maximum amount of sunshine. Given these three factors, and it makes little difference where a patient goes so long as he lives an outdoor life.
[...]The temperature of the air is also a minor consideration, so long as it is tolerably equable and not subject to rapid variations. The winter climates of the Adirondacks, of Colorado, or of Davos have the advantage of a steady cold combined with sunshine, just as the resorts of the Southern States and California, and of the south of France and Italy, have a tolerably uniform high temperature with the maximum amount of sunshine. The dryness of the air is certainly an important though not an essential factor.