The pathology and etiology of pulmonary tuberculosis : in relation to the natural method of limitation of the disease and the various methods of inducing artificial limitation

Abstract

It is not proposed, in the following pages, to write a critical digest, or even epitome, of the pathology and etiology of tuberculosis. Such a test would be impossible within the limits of a reasonable thesis owing to its complexity and magnitude. It is rather my aim to sketch rapidly the features of the pathological process, and the various factors usually designated etiological and diagnostic and in the light of the indications derived from them to ascertain the lines along which to work, in order to induce a natural arrest and eventually a complete' cure.The various steps of the argument I originally worked out in the opposite direction, that is, following an empirical line of treatment I set myself to work out, on physiological lines, the rationale concealed behind the complex pathological processes, successfully combated by it. To follow out the argument step by step, is however easier in the former direction and perhaps equally striking A vast amount of work has been done by many to unravel the numerous pathological factors, which are the primary causes of the various signs and symptoms by which we recognise the disease. Much of our knowledge is still vague, by reason of the experimental difficulties by which work on the subject is surrounded. The extent to which secondary factors enter into and influence the signs and symptoms of the disease does not yet receive the recognition which it deserves. So far with one or two exceptions to be noticed later) the treatment of tuberculosis has been practically empirical, founded on various fallacious interpretations of Pathological and clinical facts, which themselves were but.little understood. Until quite recently the progress of the disease towards a fatal issue was a sufficiently familiar prospect, while these cases which were treated satisfactorily were either relieved of their disease mechanically or treated by change of climate. In the former the process was rendered incapable of study, inasmuch as the change was sudden and the cure was independent of the effects of nature; in the latter continued observation was usually impossible. Thus.the results of treatment were frequently seen, but the gradual development of the process was comparatively rarely studied except in those cases in which progress was in the only too familiar direction. As a case progresses towards arrest of the morbid process the various secondary disturbing factors are gradually eliminated,by appropriate treatment,or by elimination of the various casual influences,and the disease stands out stripped of many familiar features; the inclusion of which in the essential clinical picture has been so fruitfully productive of misconceptions.