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tional symptoms (particularly gastritic or intestinal disturbances or rapid loss of weight).
"Slight or no elevation of temperature or acceleration of pulse at any time during the twenty-four hours, especially after rest.
"Expectoration usually small in amount or absent. "Tubercle bacilli may be present or absent.'
The symptoms observed at this period of the disease are usually so slight that they are altogether overlooked. The patient may, or may not have observed that his general health is not quite up to the normal, or he may have noticed slight loss of appetite, or syınptoms of indigestion; a cough is frequently complained of, and quite a number of patients expectorate blood-stained mucus; in some cases the pulse is slightly accelerated, and particularly toward evening, the temperature may be somewhat elevated. The classical symptoms of the disease, such as loss of weight, anorexia, severe intestinal disturbances, cough, expectoration of quantities of thick, tenacious muco-purulent material, rapid respiration, fast pulse, sweats, fevers and chills come on during the latter stages of the affection.
In these incipient cases physical examination is of the utmost value in making a diagnosis. A careful examination of the apices of the lungs will generally reveal the presence of rales, which become particularly numerous after coughing. Over the infected region the respiration is usually somewhat prolonged, and of a higher pitch than normal, but in the very early stages of the affection these signs may not be observed. After a certain amount of consolidation has occurred more or less dullness may be made out. Typical bronchial breathing, or cavernous res
piration with flatness on percussion are signs that will only be found in advanced cases.
Of course, the examination of sputum for the germ of tuberculosis is at all times of great value, and if the disease be suspected, daily investigations should be made until the matter is definitely settled; in some cases it is only after a careful search of many weeks that the bacilli are finally found.
In the short period during which the worid went wild on the subject of the treatment of consumption by tuberculin it was observed that among the most unpleasant effects produced by the injection of this substance were the rapid rise in temperature, fast pulse, severe pains in the muscle, and, in addition, increased number of rales in the chest. Similar effects were observed in tuberculous animals after injections of this substance; veterinarians quickly took advantage of this fact by injecting tuberculin for diagnostic purposes.
The results that followed the treatment of consumption with this agent were so disastrous that in the reaction that followed the drug was tabooed, and it is only quite recently that its value as a diagnosic agent in human tuberculosis is being generally recognized.
In using tuberculin for the purpose of diagnosis, the initial dose should be small,—1 mg. being quite sufficient; if no symptoms follow 2 mg. may be administered after a period of two or three days, and if still no effects are produced, 3, 5 and 10 mg. at intervals of several days may be given. Trudeau sometimes waits for several days and gives another dose of 10 mg. where the disease is strongly suspected, and no reaction has followed the previous injections.
When given cautiously in this way all experts on the subject agree that no ill effects follow, and as it offers the
means of making a diagnosis before general symptoms, or physical signs make the nature of the malady clear, there can be no question of its great value, and that it should be generally employed for this purpose.
It is noteworthy that in more advanced cases the reaction fails to follow the administering of tuberculin, probably for the reason that the body is already so flooded with the poison of the germ that the addition of a small amount of tuberculin is not taken notice of by the system.
It affords me great pleasure to say that the laboratory of the State Board of Health is now in process of manufacturing tuberculin, and that within a short time it will be supplied free to all physicians in Georgia.
I would like also to emphasize the fact, which our physicians do not seem to be generally aware of, that we are making free examinations at our laboratory for tuber-. cle bacilli, and that reports are promptly furnished physicians who send sputum to us. Not only are these examinations of great importance to the unfortunate victim himself but are of the utmost value to those who come in contact with him. I am sure that most of us have seen instances where an individual has contracted tuberculosis, and has undoubtedly infected other members of his family before the nature of the malady was recognized; under such circumstances an early diagnosis with proper instructions to the patient as to general hygienic precautions and the disinfection of his sputum would undoubtedly prevent such disastrous occurrences.
The treatment of tuberculosis along modern lines is marvelously simple; briefly stated, it consists in putting the patient practically out of doors night and day, in rest as long as the disease is active, and in sup
plying a sufficient quantity of good wholesome food. When treated in this way patients improve to an incredible degree in a very short period of time, and where the disease is truly incipient, six months to a year suffices for a complete cure in a large number of instances.
In a recent visit made to the great sanatoria of the North, I was perfectly astounded to see the wonderful effects produced by this treatment. The patient appeared almost without exception perfectly well, and exhibited absolutely no outward evidence of the character of the disease from which they were suffering. I am sure it is not an overstatement when I assert that it would be almost impossible to collect together in any part of the world an equal number of individuals who would appear to be in such perfect health.
That we have in Georgia a large number of places. where tuberculosis can be successfully treated there can be no question. The best informed all now agree that if the outdoor life, rest and proper feeding be carried out, it makes comparatively little difference where the patient is treated; of course, it is admitted that good country air is best for tuberculous patients, as it is for every one else, but even this is not essential. For a majority of patients. an altitude of from 1,500 to 2,500 feet is to be preferred, and fortunately we have a number of such places within our State which are easily accessible.
At the instance of Dr. L. G. Hardman, a member of this Association, the Legislature, at its last session, passed an act ordering an investigation as to the feasibility of erecting a State sanatorium for the treatment of tuberculosis, and I am quite sure that the bare statement of this fact will enlist the unanimous help of this Association in the support of this measure.
DISCUSSION ON DRS. OERTEL'S AND HARRIS'S PAPERS.
Dr. E. C. Thrash, of Atlanta: It would be putting it mild to say that these papers are good ones. They are strong papers by strong men, and we should give them due consideration and attention.
The fact that this is a hackneyed subject should not induce us to become indifferent. When we go into the clinic and witness nothing but cases of tuberculosis, and say to the students, "Gentlemen, we have nothing but tuberculosis this morning," the boys are apt to laugh. And that feeling follows too much through our lives. We are too indifferent. When we see tuberculosis, when we hear about tuberculosis, when we see so many articles written on the subject, and are overwhelmed, so to speak, with talk on the subject, we become entirely indifferent. And it has got to be too much of a custom among physicians, as Dr. Oertel has said, to examine a man and if he has a cough, or elevation of temperature, or something by which we might suspect incipient tuberculosis, to wait and see what it will develop into. Probably the physician will say the patient will get well after a cursory examination; but later he may find that the tuberculous process has progressed rapidly, and that the patient is now beyond treatment or the possibility of a cure. After he has collected liberal fees from his patient, from time to time, he tells him to go West, and the patient does so with perhaps little or no benefit from the change of climate. Too much of this is carried on. It is useless, after a man is emaciated and his vitality very materially lowered, to advise a change of climate, because nothing on earth then will restore the bodily functions of such a patient.
What we need is to be alert and carry out the principles advocated in these papers, to grasp the idea at once of