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THE CAVITY
DISEASES OF THE CHEST
l9#
of pathological IN the parade taking place in the lung changes tftf the whole along tuberstructur c formidable is the open most the t culoSiS t s the chief source of spread of the cavityWjthin and without the body. diseaSe ly an Aladdin come among us and c uld masic lamp, and forthwith comexisting cavities immediately d that all that no other case progress to cavicloS6' nd this state of affairs, the prop1 With tatl n tuberculosis would practically aga n of having no victims about The disease C life-blood sucking tento entwine its shortly wither and die. We can would and his lamp; but by the Aladdin invoke no persevering, rigid, diligent and skillful applidisposal, cation of many measures at our eventuation. anticipate this These We can among others such vital include measures ones as examination of contacts; mass tuberculin testing with x-ray examination of the postive reactors; a complete examination of all members of a household where there is a postive reactor, particularly one in the pre -or early school age; the segregation of all advanced cases; and the attempt by some form of collapse therapy to convert postive suptum cases to negative cases — which means closing their cavities. Every case under treatment should be closely followed at all times, with frequent sputum and periodic x-ray examinations. An amelioration or disappearance of symptoms, a sense of well being and a gain in weight may be misleading. These may occur during a time when the disease process within the Ungs mayey °c undergoing a tragic spread. c satisfactory index to the progress Patient iS the sputum and x"ray exam" mat' a 10n> A negative sputum and film showing no Pen cavit;y are mg Wel1'indicate accurately that things but conversely> an open cavity and a posti ve sputum portend trouble ahead.
CAVITY
° °v.-o
°
l?ch ses,
°
WienT*
Statistics reveal that in80% of cases he dia gnosis of tuberculosis is first macle are demonstrable; and they are lik Cavities 1^ present in 85 to % of all admissions to p Sanatorium Sllrely this would tend rove our g0 hat We are yet far removed from possible, cavities must be closed wWhere impossible — and with the
the^
-
rapid advances in collapse
therapy this group — is becoming progressively smaller these cases should be segregated. An open cavity is always a potential, and usually a real, menace. It is a menace to the individual who harbors one, in that it is the frequent cause of a bronchogenic spread to other parts of the lung or even to the opposite lung. It is a menace to the public at large in that it is the source of innumerable tubercle bacilli discharged into the outside world to infect other innocent and unsuspecting victims. When there are large numbers of tubercle bacilli in the sputum, it is presumptive evidence of the presence of larger or smaller cavities. The most reliable means for their detection is the x-ray; but they are not always revealed on the film even when they may be proved to exist. By the use of Tomography (x-ray exposures made at varying depths within the lungs) cavities can be shown which were not disclosed by the usual procedures. The persistence of metallic, consonating or large moist rales over an area in the upper lobe, with or without amphoric or cavernous breathing and the classical post tussic suction sound, is reliable evidence of excavation. A postive sputum under these conditions is practically confirmatory. It may be well to again emphasize that an appropriate slogan in our campaign against tuberculosis would be CLOSE THAT C. H. H. CAVITY. NEW YEAR'S RESOLUTIONS Resolved: That we will continue to look for the early case of tuberculosis. Resolved: That we will examine and tvberculin test all contacts, and that we will x-ray all postive reactors. Resolved: That we will institute early collapse of diseased lungs. Resolved: That we will isolate all open cases of tuberculosis. Resolved: That we will support the educational program of the American College of Chest Physicians, and the National Tuberculosis Association. Resolved: That we will subscribe to and support the journal, DISEASES OF THE CHEST. 7
l9#
of pathological IN the parade taking place in the lung changes tftf the whole along tuberstructur c formidable is the open most the t culoSiS t s the chief source of spread of the cavityWjthin and without the body. diseaSe ly an Aladdin come among us and c uld masic lamp, and forthwith comexisting cavities immediately d that all that no other case progress to cavicloS6' nd this state of affairs, the prop1 With tatl n tuberculosis would practically aga n of having no victims about The disease C life-blood sucking tento entwine its shortly wither and die. We can would and his lamp; but by the Aladdin invoke no persevering, rigid, diligent and skillful applidisposal, cation of many measures at our eventuation. anticipate this These We can among others such vital include measures ones as examination of contacts; mass tuberculin testing with x-ray examination of the postive reactors; a complete examination of all members of a household where there is a postive reactor, particularly one in the pre -or early school age; the segregation of all advanced cases; and the attempt by some form of collapse therapy to convert postive suptum cases to negative cases — which means closing their cavities. Every case under treatment should be closely followed at all times, with frequent sputum and periodic x-ray examinations. An amelioration or disappearance of symptoms, a sense of well being and a gain in weight may be misleading. These may occur during a time when the disease process within the Ungs mayey °c undergoing a tragic spread. c satisfactory index to the progress Patient iS the sputum and x"ray exam" mat' a 10n> A negative sputum and film showing no Pen cavit;y are mg Wel1'indicate accurately that things but conversely> an open cavity and a posti ve sputum portend trouble ahead.
CAVITY
° °v.-o
°
l?ch ses,
°
WienT*
Statistics reveal that in80% of cases he dia gnosis of tuberculosis is first macle are demonstrable; and they are lik Cavities 1^ present in 85 to % of all admissions to p Sanatorium Sllrely this would tend rove our g0 hat We are yet far removed from possible, cavities must be closed wWhere impossible — and with the
the^
-
rapid advances in collapse
therapy this group — is becoming progressively smaller these cases should be segregated. An open cavity is always a potential, and usually a real, menace. It is a menace to the individual who harbors one, in that it is the frequent cause of a bronchogenic spread to other parts of the lung or even to the opposite lung. It is a menace to the public at large in that it is the source of innumerable tubercle bacilli discharged into the outside world to infect other innocent and unsuspecting victims. When there are large numbers of tubercle bacilli in the sputum, it is presumptive evidence of the presence of larger or smaller cavities. The most reliable means for their detection is the x-ray; but they are not always revealed on the film even when they may be proved to exist. By the use of Tomography (x-ray exposures made at varying depths within the lungs) cavities can be shown which were not disclosed by the usual procedures. The persistence of metallic, consonating or large moist rales over an area in the upper lobe, with or without amphoric or cavernous breathing and the classical post tussic suction sound, is reliable evidence of excavation. A postive sputum under these conditions is practically confirmatory. It may be well to again emphasize that an appropriate slogan in our campaign against tuberculosis would be CLOSE THAT C. H. H. CAVITY. NEW YEAR'S RESOLUTIONS Resolved: That we will continue to look for the early case of tuberculosis. Resolved: That we will examine and tvberculin test all contacts, and that we will x-ray all postive reactors. Resolved: That we will institute early collapse of diseased lungs. Resolved: That we will isolate all open cases of tuberculosis. Resolved: That we will support the educational program of the American College of Chest Physicians, and the National Tuberculosis Association. Resolved: That we will subscribe to and support the journal, DISEASES OF THE CHEST. 7