1902 Journal of the American Medical Association (JAMA)  
recognized. If we preserve the term chronic interstitial nephritis for the indurated or contracted kidney it might be well to adopt Riesman's6 expressions, secondary interstitial nephritis for this form and primary interstitial nephritis for the slowly developing, insidious, cardio-vascular, typical contracted kidney. As a subhead under chronic interstitial nephritis should be placed the arteriosclerotic kidney with its striking local vascular changes that are but a part of a more general
more » ... more general arteriosclerosis. This can generally be recognized at the autopsy and can be suspected and permits of a probable diagnosis during life, particularly in the aged. The classification, then, that seems to me the best is practically that of Senator. It is one that appeals to the clinician as well as to the morbid anatomist. The term "parenchymatous" can be used in place of "diffuse without induration," because, though not literally expressive of the true condition which is more or less diffuse, it recognizes what is true, that in this form the parenchymal changes predominate; they are quantitatively greater than in the second variety, where the process, while diffuse, produces chiefly interstitial or stromal changes with resulting induration. The classification would be as follows : 1. Chronic parenchymatous nephritis. (Chronic diffuse nephritis without induration.) 2. Chronic interstitial nephritis. (Chronic diffuse nephritis with induration.) a. Primary chronic interstitial nephritis. b. Secondary chronic interstitial nephritis c. Arteriosclerotic kidney. (Arteriosclerotic interstitial nephritis.) 3. Mixed type, i. e., a combination of 1 and 2. With an early diagnosis and proper treatment most cases of pulmonary tuberculosis should recover. That the disease is curable, is to-day generally recognized by medical men, and pathologists are constantly demonstrating at the postmortem table that no disease gives stronger evidence of healing tendencies than tuberculosis. Boudet of Paris recently reported 138 autopsies in which 117 revealed cicatrices of healed tuberculosis. Clinical reports from the modern open-air institutions largely confirm these statistics. The latest available information from Nordach in the Black Forest, Kimberly, South Africa, the Adirondack Cottage Sanitarium in New York, and others, show that from 20 to 35 per cent, of all cases admitted are absolutely cured as proven by the absence of bacilli, a return to good health and the resumption of the ordinary vocations of life. These clinical reports do not adequately represent the actual percentage of recoveries. By far the largest number of cases that recover are never recognized during the course of the disease and are only revealed at the autopsy. As a matter of fact from 60 to 73 per cent, of all cases of pulmonary tuberculosis recover as proven by autopsies where death has been the result of other causes. 6. Hektoen and Riesman: An American Text-Book of Pathology, p. 942. In every case of pulmonary tuberculosis are .found two conditions : one caseation with subsequent tissue destruction and more or less mixed infection; the other fibrosis, cicatrization and healing, the ultimate result in a given case depending on the resistance of the individual and the capability of the body to restrict and limit the growth of the bacilli and consequent extension of the disease. To produce and strengthen these capabilities must be the aim of all curative treatment, whether it be by specific medication or by open-air treatment. The status of specific medication in tuberculosis is, to say the least, uncertain. It can at best be regarded as but an auxiliary to a natural hygienic and diatetic treatment. As yet there has been no indisputable evidence of benefit derived from the use of the serums or tuberculin except for diagnostic purposes. The great problem in the cure of tuberculosis is that of nutrition, and any drug that has a tendency to disturb the action of the digestive apparatus is positively contraindicated, and my personal observation leads me to believe that more damage has been done by the indiscriminate use of creosote, guaiacol, ichthyol, etc., than has benefit been derived. To my mind the open-air treatment is ideal, and the results derived from it are certainly most gratifying. The principles which this treatment recognize as of vital importance, without which all else is useless, are comprised in the essentials to perfect animal life, viz., pure air in unlimited quantities both day and night, good food and plenty of it, and, as nearly as possible, complete repose. How and under what climatic conditions these principles may best be applied is the object of this paper. DIAGNOSIS. Early diagnosis is of supreme importance, and is much more frequent in the past few years than formerly, as shown by the relatively large number of incipient cases that are sent to our health resorts. There is no good reason why pulmonary tuberculosis should not be recognized in the prebacillary stage and before a cough has developed. The malaise, anorexia, gastric disturbance, evening temperature and night sweats and the reaction produced by tuberculin are as characteristic and classical of tuberculosis as is a cough accompanied by bacilli. If a case of tuberculosis is recognized within the first few weeks following the infection and placed under the best possible hygienic surroundings, in a climate where an absolute outdoor life can be followed, the chances of recovery are good. If the diagnosis is not made until a secondary infection has supervened, and night sweats, rigors, fever and profuse expectoration are pronounced, a change of climate and to the best possible conditions seldom afford much improvement. All our efforts should be made toward the early detection of the disease, as in that and that alone lies our only real success in treatment. INSTRUCTION OF PATIENTS. The patient should be fully acquainted with the nature of his ailment, as much for his own safety as for the protection of others. It is not possible to properly treat a patient for tuberculosis who is not fully aware of the nature and gravity of the disease. Rules made for his guidance will not be obeyed unless he knows what is the matter with him and that their violation will be invariably followed by disastrous results. Again, unless a patient understands the serious nature of his disease he will stop treatment as soon as he feels a little better, thus greatly reducing his chances of re-
doi:10.1001/jama.1902.52480400034001j fatcat:3vbxsmfpija6lcsqjuaooy5hfu