" THE SHIBBOLETHS OF TUBERCULOSIS."
[To THE EDTPOR or THE " SPECTATOR."] SIR,—With reference to your review in the Spectator of December 18th of Dr. Marcus Paterson's The Shibboleths of Tuberculosis, I should like to make the following remarks, as, so far as can be observed, the unfortunate public must be under considerable doubt as to what should be done if they are so unfortunate as to contract tuberculosis. From long ex- perience, I believe I cannot do better than quote a statement made by Professor Niemeyer, of Ttibingen, at least as long ago as UK With regard to the prevailing methods of treating pulmonary tuberculosis in vogue at that time he makes the following remarks :—
" In the first case strict measures are as a rule considered useless and their enforcement unnecessary. The patient is allowed to follow his employment until the rising pyrexia and the increasing debility force him to remain at home, or until haemorrhage, pleuritic pains, the appearance of dulness over the chest urgently demand that the supposed `secondary' pneumonia and pleuritic processes be submitted at least to a symptomatic treatment. It will not be said that I exaggerate. Let us be sincere. Is not this laisser eller ' practice founded On reasoning of everyday occurrence with regard to the affec- tion under discussion? It is seldom that a medical man re- proacher himself for having by his carelessness been guilty
of the development of a phthisis florida {galloping consump- tion). . . . It is true, even in case the physician.should have fully recognised the nature of the disease, he will not be able to cut it short at once, but still he has every reason to give the strictest orders; he must do everything ill his power to protect the patient from injurious influences. . . Let anyone make the experiment of having patients with the supposed signs of commencing pulmonary tuberculosis strictly confined to their beds for a time, forbidding them all un-
necessary talking and coughing . . and he will soon satisfy himself that many a patient gets well who would formerly have been assumed to be the subject of tuberculosis and therefore incurable."
The last paragraph is an almost complete summary of the correct treatment of pulmonary tuberculosis; therefore, whether the above method is attempted in any given sanatorium or not should be the criterion upon which it should be judged, and it would be well for the public to revise their estimates as to the relative importance of rest and exercise in the treat- ment of this disease, always remembering that the patient having had the disease arrested by the above means must be gradually brought back to a full capacity for work. One is often inclined to wonder whether provision having been made for the cure of tuberculosis by the provision of sanatoriums, the antidote to cure is not also provided by not allowing the patients to lie in bed until their temperatures are normal.
Having had a largo experience of general practitioners with reference to tuberculosis, I maintain that on the whole they possess as much knowledge of tuberculosis as many so-called experts, and, if not interfered with by specialists who know less than themselves, are quite competent to make reasonable diagnosis in cases of tuberculosis, and if properly conducted institutions are provided are pleased to send their patients. Unfortunately, they seldom meet with any encouragement.—I
am, Sir, &c., EDWARD E. PREST, Ayrshire Sanatorium, New Cumnock.
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