The patient usually has been treated for a dozen diseases before the correct diagnosis is made, which is very fortunate, as it is much easier to cure the disease early than it is later on.To combat tuberculosis there is yet no drug, no serum, no “cure”.

(from “Essentials of Medicine”).

CHRONIC pulmonary tuberculosis, characterised by a slow formation of conglomerate tubercles, and followed either by fibrosis or by slow cavity formation, is the common form of consumption. It is very insidious in its onset and course. The patient usually has been treated for a dozen diseases before the correct diagnosis is made, which is very fortunate, as it is much easier to cure the disease early than it is later on.

The chances are that this patient will notice that he is losing weight, that he fatigues a little easier than before, that he is little pale, that he has a little indigestion and a poor appetite. He certainly will not realise, until someone tells him of it, that he coughs or at least “clears his throat” every morning just after rising.

He may or may not expectorate what is raised, but if he does, it is “only slime”, “only mucus from the throat”. He will perhaps feel rather tired on afternoons between four and six oclock, but in the morning he feels in fine condition.

If, by an accident, his temperature is taken, the chances are that it is found to be subnormal (95.5 to 98.4F.) in the morning and from 99 to 99.5 in the afternoon. “No fever, merely a high normal temperature,” he will say. He surely will take some medicine now.

If his paleness is marked, a diagnosis of “anaemia” often is made. Then iron in good doses, and some “tonic” are given to him. Perhaps his loss of appetite and his “indigestion” are what trouble him most, and so his stomach is treated. His indigestion may be extreme; he may vomit every meal; he may have severe pain after eating; he may loathe the sight of food. It is very difficult to persuade this man that his stomach is perfectly normal; and yet such is often the case.

Or perhaps his trouble began with a cold, which “has hung on”. He knows that he does cough a little every morning but the slight amount of innocent-looking sputum does not worry him. To him it is only a case of “neglected cold”, of “chronic bronchitis”, a “winter cough” – nothing more. Or, perhaps the trouble is a little more advanced than we have been supposing. He has chilly feelings in the afternoon, or a slight sweat at night.

The chances are that he will be sure it is “malaria” and will begin taking quinine. Or perhaps he has a slight touch of pleurisy, a “stitch in the side,” or a little “water on the chest”. He consoles himself with the reflection that it is only “pleurisy”.

Perhaps he has noticed that he is getting hoarse, possibly it also hurts him to swallow; “chronic laryngitis” is his consoling thought. Perhaps the glands in his neck get large and stay so; yet this does not worry him; “scrofula,” he says.

Possibly while “in the best of health” he has a sudden desire to cough, and expectorates a mouthful of bright red blood. Then he is frightened. This man is fortunate, for, although his case need not be as advanced as many cases of the kind described above, he now is ready to obey orders, and so he will have a better chance to get well than any of the others.

There are to-day in every large city probably hundreds of patients who are treating themselves, or are being treated, for one of the above-mentioned diseases, and yet their real trouble is a little spot in the lungs, which gives no local symptoms.

There the disease is either spreading slowly, or is being slowly controlled by the self-protecting agencies of the body. In over one half of these cases the correct diagnosis will never be made, but the patients will get well, thanks to their own inherited vis medicatrix naturae, and no thanks to any of the expensive tonics they have been taking.

Other patients, however, after a few months during which the diagnosis and hence the medicines have been changed several times, finally realise that they have a lung trouble. The cough has become frequent and troublesome; there is no doubt as to the afternoon fever; the patient has night-sweats; he loses weight and strength rapidly, and he is obliged to admit that he is “going into a decline” or that he “has a chronic cough, which may turn into consumption if he doesnt check it at once”.

So more cough medicine is taken. Finally, he admits that now at least he has consumption. “Has consumption”? He has had it a long time, even before that day when months ago he first noticed a little paleness, dyspepsia, or loss of weight; but such is the optimisms of tuberculosis patients, such the effect of the euphemisms used by their friends, that the disease has had months in which to get good headway-now it claims its victim.

Haemorrhage are frequent accidents of chronic tuberculosis. Some occur very early in the disease, and they may even be the very first symptoms. Small in amount, these early haemorrhages are never serious, and they usually serve the purpose of frightening the patient into taking good care of himself. Some cases, the “haemorrhagic type”, have haemorrhage after haemorrhage during the whole course of their disease.

The most important haemorrhages, however, occur when the patient has almost, or entirely, recovered from consumption. These are usually profuse, often fatal, and they come very unexpectedly. They are not due to the activity of the tuberculosis, but to the injury inflicted years before on the arteries during cavity formation.

Tuberculosis is more a house than a family disease. The soil is made favourable or hostile by our manner of life also. These germs find a poor soil in the man who lives an active, outdoor life with plenty of exercise, food and sleep. If, however, he has a chronically infected nose or throat he may contract it easily despite his outdoor life.

The soil (our body) seems especially favourable for the germ after an attack of measles, whooping-cough, typhoid fever, smallpox, diabetes, and during any chronic disease, such as kidney or liver trouble. An infected nose or tonsils can keep the tuberculosis stirred up.

A family moving into a new house should always ascertain whether or not a consumptive lived there before them, and if one had, the whole house should be properly cleaned, re-prepared, and re- painted. One case will illustrate this. A man in our employ died of chronic consumption.

The health officials fumigated the room in which he died, officially oblivious of the fact that he had lived for months in the whole house. Then another employee moved into that house with his wife and four children, all in good health. In six months the wife and three children had died of consumption, later the baby died, and now the husband has a chronic cough. This is not an unusual case.

Tuberculosis is above all else a house disease, and houses which have one case now will usually be found to have been the home of several cases in the past, or will become such in the future. The tubercle germs in the sputum, on the walls, or on the floor of a poorly lighted room can retain their virulence for six weeks or more. Who next will move into that house?.

To combat tuberculosis there is yet no drug, no serum, no “cure”. The market is full of such remedies with their impoverishment of the patient, so far as his money goes, and the loss of valuable time which should have been spent in combating the disease.

C. P. Emerson