Minimal tuberculosis: a discussion of assessment, prognosis, and treatment, based on 64 cases

Abstract

With the development of mass radiography Pulmonary Tuberculosis is being diagnosed at an earlier stage in a higher percentage of cases and as a result the problem of the " Minimal" lesion has become a very vital one. Once it ha.s been decided that a lesion roust be considered tuberculous, it is the question of its activity, prognosis, and treatment that is of importance. More and more the difficulties and limitations of our methods of assessment of the activity of small lesions are being realised. The problems of prognosis and treatment are perhaps easier to solve once the degree of activity of a lesion has been assessed, but here there are also many differences of opinion, especially regarding the advisability of collapse therapy and the optimum time for its introduction.I propose to discuss these problems, basing my observations on 64 cases of minimal tuberculosis which have been followed up for from one to five years. Various other questions which arise out of the discussion of these problems will also be referred to.For the purpose of this discussion Minimal Tuberculosis is defined as by the National Tuberculosis Association of America.The cases in this paper are a, selected group in that they are all females aged from 15 to 40 years of age, mostly from the lower income groups. The majority of them were patients sent to the sanatorium wards of Law Hospital, Carluke, Lanarkshire, by the Tuberculosis Officers of the West of Scotland, during the years of 1942 to 1947. The others were nurses and patients seen in the general wards of the hospital. As such, these cases are not representative of minimal cases in general,for the following reasons s Only a. few were diagnosed by miniature mass radiography or routine radiography, most of them had been examined because of a history of contact with an active case, or because of the presence of symptoms. Furthermore, they had been selected in that they had been considered active by an experienced Tuberculosis Officer who had recommended their admission to a sanatorium.I hope to prove in this paper particularly two points : 1/ The need for close and prolonged supervision of the minimal lesion, whatever its nature, and 2/ the need for early consideration of collapse therapy.Even this small series of cases seems to me to be illustrative enough to point these lessons.