Asthma seems to have a decided re tarding effect upon the progress of pul monary tuberculosis, delaying the fatal result sometimes for years. It also seems to prevent an absolute arrest or cure.
Thrombosis occurred 19 times in 177S cases of pulmonary tuberculosis. Of these 6 patients were between 20 and 30, 7 between 31 and 40, 5 between 41 and 50, 1 was 60 years old. Of the patients 12 were women, 7 men. They were prac tically all advanced cases of phthisis in which death ensued within one or several months. The thrombosis affected a great variety of veins, most frequently those of the lower extremities. H. Ruhl and Hicrokles (Berl. klin. Woch., Jan. 23, '99).
The prognosis in all stages of the dis ease is relative to the degree of careful ness exercised by the patient. Careless ness can render a case hopeless that pos sesses all the other factors that make up a good prognosis.
Ehrlich's diazo-reaction in tuberculo sis. It is chiefly in pulmonary tuber culosis that the reaction is of high prog nostic value. Cases which give absolute, undisguised, positive reactions to the diazo-test are considered fatal as to prog nosis. Reagent used (the original one of Ehrlich) is as follows:— Of Reagent A, 49 cubic centimetres are taken, together with 1 cubic centimetre of B, and well shaken. Then to about 10 cubic centimetres of urine is added a like quantity of the reagent, and again the mixture is well shaken. Finally, about one-eighth of the quantity of am monia is added. Then, with positive re sults, a red coloration of the foam takes place. If the urine be allowed to stand for twenty-four hours a dark-green pre cipitate will form. It is to be noted that the ammonia is to be added, not by drops, but the requisite quantity at once. The previous ingestion of certain drugs such as naphthalin, chrysarobin, gallic acid, tannigen, and tannalbin seems to prevent the reaction from taking place. The presence of a positive reaction is in dependent of fever, of the number of tubercle bacilli, and of the quantity of the sputum. The diazo-test is rarely positive in mild eases of tuberculosis; and only when acute infections set in, which of themselves alone would give negative results, does it give a positive reaction. M. Michaelis (Berliner klin.
Woch., Mar. 26, 1900).
Treatment.—SELECTION OF CASES.— Individualization of patients is the note of successful treatment of tubercu losis; in nothing is this so manifest as in the selection of the climate or resort to which individuals should be sent. Solly, for the sake of convenience, di vides his cases into three forms: tuber culous, pneumonic, and catarrhal.
Purely tubercular cases, catarrhal cases, or those combining these two char acteristics, do better in cold, dry cli mates, while for pneumonic cases a warm, dry climate is preferable. As the majority of cases met with present the dual character of tubercular and rhal, it may be stated that, in general, curable or arrestable cases do better in a cold, bracing climate at a moderate elevation of two to three thousand feet above sea-level. Again, we often meet patients in whom certain organic heart lesions contra-indicate residence at a high altitude or one whose disease is complicated by diabetes, indicating the necessity of moderately-high elevation.
The more incipient the tuberculosis, the more pure is its tubercular character, and such cases are better adapted to a high altitude.
In 169 cases with tubercle bacilli ex amined at the Adirondack Sanitarium, 42 per cent. had lost their bacilli on dis charge; of the incipient cases 75 per cent. were apparently cured and of the ad vanced. only 19 per cent. This shows the better prognosis for the early cases. Other observations also prove that one specimen proves little or nothing in re gard to prognosis. If the number of ba cilli steadily decrease in a series of ex aminations at intervals sufficiently long, the patient may be improving, but the constitutional symptoms and local signs give much more accurate information. If on repeated examinations large quan tities of tubercle bacilli are found, the disease had probably advanced to cavita tion. Repeated observations seem to show that the morphology of the tubercle bacilli affords little or no ground for prognosis. but the short bacilli are sug gestive of a more active process. Clumps are more apt to he found in the severe cases, but may occur in all. L. Brown (Jour. Amer. Med. Feb. 21, 1903).