Tuberculosis; a treatise by American authors on its etiology, pathology, frequency, semeiology, diagnosis, prognosis, prevention and treatment

Front matter

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Part I Etiology And Morbid Anatomy

History 13

Types of Tubercle Bacillus 13

Morphology of the Tubercle Bacillus 15

Staining 15

Other Acid-fast Bacilli — Pseudo-Tubercle Bacilli 19

Diagnosis of Tuberculosis by Microscopic Examination 20

Cultivation of the Tubercle Bacillus 20

Biology of Tubercle Bacillus . . * 23

Chemical Composition of the Tubercle Bacillus 26

Poisons of the Tubercle Bacillus 2S

Preparation of Tuberculin * 30

CHAPTER II TUBERCLE AND MORBID ANATOMY Histogenesis and Fate

Origin of Tubercle ....

Tuberculous Granulation Tissue

Tuberculous Exudative Inflammation

Caseation

Healing

Points of Entrance and Primary Localization of Tubercle Bacilli Dissemination of Tuberculosis within the Infected Body

X CONTENTS

Acute General Miliary Tuberculosis

The Morbid Anatomy of Pulmonary Tuberculosis .... Acute General Hematogenous Tuberculosis of the Lungs Partial Disseminated Hematogenous Tuberculosis of the Lungs

Localized Pulmonary Tuberculosis

Ulcerative Tuberculosis of the Lungs ......

Mixed Infection in Pulmonary Tuberculosis

Fibroid, Quiescent, and Healed Tuberculosis of the Lungs

64 69 70

70 71 74

77 78

Animals in General 80

Man 80

Individual Resistance 80

Normal Physiologic Resistance 81

Influence of Age 81

Influence of Heredity 81

Nature of Physiologic Resistance 82

Subnormal Resistance — Predisposition 82

Influence of Sex 83

Inherited Predisposition 83

Inherited Structural Defects ■ . 84

Local Predisposition 86

Acquired Predisposition 87

Specific Susceptibility from Previous Tuberculous Infection .... 87

Lymphatic 87

Pulmonary 88

Nonspecific Susceptibility 89

Infectious Diseases 89

Diseases of Nutrition 90

Miscellaneous 91

Injuries 91

Increased Resistance 91

Physiologic 91

Occupation 91

Diathetic 92

Diseases 92

Specific Increase of Resistance 92

Experiments 93

Application 94

Explanation of Mechanism 95

Specific Substances in the Blood 96

Agglutinins and Precipitins 96

Opsonins 96

Antitoxins 96

Summary 97

CONTENTS

XI

Part II Frequency And Distribution

FREQUENCY OF TUBERCULOSIS General Considerations Frequency in Autopsies Autopsies in Children Frequency Intra Vitam "Tuberculosis a Children's Disease"

Morbidity Statistics ....

Mortality Statistics and the Decrease of Tuberculosis Geographic Distribution

PAGE

TUBERCULOSIS AMONG THE D.\RK-SKINNED RACES OF AMERICA

Tuberculosis in the Negro ..."

Tuberculosis in the Indian . . .

Tuberculosis Among the Japanese and Chinese ... . . .

121 127 129

Tuberculosis in Hospitals for the Insane

Diagnosis of Tuberculosis in the Insane

Treatment of Tuberculosis in the Insane

Individual Treatment

133 134 135 135

Part III Symptomatology And Diagnosis

Portal of Entrance for Infection Other Portals of Entrance Clinical Stages Progression of the Infection

Anergy

Scrofulosis ....

Prophylaxis and Therapy .

CHAPTER I SYMPTOMATOLOGY OF PULMONARY TUBERCULOSIS

Introduction ....

Chronic Phthisis .

Acute Phthisis Acute Miliary Tuberculosis

149 150 153 155

Xll CONTENTS

PAGE

Fever 159

Hoarseness 171

Sweats 171

Languor 172

Emaciation 173

Anorexia 175

Dyspnea 176

Cyano.sis 178

The Circulatory System 17S

Digestive System 182

The Liver 188

Urinary System 188

The Bones and Mu.scles 191

The Skin 192

The Hair 193

The Physical C'ondition 193

The Special Senses 196

The Larynx 197

Cough 200

Expectoration 204

Microscopic Examination 207

Hemorrhage 212

Pain 222

Inspection 224

Palpation 232

Mensuration 233

Percussion 237

Auscultation 246

Roentgen Rays 268

Blood 285

Metabolism 292

Sputum Examination 327

Symptoms and Clinical Course ■ . . . . 335

Other Diagnostic Measures 339

The Tuberculin Test 339

Modifications of the Tuberculin Test 346

On the Recognition of Stages 361

On Recording Findings 374

CONTENTS xiii

PAGE

Metabolism . . 380

Diagnostic Value . . . 380

Prognostic Value 3S1

The Cutaneous Reaction 382

Other Diagnostic Methods 334

Sputum Examination 355

Physical Diagnostic Measures 335

Use of X-Rays 335

Prognosis 386

Part IV Pr0phyl.4xis Of Tuberculosis Ixtroductiox

CHAPTER I INDIVIDUAL PROPHYLAXIS

Infancy 393

Childhood 397

Youth 400

Adult 400

Measures for Tuberculous Individuals 393

Closed Tuberculosis 404

Scrofulosis 405

Closed Pulmonarj^ Tuberculosis 405

Open Tuberculosis 405

Duty of Consumptive Individual to Society 408

Duty of Society to Consumptive Individual 408

Marriage 409

Historical Review 410

Handbills and Invitations to Lectures 414

Economic Loss to the Commonwealth through Tuberculosis . . .414

Protest Against Patent Medicines and "Sure" Consumption Cures . . 410

Character of Tuberculosis Lecture 416

Unjustified Prejudice against Consumptives 417

Federal Phthisiophobia 418

State Phthisiophobia— Goodsell-Bedell Law 420

Results of Federal and State Phthisiophobia 422

XIV CONTENTS

PAGE

Law of Mexico as a Contrast to the Goodsell-Bedell Law .... 423

Journals Devoted to the Prevention of Tuberculosis 424

The Public Press and Tuberculosis 424

Tuberculosis Clinic 433

Advice and Care Stations 438

Seaside and Inland Sanatoria for Tuberculous Children 439

Day Camps 440

New York's Ferryboat Day Camp 441

Class Method at Home 441

Special Relief Work of Tuberculosis Committee of the C. (). S., New York . 442

Maternity Sanatoria 444

Medical Mission of the Tuberculosis Sanatorium 445

Social Mission of the Tuberculosis Sanatorium 445

Duty of the Municipality toward the Family of the Consumptive . . . 44(3

Preventatorium 440

Agricultural and Horticultural Colonies 447

Remuneration of Physicians in Public Tuberculosis Institutions . 447 Compulsory Notification of Tuberculosis Cases and the Work of the Health

Department in Relation Thereto 447

Compulsory Registration in the United States Considered by a Layman . 458

Care of Tuberculous Federal Employees 463

Care of Tuberculous Insane 463

Care of the Tuberculous in Almshouses, Asylums, and Boarding Schools . 465

Tuberculosis in Prisons and Reformatories 465

Tuberculosis and Domestic Animals 473

Supervision of Slaughter-houses 474

Protection against Infection from Tuberculous Milk 474

Housing of the Masses, Good Tenement-house Laws and their Strict Enforcement Essential 477

Parks and Playgrounds 478

Emigration from City to Village 479

Creation of Schools of Forestry and the Preservation of Forests . . 479

Sanitation at Home 481

Window Tent for the Open-air Treatment at Home 482

Dry Air and the Danger from Overheated Dwellings 486

Danger from Dry Sweeping 486

The Common House-fly as a Propagator of Tuberculosis .... 487

Prevention of Tuberculosis in the School Child 488

Sanitation of Workshops, Factories, Sto;-es, etc. 492

Antituberculosis Work Among Factory Workers 492

Insurance against Tuberculosis 493

Economic Meaning of Tuberculosis 495

Raising of Funds for Tulierculosis Propaganda 495

Special Dispensaries 496

Compulsory Examination of Children 496

Day and Night Camps 497

Administrative Control .... 497

Naval and Military Prophylaxis ... ... 497

Prison Prophylaxis 498

CONTENTS XV

PAGE

Prostitution 498

Children's School Farms 498

Trained Nurses 499

Public Schools, Colleges, etc 499

Insurance of Workingmen against Sickness 500

Resolutions 500

PART V TREATMExXT Historical Introduction 508

Schema for Tuberculins and Tubercle Bacillus Vaccines 511

Varieties of Tuberculin Used Clinically 515

Chemistry of Tuberculin 517

Methods of Administration 518

Intravenous 518

Oral 518

Inhalation 519

Dermin 519

Subcutaneously 519

Dilutions . . 520

Preservation in Dilution 520

Method of Diluting 520

Diluents 521

Estimating Dilutions 521

Preparations for Injections . . _ 523

Cleansing of Skin 523

Needles 523

Accidental Inoculation 523

Site of Injection 523

General 524

Beginning Dose 524

Interval 525

Increase of Dose 525

Time of Injection 527

Record of Treatment 527

Typical Reaction 529

Skin Reaction 530

Organ Reactions 531

Localizing Symptoms 531

General Symptoms ... 532

Temperature ... 532

XVI CONTENTS

PAGE

Antipyretic Action 534

Increased Susceptibility 534

Pulse 534

Final Dose 535

Hypersusceptibility 538

Value of Small Doses 538

Schemata 539

Selection of Patients 541

Theory of Action 541

Symptoms and General Condition 543

Elevated Temperatures 543

Duration of Disease 545

Age 545

Prophylactic Use 545

Advice for Inquiring Patients 545

Selection of Tuberculin 545

Duration of Treatment 548

Repeated Courses 549

Tuberculin Test 549

Treatment During the Administration of Tuberculin 550

Sanatorium 550

Rise of Temperature 550

Medicinal 550

Vaccines 551

Blood 551

Mobilization of Tubercle Bacilli 553

Sputum 553

Urine 554

Elevated Temperature 554

Hemoptysis 555

Pathologic Changes 555

Experimental Results , . . . 556

Reports of Tuberculin Treatment 560

Loss of Tubercle Bacilli 564

Antagonistic Bacteria 565

Bacterium Termo 565

Erysipelas 565

Syphilis 565

Yeast 566

"Acid-fast" Bacteria 566

Attenuated Tubercle Bacilli 566

CONTENTS xvii

PAGE

Vaccination 567

Products of the Tubercle Bacillus 567

Organotherapy 568

Lungs 568

Lymphatic Glands 569

Muscle 570

Blood Cells 570

Hemotherapy 571

Serotherapy 571

Varieties 572

Administration 572

Serum Disease 573

Maragliano's Serum 573

Marmorek's Serum 574

Antistreptococcic Serum 575

Creosote and its Derivatives 576

Arsenic and its Derivatives 577

Alcohol 578

Drugs that Produce Leucocytosis . 579

Ichthyol 581

lodin 581

Silver 582

Lecithin 582

Calcium 582

Strychnin 583

Inhalations 583

Sprays 584

Injections 584

SPECIFIC THERAPEUTICS OF MIXED AND CONCOMITANT INFECTIONS

Specific Therapeutics of Mixed and Concomitant Infections .... 589

HYGIENE. DIET AND OPEN AIR IN THE TRE.\TMENT OF TUBERCULOSIS

Food 601

Milk 603

Eggs 603

Meat 604

Prepared Foods ... 604

Alcohol ... 604

Carbohydrates ... 605

Dietaries 605

Air and Environment 608

XVIU

CONTENTS

Clothing

Hydrotherapy and Hardening .

Symptomatic Treatment

Debility and Loss of Appetite and Weight

Anemia ....

Fever

Cough

Night Sweats

Gastro-intestinal Disturbances

Hemorrhage ....

Cardiac Weakness and Dyspnea Complications ....

Insomnia ....

Pain

Pleurisy with Effusion

Empyema ....

Pneumothorax

Pityriasis versicolor

Ischiorectal Abscess .

Tuberculous Laryngitis

Diarrhea ....

The Sanatorium, its Construction an Requisites of the Sanatorium ....

Selection of Sanatorium Site ....

Planning and Construction ....

The Administration Building ....

General Planning of the Sanatorium Building Building Material and Cost ....

Management and Sanatorium Regime .

D Management

PAGE

Chapter IV Climatic Treatment

Relations of Climate to Physical and Psychical Condition .... 663

Cla.ssification of Climates 666

Effect of Excessive Illumination 670

The Principles of Physiologic Rest 679

Historical Aspects 680

General Definition of Climatotherapy 682

Is there a Specific Climate for Pulmonary Tuberculosis? .... 682

Principal Types of Climate 684

Ocean Climates 684

Inland Climates 686

General Utilization of Climatic Treatment ........ 690

CONTENTS xix

PAGE

Open and Closed Resorts 692

The Selection of a Special Climate or Resort 696

United States Resorts 700

The Adirondack Mountains 701

New Jersey > . . 702

Pennsylvania 703

Blue Ridge Mountains 703

Appalachians 703

Florida • 706

Rocky Mountain Resort Region 707

New Mexico 710

.Arizona 713

California 714

Foreign Resorts 717

Mexico . 717

Canada 718

Madeira 718

Canary Islands 718

Europe 718

Southern Spain 719

Africa 719

Russia 719