[ Reprinted from 
Monthly Cyclopaedia and Medical Bulletin 
Nov. 1908.] 
TREATMENT OF TUBERCULOSIS OF THE LUNGS. 
By JOSEPH WALSH, M.D., 
Assistant Medical Director Henry Phipps Institute. 
The general" symptoms manifested by patients with tuberculosis of the 
lungs are: cough, expectoration, loss of weight, stomach disturbances, chills, 
night-sweats, haemorrhage, acceleration of the pulse-rate, and fever. 
The general treatment for tuberculosis of the lungs, as recommended 
to-day, consists in unlimited fresh air, management of the diet so that the 
patient will get an excess of good nourishment, and regulation of rest, exer- 
cise, or work. 
All the symptoms accompanying the disease are directly or indirectly 
due to the systemic infection; the natural thing, therefore, is to ignore the 
particular symptoms and treat the general condition. In the very great 
majority of cases the symptoms will clear up or ameliorate so rapidly that 
treatment for the special symptoms will be found unnecessary. 
How the treatment acts is illustrated by the two following cases, an 
acute and a chronic case treated at their homes: 
Case I.-An acute case. F. R., male, 27, married, cigar-maker by trade, 
came to me on January 15, 1903. His family history was perfect and he had 
never before consulted a physician. There was exposure to contagion in two 
ways, namely, through his wife, who had a very mild chronic tuberculosis, 
and possibly through his occupation of cigar-maker. 
His history was that he had been in perfect health, absolutely robust, 
up to four months previously, when he took a " cold." After a slight im- 
provement it gradually became worse, he lost his appetite, gradually de- 
creased in weight, until now he had the appearance and subjective symptoms 
of a full-fledged consumptive. He had lost forty pounds in weight (he had 
been one hundred and seventy-five months previously), was coughing, espe- 
cially at night, was expectorating considerable yellowish sputum, was 
dyspnoeic, and was so weak that he could scarcely stand. 
Examination.-Respiration, 36; pulse, 140; temperature, 100.4 at 2 
f.m. ; heart, negative; lungs, decided dullness over both apices with impair- 
ment of resonance on the left to the second rib anteriorly and to mid-scapula 
posteriorly. There was bronchial breathing over both apices and prolonga- 
tion of expiration all over both lungs. The sputum showed tubercle bacilli. 
His household goods were packed and he was about to start for Colo- 2 
TREATMENT OF TUBERCULOSIS OF THE LUNGS. 
rado, when he was advised to inquire about the White Haven Free Sana- 
torium. He was too acutely ill for the White Haven Sanatorium, and 
likewise too ill to attempt a long trip. I was unwilling to give anything but 
an unfavorable prognosis while the acute condition lasted, but insisted that 
his only chance for life was in remaining at home and carrying out the 
treatment there as well as possible. 
It happened that he was living on the outskirts of town in a rather pleas- 
antly situated two-story house with a piazza. He was given the second-story 
front room, and the bed was placed in the bay-window. Due to the persever- 
ance of a plucky wife, the windows were never closed from the time I first 
opened them. Despite much inclement weather during the next two months, 
February and March, he slept close to these open windows every night, and 
during the second month sat out from six to eight hours on the piazza every 
day. One trip up and down a short flight of stairs was the limit of his exer- 
tion for two months. He was kept at rest until his pulse was below no. 
For nourishment he began with one solid meal in the middle of the day, 
and two quarts of milk and six raw eggs distributed over the rest of the day. 
He gradually increased this till he was taking for breakfast (7.30 a.m.) one 
and one-half pints of milk and three raw eggs, with fruit and cereal; at 9.30 
a.m. one pint of milk and two raw eggs; at 12.30 p.m. dinner, composed of 
soup, meat, three or four kinds of vegetables, and fruit with milk as a 
beverage; at 4.30 p.m. one pint of milk and two raw eggs; at 6.30 p.m one 
and a half pints of milk and three raw eggs with milk-toast or boiled rice; 
at 9 p.m. a glass or two of milk, not infrequently with an egg. 
For the two months he was at rest I had no chance to weigh him. At 
the end of this time he came to my office and I found that he had gained only 
two pounds. This was at the time not encouraging, though later I was able 
to attribute it to the acuteness of the symptoms. 
His cough had, however, lessened materially, he had stopped expector- 
ating, and he was feeling well. He was now put on graduated exercise in 
the form of walking. He continued his fresh air and nourishment. From 
this time he gained steadily. On his second visit to my office (at the 
end of the third month) he had gained six pounds; at the end of the fourth 
month he had gained ten pounds and all subjective symptoms had disap- 
peared entirely; that is, he felt perfectly well, had not the slightest cough, 
and never expectorated. 
The next three months he spent with friends in the country and came 
back to town at his old weight, one hundred and seventy pounds (when I 
first saw him he weighed one hundred and thirty). During the last month 
he went back to three solid meals a day. He returned to work seven months 
after I first saw him, has worked every day since, and has never had a 
symptom of any kind. 
The only medication he ever had was combinations of pepsin, hydro- 
chloric acid, phosphoric acid, strychnia, arsenic, nitro-glycerine, and a few 
small doses of creosote to correct a temporary stomach disturbance. In 
addition to these drugs by the stomach he used an inunction of europhen (a TREATMENT OF TUBERCULOSIS OF THE LUNGS. 
3 
preparation of iodine) dissolved in olive oil. From the beginning of the 
treatment he never had any set back-not even a cold. 
Case II.-A chronic case. McD., male, 27, married, a dental student, 
came to me on September 9, 1902, in the vacation between the second and 
third or last years. His family history showed his father and mother living, 
though suffering from what he described himself as a very chronic tuber- 
culosis of the lungs. The history of exposure, therefore, extended over his 
whole life. 
His personal history was that he had a haemorrhage three years before 
during a severe attack of grippe, and had been sick off and on during his 
entire first year as a student of dentistry, having had at one time bronchitis 
and again pleurisy, but had recuperated during the vacation. During his 
second year he had been reasonably well. 
During the present vacation he had worked pretty hard, had lost 
weight (his highest weight was one hundred and thirty-five; he was now 
one hundred and thirteen), and two days before I saw him had quite a 
severe haemorrhage. He had had a slight cough for years which was now 
annoying him considerably. The other symptoms were expectoration, 
dyspnoea on exertion, loss of appetite, constipation, and rather profuse night- 
sweats (every night). 
Examination.-Respiration, 30; pulse, 112; temperature, 100 at 11 
a.m. ; heart, normal; lungs, absolute dullness on the left to the second rib 
anteriorly and to spine of scapula posteriorly, with bronchial breathing. I 
found nothing else. His sputum showed tubercle bacilli. 
Treatment.-Rest till the next visit (three weeks later), sleep alone and 
with windows wide open at night, and sit out on the pavement all day. 
(There was no porch to the house and the house was in the centre of a 
thickly inhabited district.) He was boarding and protested against making 
the meagre meal the boarding-house served for lunch his one solid meal. 
The solid meal was, therefore, allowed in the evening (6 o'clock), with milk 
and eggs the rest of the day. Though his appetite was poor he managed 
to force two and a half quarts of milk and four raw eggs in addition to one 
solid meal for two weeks. 
The night after the examination he had another haemorrhage, yet when 
he came to the office, September 30th, three weeks after the first visit, he had 
gained seven pounds. Three weeks later he had added nine pounds more to 
his weight, and subjective symptoms had entirely disappeared when he 
caught a very severe cold which cost him four pounds in seven days, and a 
recurrence of all the symptoms. For this he was sent to bed for one week. 
Two weeks later, October 30th, he had regained his lost weight, was 
again free from subjective symptoms and insisted on returning to work. 
He was allowed under protest, though after events proved the protest un- 
called for. In the meantime he had gradually increased his diet to one solid 
meal, three quarts of milk and nine eggs. On December 15th, though he had 
been at work six weeks, he weighed one hundred and forty-one pounds, or 
twenty-eight pounds more than when I first saw him on September 9th. 4 
TREATMENT OF TUBERCULOSIS OF THE LUNGS. 
Since the cold, two months previously, he had constantly increased in 
strength and progressed without symptoms of any kind. For four weeks he 
had been going to bed at n p.m. and rising at 6.30 a.m. 
Most of his time was spent in the mechanical dentistry room where the 
amount of fresh air was limited by the objection of others to open windows 
in December. He slept, however, with wide open windows at night and 
rode to and from the college, a distance of three miles, standing on the front 
platform of the car. He now decreased his diet to three pints of milk, four 
eggs, and two solid meals. 
He graduated successfully in the spring, weighing one hundred and 
forty-nine pounds, thirty-six pounds more than when I first saw him. He 
has visited my office or I have heard from him off and on since then, over 
four years, but he has never had a symptom of his old trouble. What he 
says is that he never knew what it was to feel well before. His pulse 
remains constantly under 90, his temperature does not fluctuate one degree 
in the twenty-four hours, he has no cough, no expectoration; in fact, as I 
said, no symptom. 
The only medication given was strychnia, tincture of nux vomica, 
Fowler's solution, pepsin, hydrochloric acid, phosphoric acid, nitro-glycerine, 
phenacetin, and salol. The first six remedies were administered in the way 
of tonics, alone or in various combinations; the nitro-glycerine, gr. 
three times a day, was given on account of the spitting of blood; the 
phenacetin and salol for the cold in the head, which was associated with 
pains throughout the body. (I may say here that as time progresses I have 
given drugs like phenacetin and salol less frequently.) 
In both these cases exactly the same treatment was carried out, namely, 
rest while there were acute symptoms, either due to a cold or the tuberculous 
process itself, forced nourishment and abundance of fresh air. Practically 
nothing else was done, because I do not believe that the simple tonics admin- 
istered had very much bearing on the cures. 
In the first case rest was called for by the general weakness, the rapid 
pulse, and the temperature. The management of rest is one of the most 
difficult things to learn in the treatment of tuberculosis, because each case 
requires special study, yet there are general symptoms demanding it in any 
sort of a case, namely, elevation of temperature above 101 (or even 100) 
any time during the day, acceleration of the pulse-rate above 120, marked 
emaciation, and marked weakness. Even when exercise has been instituted 
it must be carefully watched. If this exercise produces an elevation of 
temperature or acceleration of the pulse-rate, it must be stopped or cut 
down. Under no circumstances should it ever be continued to the limit of 
fatigue. Since the first rule of medicine is to do no harm, it is safe to say 
that when in doubt rest should be insisted on; in other words, rest is less 
likely to do damage than inadvisable exercise. 
The fresh air was obtained in both cases by the very ordinary means 
insisted on with all patients, namely, they must sleep in a room alone with 
wide open windows no matter what the weather; they must be outside as TREATMENT OF TUBERCULOSIS OF THE LUNGS. 
5 
many hours of the day as possible, resting when exercise is not advised. 
There is positively no contra-indication to the open windows in the bed 
room: elevation of temperature, acute cold, nothing must be permitted to 
close the windows. 
In the one case the patient sat out on a porch all day; in the other 
during his period of rest he sat out on the pavement. In the latter case 
when the patient went to work, he managed to get a work-table in the 
mechanical dentistry room near the window, and despite the not infrequent 
complaints of those about him he usually kept it open. Going to and from 
school he rode on the front platform of the street car, both in order to get 
the fresh air and avoid contact in a closed car with the crowds, where some 
one is practically always disseminating organisms of colds. 
The only symptom complained of in the first case was the cough. He 
was, as he said himself, coughing night and day. No special therapeutic 
measure was enjoined for it, yet on the regime of fresh air and easily 
assimilated food, it cleared up entirely in eight weeks and was no longer 
troublesome after the third day. We find this result in practically all cases, 
especially before the formation of large cavities, namely, that the cough at 
least ameliorates considerably under fresh air and proper nourishment. 
Sometimes, however, the cough is very troublesome, due not so much 
to the tuberculosis per se as to an acute cold or bronchitis complicating. 
These complications are readily recognized by the elevation of temperature, 
the appearance of the throat, and the moist rales found in the chest on 
ausculation. 
The second case manifested such a cold at the end of the third week of 
treatment; his symptoms were sore throat, headache, diarrhoea, and a return 
of the cough in all its severity. Examination showed temperature 100.4, 
pulse 120, and on ausculation moist rales all over both chests. He was sent 
to bed for one week and the diet restricted to milk and raw eggs on account 
of the diarrhoea. The diarrhoea was not severe, and was ignored except for 
the benefit it might receive from the rest in bed and the restriction of the 
diet. The sore throat was treated by small doses of calomel ( gr.), 
repeated about every fifteen minutes; the bronchitis by ammonium chloride 
in combination with a little pancreatin and tincture of nux vomica. 
In all cases where the cough is not due to an acute cold I depend at first 
on the fresh air and regulated diet to clear it up; if it does not gradually 
improve every detail of the patient's routine is studied to see if anything is 
being done contrary to rule. Usually it is found that the patient has not 
been getting the proper amount of fresh air, or he has been introducing 
articles into his dietary not mentioned in the original routine, or has been 
taking various drugs on his own hook for the alleviation of the cough like 
various proprietary cough-tablets or an old woman's cough syrup. 
If, despite the most careful regulation of the diet and all the fresh air 
possible, the cough and expectoration continue, the sputum is examined with 
special reference to streptococci, and if they are found creosote is given. 
Even without an examination of the sputum a general indication for the 6 
TREATMENT OF TUBERCULOSIS OF THE LUNGS. 
administration of creosote would be cough with profuse yellowish expectora- 
tion which did not clear up on general treatment. 
Creosote has been in its time a most lauded and a most abused remedy. 
It is at present believed to have little or no effect on the tuberculous disease 
per se, but to have more or less influence on a streptococcic infection com- 
plicating. To accomplish results it should be given in quite large doses, and 
yet in such a way as not to irritate the gastro-intestinal tract. This is done 
by diluting it well and gradually increasing the dose. An easy routine way 
of prescribing it is in hot water. If the water is hot enough it will dissolve 
the creosote and be almost, if not quite, tasteless. In cases in which I 
administer it I begin with one drop three times a day, one half-hour before 
meals, and increase one drop every three days, insisting that it be diluted 
with at least one tablespoonful of hot water to each drop. 
There is one thing that cannot be insisted on too strongly, and that is 
the importance of avoiding opium in any form in the treatment of tubercu- 
losis of the lungs. Its influence for evil on the course of a tuberculous case 
is so marked that it is likely that we do not know its entire action in these 
cases, yet we do know that opium depresses all the functions which we ought 
to be stimulating. It depresses digestion, assimilation, and the already over- 
worked heart. It is most frequently administered for the purpose of con- 
trolling the cough, and is at best capable of giving but temporary relief not 
comparable with the permanent relief produced by the fresh air and the 
regulation of the diet. 
Stomach disturbance as a symptom, either in the form of vomiting or 
indigestion, practically always yields to an easily assimilable diet of milk and 
eggs with solid food at only one meal. Occasionally absolute restriction to 
milk and eggs, and rarely peptonization of the milk for a short time, is 
required. 
The diet of milk and eggs is sometimes complained of in advance on the 
old-familiar ground of biliousness. Biliousness to the ordinary patient 
means constipation with headache. He may be told at once that he will find 
no such result. The only reason for milk being constipating is on account 
of the small residue it leaves, this residue being insufficient to make a bowel 
movement. This is prevented in two ways: first, by the milk and eggs being 
ordered in quantities large enough to have a residue; second, by the taking 
of the solid meal. Personally I sometimes have complaints of too frequent 
bowel movements on the diet mentioned, but practically never of constipation. 
Nevertheless, with a tendency to constipation, there is no objection to 
fruit at breakfast, or, as a matter of fact, at any time during the day. The 
first-mentioned patient took thirteen glasses of milk and ten eggs, the second 
twelve glasses (three quarts) and nine eggs. My usual orders to patients 
now are three quarts of milk and six eggs daily. 
The eggs were taken in several ways, but never with alcohol, namely, 
straight from the shell, with pepper and salt, with lemon, pepper and salt, or 
beaten up in the milk with or without nutmeg, pepper or salt. Alcohol, even 
in the form of sherry wine is not recommended.