《Tuberculosis in The Child And The Adult》

CHAPTER ⅠTHE DECLINE IN TUBERCULOSIS17

Tuberculosis a Preventable and Curable Disease17

The Decline in Tuberculosis17

Tuberculosis of the Present21

Tuberculosis of the Past23

Steps in Progress24

Sanatorium Treatment28

Foundation of Rest Treatment28

Factors Which Are Aiding Progress29

CHAPTER ⅡTHE FORMATION AND AFTER-COURSE OF THE PRIMARY LESION34

Source of Infecting Bacilli34

Dissociation Forms of Tubercle Bacilli35

Routes of Infection37

General Defense of the Body Against Tubercle Bacilli38

The Local Cellular Reaction to the Tubercle Bacillus39

Location of the Primary Lesion40

Results of Primary Infection41

Extension of the Primary Complex45

Healing of Primary Tubercle46

CHAPTER ⅢTHE HOST＇S RESPONSE TO REINOCULATION OF TUBERCLE，BACILLI50

Koch＇s Phenomenon50

Further Experimental Studies Establishing Immunity in Tuberculosis52

Influence of Dosage and Virulence of Bacilli Upon Patient＇s Reactions54

The Reactive Phenomena to Reinoculation56

Endogenous and Exogenous Sources of Bacilli of Reinfection63

The Relationship of Bacillemia to Reinfection and Clinical Tuberculosis65

Bronchogenic Route of Reinfection．Its Relationship to Clinical Tuberculosis67

Relationship of Contiguous Reinfections to Clinical Tuberculosis68

Relationship of Lymphatic Reinfection to Clinical Tuberculosis69

CHAPTER ⅣCHILDHOOD TUBERCULOSIS73

Infection73

Frequency of Tuberculous Infection in Childhood73

Factors Which Predispose the Child to Infection76

Of What Does the Primary Infection Consist78

Latent Tubercle Bacilli78

Latent Primary Lesions79

Methods of Diagnosing the Primary Focus79

Effect of Healed Lesions on the Child83

The Effects of Unhealed Lesions on the Child87

CHAPTER ⅤCHILDHOOD TUBERCULOSIS(CONT＇D)90

Tuberculous Disease90

The Pulmonary Component of the Primary Complex90

The Glandular Component of the Primary Complex90

Difference in Tuberculous Lesions According to Age Periods93

Symptomless Course of Unhealed Primary Complex98

Symptoms Which May Be Caused by Incompletely Encapsulated Primary Complex99

Metastases in Childhood104

Active Tuberculosis in Childhood105

Epituberculosis116

Temperature120

Height Weight and Tuberculosis122

Emotional State of Child122

Prognosis in Incompletely Healed Primary Complex123

Treatment of Active Primary Complex123

Best124

How to Determine the Amount of Rest Required125

Food126

Cod Liver Oil128

Viosterol128

Heliotherapy129

Tuberculin131

Psychologic Aspects of Treatment132

Where Shall Such Children Be Treated132

CHAPTER ⅥIMMUNIZATION AGAINST TUBERCULOSIS134

The Prevention of Childhood Infections by Immunization134

CHAPTER ⅦFACTORS IN THE DEVELOPMENT OF THE ADULT TYPE OF TUBERCULOSIS140

Adult Type of Tuberculosis Defined140

Factors Which Favor Development of the Adult Type of Tuberculosis140

Changes in Previous Foci141

Effect of Other Diseases142

Physiochemical Change142

Changes in Nutritional Requirements of Bacilli143

Occupational Factors143

Constitutional Factors Which Favor Tuberculous Disease144

Accidental Factors Favoring Reinoculation145

What Causes Diagnostic Phenomena146

Minimal and Subminimal Infections147

Pathologic Characteristics of Adult Tuberculosis148

Proliferative Lesions148

Exudative Lesions149

Atelectasis150

Cavity151

Miliary Tuberculosis159

CHAPTER ⅧTHE VISCERAL NEUROLOGY OF PULMONARY TUBERCULOSIS102

The Vegetative Nervous System162

Embryologic Relationships of the Lungs164

Segmental Relationships of the Lungs166

Segmental Relationships of the Pleura168

Reflexes Produced in the Lungs，the Stimuli Arising Elsewhere in the Body168

Asthma169

Massive Collapse or Pulmonary Atelectasis169

Bronchitis172

The Lungs as Affected by Sympathetic Reflexes and Substances Whose Action Simulates Stimulation of the Sympathetics172

Manner in Which Visceral Structures Are Affected by Toxins of Pulmonary Tuberculosis173

Manner in Which Visceral Structures Are Reflexly Affected by the Allergic Inflammatory Reaction Due to Pulmonary Tuberculosis175

Distribution of Pulmonary Reflexes176

Distribution of Pleural Reflexes177

CHAPTER ⅨTHE VISCERAL NEUROLOGY OF PULMONARY TUBERCULOSIS(CONT＇D)180

Classification of Reflexes Which May Be Caused by Pulmonary Tuberculosis180

Viscerosomatic Reflexes Caused by Afferent Impulsus Which Course With the Sympathetica181

Reflex Spasticity Expressed in the Muscles of the Shoulder Girdle and Diaphragm183

The Trophic Reflex in the Somatic Tissues Caused by Stimuli Arising in the Lung185

The Sensory Reflex From the Lung188

Flushing of the Face and Ear189

Visceroskeletal Reflexes of Parasympathetic Origin189

Spasm of the Sternocleidomastoideus and Trapezius191

Flushing of the Face191

Motor and Trophic Effects in the Facial Muscles191

Motor and Trophic Reflexes in the Tongue191

Sensory Phenomena About the Head and Face192

Viscerovisceral Reflexes in Which Both Afferent and Efferent Fibers Course With the Sympathetics193

Dilatation of Pupil194

Tachycardia195

Inhibition of Motility and Secretory Activity in the Gastrointestinal Tract195

Increased Activity in the Sphincters196

Viscerovisceral Reflexes in Which Both Afferent and Efferent Fibers Belong to the Parasympathetic System196

Effects in the Nasopharyngeal Structures197

Reflex Disturbance in the Larynx198

Cough199

Reflexes in the Gastrointestinal Tract199

Reflex Effects Shown in the Heart200

CHAPTER ⅩDIAGNOSIS OF PULMONARY TUBERCULOSIS207

The Clinical History and Symptomatology207

Necessity of Accurate Study of the Patient and His Reactions207

Importance of Clinical History208

History of Tuberculous Illness209

Masquerading Syndromes of Early Tuberculosis210

Allergy the Cause of Symptoms212

Etiologic Classification of Symptoms212

Evaluation of Symptoms215

Symptoms of Toxemia216

Reflex Symptoms223

Local Symptoms or Symptoms Caused by the Tuberculous Process Per Se226

CHAPTER ⅪDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)232

Examination of the Chest：Inspection232

General Inspection232

Inspection of the Chest233

Normal Chest233

Changes Due to Right-or Left-Handedness235

Size，Contour，and Shape of the Chest236

Pathologic Forms of the Chest236

Change in Motility of Chest an Indication of Pathologic Changes Within237

Lessened Motility Due to Previous Pathology in the Lung and Pleura237

Reflex Lessened Motility of Thorax in Active Tuberculosis238

Reflex Degeneration of Skin，Subcutaneous Tissue，and Muscles Resulting From Pulmonary Inflammation240

Reflex Degeneration of Skin，Subcutaneous Tissue and Muscles Resulting From Pleural Involvement241

CHAPTER ⅫDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)245

Examination of Chest：Palpation245

How Does Palpation Give Diagnostic Information in Pulmonary Tuberculosis245

The Detection of Pulmonary Reflexes by Palpation246

The Pulmonary Motor Reflex247

How to Palpate Muscles for the Detection of the Pulmonary Motor Reflex248

Lagging of the Side248

The Pulmonary Trophic Reflex249

Pleural Trophic Reflex250

The Detection of Different Densities in the Thorax by Palpation252

CHAPTER ⅩⅢDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)256

Examination of Chest：Percussion256

Value of Percussion256

Chests Cannot Be Standardized for Percussion256

Character of Percussion Stroke257

Common Errors in Percussion257

Apical Contraction260

Effect of Apical Muscles on Percussion261

Diagnostic Value of Percussion261

CHAPTER ⅩⅣDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)263

Examination of Chest：Auscultation263

Causes of Auscultatory Phenomena in Pulmonary Tuberculosis263

Changes Due Directly to the Inflammatory Reaction in the Lung263

Changes Due to the Condition of the Muscles264

Importance of Auscultation265

How to Carry Out Auscultation266

Respiratory Sounds in Early Tuberculosis267

Why Respiratory Sounds Differ in Early Tuberculosis268

Rales269

Origin of Rales or Adventitious Sounds270

CHAPTER ⅩⅤDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)275

X-ray of the Chest275

Diagnostic Evidence Revealed by the X-ray275

Why the X-ray May Pail to Show Tuberculous Lesions275

Roentgen Ray Shadows Depend on the Chemical Composition of Tissues276

Error Due to Vertical Plane in Which Chest Pathology Is Found278

Avoidable Errors of Technic279

Relation of Allergy to Shadows on the X-ray Film279

Place of X-ray in Diagnosis283

Normal Chest Film284

The X-ray Diagnosis of the Primary Complex284

The Value of the X-ray in Diagnosis of Adult Tuberculosis286

The Use of the Fluoroscope287

CHAPTER ⅩⅥDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)292

Examination for Tubercle Bacilli292

The Relation of Bacillus Bearing Sputum to the Pulmonary Lesion292

The Part of the Tubercle Bacillus in Diagnosis295

Meaning of the Cellular Content of Sputum295

Instructions for Collecting Sputum for Examination298

Methods of Concentration in Sputum Examination298

The Dilution-Flotation Picric Acid Method299

CHAPTER ⅩⅦDIAGNOSIS OF PULMONARY TUBERCULOSIS(CONT＇D)303

Tuberculin Tests303

What Is Meant by Positive or Negative Reactions in Diagnosis303

Nature of Tuberculin Reaction307

Subcutaneous Tuberculin Test309

Cutaneous Tuberculin Test312

The Intradermal Test314

The Percutaneous Test of Moro316

CHAPTER ⅩⅧTHE BLOOD REACTION IN TUBERCULOSIS318

Erythropoietic System318

The Leucocytic System319

Relative Percentage of Lymphocytes in Peripheral Blood320

Sedimentation Hate of Bed Corpuscles320

The Schilling Hemogram321

CHAPTER ⅩⅨCOMPLICATIONS OR PULMONARY TUBERCULOSIS325

Tuberculous Laryngitis325

Larynx Ideal Place to Observe Tuberculous Process325

Method of Invasion326

Diagnosis326

Cough327

Increased Secretion327

Obstruction328

Differential Diagnosis328

Treatment329

CHAPTER ⅩⅩCOMPLICATIONS OR PULMONARY TUBERCULOSIS(CONT＇D)331

Tuberculosis of the Intestine331

Incidence of Intestinal Infection331

Method of Infection331

Diagnosis of Intestinal Tuberculosis332

Diarrhea332

Temperature333

Weight333

Physical Examination333

X-ray333

Blood in Stool333

Prophylaxis334

Prognosis334

Treatment335

Fistula in Ano337

CHAPTER ⅩⅪCOMPLICATIONS OF PULMONARY TUBERCULOSIS(CONT＇D)340

Pleurisy340

Pleurisy as a Sign of Early Tuberculous Infection340

Pleurisy in the Course of Pulmonary Tuberculosis341

The Site of Pleurisy344

Pleurisy at the Base With Pain Radiating Over Abdomen345

Other Causes of Pleural Effusion346

Nature of Effusions347

Microscopic Study of Effusions348

Diagnosis of Pleurisy348

Recurrent Pleural Pain349

Treatment of Pleurisy350

Treatment of Tuberculous Empyema351

Treatment of Nontuberculous Empyema351

Treatment of Empyema by Closed Drainage352

CHAPTER ⅩⅫCOMPLICATIONS OF PULMONARY TUBERCULOSIS(CONT＇D)356

Pulmonary Hemorrhage356

Diseases Commonly Accompanied by Hemorrhage356

Cause of Pulmonary Hemorrhage in Tuberculosis356

Factors Which Induce Hemorrhage358

Treatment of Pulmonary Hemorrhage359

Diet in Hemorrhage363

Constipation364

CHAPTER ⅩⅩⅢMAJOR PATHOLOGIC PROCESSES IN TUBERCULOSIS365

Proliferation366

Exudation368

Caseation370

Cavity371

Calcification372

CHAPTER ⅩⅩⅣTREATMENT OF TUBERCULOSIS375

Certain Principles Which Underlie the Successful Treatment of Tuberculosis375

Pathologic Evidence of Healing375

Small Lesions Heal Most Readily375

Is There a Benign Tuberculosis376

How Lesions Heal378

Why Lesions Fail to Heal381

Why Treat Tuberculosis381

When Should Tuberculosis Be Treated381

How Should Tuberculosis Be Treated385

Psychology of the Tuberculous Patient386

Technic of Treatment387

Segregation and Control of the Patient388

Who Shall Treat Tuberculosis389

Where Shall Tuberculosis Be Treated389

Home Treatment391

Individuality in Treatment391

CHAPTER ⅩⅩⅤTREATMENT OF PULMONARY TUBERCULOSIS393

Open Air393

Effects of Open Air393

How to Obtain the Benefits of Open Air394

Increased Cleanliness of Open Air395

Clothing May Increase or Decrease Benefits of Open Air396

CHAPTER ⅩⅩⅥTREATMENT OF PULMONARY TUBERCULOSIS(CONT＇D)398

Rest and Exercise398

Physiology of Rest and Exercise399

Food Requirements of Rest and Exercise400

Oxygen Requirements of Rest and Exercise400

Circulatory Requirements of Rest and Exercise401

Nervous Correlation Necessary in Exercise402

Exercise Spreads Disease and Increases Toxemia402

Beneficial Effects of Rest When Disease Is Active403

Psychical Rest Must Also Be Maintained404

Desirability of Exercise When Disease Is Quiescent404

Factors to Be Considered in Determining When Exercise May Be Safely Instituted405

Technic of Applying Rest and Exercise407

Importance of Building Up the Patient＇s Ability to Exercise Before Treatment Is Discontinued and Especially Before Beginning Work409

CHAPTER ⅩⅩⅦTREATMENT OF PULMONARY TUBERCULOSIS(CONT＇D)411

Diet411

Rational Diet411

Diet Affected by Patient＇s Metabolism411

Daily Requirements in Calories413

Vitamins414

Salts in Diet416

Soft Nonirritating Diets417

Sauerbruch Diet417

CHAPTER ⅩⅩⅧTREATMENT OF PULMONARY TUBERCULOSIS(CONT＇D)420

Light420

Source of Light Energy420

Action of Radiant Energy Upon Body421

Technic of Applying Light Therapy423

Artificial Light Therapy427

CHAPTER ⅩⅩⅨTREATMENT OF PULMONARY TUBERCULOSIS(CONT＇D)429

Tuberculin429

Healing in Tuberculosis and the Immunity Reaction429

What Is Necessary to Establish Immunity to Tuberculosis429

The Tuberculin Reaction434

Preparations of Tuberculin438

Dilutions441

Choice of Patients for Tuberculin Treatment441

Methods of Administration443

CHAPTER ⅩⅩⅩTREATMENT OF PULMONARY TUBERCULOSIS(CONT＇D)453

Compression Therapy：Induced Pneumothorax，Phrenic Interruption，Thoracoplasty，and Pneumolysis453

Relation of Local Rest to Healing453

Methods of Treatment Which Have as Their Purpose Relaxing and Compressing the Lung455

Induced Pneumothorax457

Indications for Induced Pneumothorax458

Contraindications to Pneumothorax Treatment460

Advantages of Pneumothorax Over Other Operative Procedures461

Method of Doing a Pneumothorax463

Bilateral Pneumothorax465

How Long Shall Collapse Be Carried On472

Oleothorax472

Operations on the Phrenic Nerve473

Thoracoplasty477

Pneumolysis480

Intrapleural Pneumolysis481

CHAPTER ⅩⅩⅪTREATMENT OF PULMONARY TUBERCULOSIS(CONT＇D)484

Treatment of Common Symptoms484

Cough485

Nerve Imbalance486

Digestive Disturbances487

Asthmatic Type of Breathing490

Night Sweats490

Toxemia490

Inanition491

CHAPTER ⅩⅩⅫTHE APPLICATION OF DIAGNOSTIC AND THERAPEUTIC PRINCIPLES IN CLINICAL PRACTICE WITH ILLUSTRATING CASES494

Early Lesions494

The Importance of Early Diagnosis and Treatment494

Diagnostic Data Vary in Different Patients495

The Diagnosis and Treatment of Tuberculosis With Insidious Onset498

The Diagnosis and Treatment of Tuberculosis With Acute Onset507

The＂Early Infiltrate，＂518

The Primary Complex in Adult Life521

Primary Complex Characteristics in Adult Tuberculosis522

Cases Which Present Particular Difficulties in Diagnosis523

Chronic，Advanced Lesions531

The Diagnosis and Treatment of Chronic Advanced Lesions531

Preponderantly Proliferative or Chronic Fibroid Tuberculosis532

Preponderantly Exudative Tuberculosis545

Tuberculosis With Fibrosis and Marked Contraction of the Lung561

Diagnosis and Treatment of Cavity569

Cases Illustrating the Use of Pneumothorax571

Cases Illustrating the Use of Phrenicectomy581

Cases Illustrating the Use of Thoracoplasty586