The =alimentary tract= is frequently the seat of tubercular
inflammation. The intestines may be involved primarily or else
secondarily from the lungs or peritoneum. The =primary form= is
most common in children. There is slight fever, pains of a colicky
nature, irregular and persistent diarrhea. The disorder is commonly
unrecognized, being mistaken for appendicitis or other intestinal
disorders, until emaciation, sweats, the continued fever or lung
involvement are manifested.
The stomach, esophagus, pharynx, tonsils, palate, tongue and lips may
be the seat of a tubercular lesion.
The =serous membranes= are usually secondarily involved. The peritoneum
is generally invaded from contiguous organs, especially the intestines,
although the pleurae may be the starting point (and in the female the
generative tract is a source). The disease may be either acute or
chronic. In the former it starts abruptly with vomiting, pain in the
abdomen, fever, and possibly diarrhea. In the chronic form there are
fever, pains, emaciation, weakness and the abdomen is distended. The
enlarged glands may be felt through the walls. There may be ascites, or
the walls of the peritoneum are adherent, or the tubercles may ulcerate.
The endocardium is occasionally the seat of acute or chronic
tuberculosis. It is usually secondary. Likewise the pleurae are
sometimes involved. The chronic form is more common.
The =genito-urinary system= is subject to tuberculosis. The bladder,
ureters and pelvis of the kidney are attacked, and from these the
kidney; or possibly the kidney involvement is part of a general
tuberculosis. (See pyelitis). The ovaries, Fallopian tubes and uterus
are also subject to tubercular invasion. The =diagnosis= depends
upon finding the bacilli, the symptoms indicating, oftentimes, an
inflammation only. Also the prostate, testicles and seminal vesicles
are attacked.
Tuberculosis of the mammary glands is rare. In miliary tuberculosis
the liver is commonly affected, often secondary to other tissues,
especially the peritoneum, lymphatics and lungs.
The blood-vessels and heart are sometimes involved from nearby organs
or from miliary tuberculosis. The brain and cord are also at times
invaded. This has been described under meningeal tuberculosis.
=Diagnosis and Prognosis of Tuberculosis.=—The osteopath should be
familiar with the various forms of the disease. An understanding of
the pathology and clinical symptoms is essential. The finding of the
bacillus, provided there are symptoms of inflammation, is diagnostic.
Much depends upon the patient’s constitution, hygiene, sanitation,
food, fresh air and general management. The osteopathic lesion is
decidedly an important factor, but the treatment must be balanced from
both the distinctive osteopathic view and that of general management.
Then the patient’s part is as necessary as the osteopath’s. Under
proper care and treatment, unless the disease has progressed to a
marked degree, there is always a tendency toward recovery, but, to
emphasize again, the osteopathic treatment, the environment and
general hygiene should be thoroughly understood and appreciated, for
at best, the disease is treacherous. Even after an apparent recovery
is made, the patient should be under observation; there is always
danger of recurrence. Tuberculosis can often be treated successfully,
or arrested, provided the disease has not progressed to a late stage;
although many times, in the later stages, life can be considerably
prolonged by careful treatment.
=Treatment of Tuberculosis.=—The =prophylactic treatment= of
tuberculosis should receive first consideration. The sputum should
be thoroughly disinfected and care taken that the patient does not
spit about carelessly. A spit-cup should be provided and the sputum
collected and destroyed by burning and the cup sterilized. The patient
should be well taken care of and given a separate apartment, so that
the danger of conveying the disease to others is reduced to a minimum.
He should occupy a single bed. All unnecessary furnishings of the room
should be removed and the objects that remain in the room should be
frequently aired and disinfected. The general and sanitary environment
of the patient should be as favorable as possible to hygienic living.
Many times a change of residence is of great benefit. When possible
the patient should be out of doors and light exercise taken. The body
should be well protected by flannels, the year around.
Keene[61] would carry prophylaxis to careful examination of the
pregnant woman to avert a sudden development of tuberculosis after
parturition; also of the child, after birth, to remove any predisposing
lesions. The mother with a tubercular tendency should, under no
circumstance, nurse the child and should be instructed to observe
any disposition on the part of the child to acquire malpositions in
sitting, standing or walking.
Another important consideration in the prophylactic treatment is
the inspection of dairies and slaughter houses. The disease may be
transmitted by infected milk. There is less danger of infection through
meat; although all animals that present distinct lesions should be
confiscated. Sanatoria and other special arrangements for the care of
patients should be encouraged.
The =Treatment of the disease= consists primarily in locating the
cause of the devitalized condition of the cellular tissue. This is
the vital point to be considered and requires a thorough examination
of anatomical structures in the region involved. There is a reason
why the tissues are in a depraved state and it is our work to examine
thoroughly the structures that might become deranged anatomically and
cause an obstructed innervation or vascular supply. The disease is
not primarily due to the bacilli; the bacilli would not have infected
the system had it been in a healthy state. Hence, the object of
the treatment in tuberculosis is to favor a building up of normal,
well-nourished tissues so that it is impossible for the bacilli to
infect the region. Of course, destruction of the bacilli is important,
but we cannot expect to do much by the use of a parasiticide, for we
are not then influencing or affecting the real cause of the disease.
If we can improve the arterial circulation to the diseased tissues,
we will be striking at the root of the disease and the healthy blood
will be the only parasiticide necessary. This is where the osteopathic
theory of the cause of disease differs from that of other schools
of medicine. At the local points of infection there is a decided
malnutrition of the tissues, due to a lack of proper blood to the
parts, thus favoring the lodging of micro-organisms; by reestablishing
normal nutrition nature will repair the tissues if the condition is
curable. Hence, it can be seen at once that if the case is curable
osteopathic treatment will meet the demands scientifically.
The preceding is the keynote of osteopathic therapeutics; not
only in the treatment of tuberculosis, but in all diseases where
micro-organisms play an important part. In =tuberculosis of any part
of the body=, it is the duty of the osteopath to carefully examine
the structures that may become anatomically deranged, from any cause,
affecting the nerve, blood and lymphatic supply to the tissues or
organs diseased. Correction of anatomically deranged tissues and
attention to the hygiene, diet and general health of the patient
constitute the treatment.
On the subject of Pulmonary Tuberculosis, W. Banks Meacham says:
“In cases of =pulmonary tuberculosis= it should be remembered that
the pathological lesion in the lung is a result of a general systemic
interference—an interference so great that the body as a whole loses
its stored-up heat in excessive temperature, loses its reserve
nutrition, as manifested by early and continuous loss of weight.
“Therefore the causative osteopathic lesion should not be sought alone
over the site of the pathological lung lesion but rather in that area
where general nutrition is osteopathically affected.
“A few general considerations of =osteopathic mechanics= involved in
nutrition should be ever present with the searcher for the cause of
pulmonary tuberculosis. For instance we know that ingested fat is acted
upon by the pancreatic enzymes; that the invertin of the intestine is
an endocrine secretion. In diet we seek to administer an excess of fats
to take the place of fat-loss in this disease, often losing sight of
the fact that some mechanical maladjustment prevents fat-splitting into
a form suitable for tissue assimilation.
“It is common osteopathic knowledge that lesions of the upper dorsal
area have a profound influence on general nutrition. Consequently it
is to this area that we must look for the causative osteopathic lesion
in this disease. The influence of this area is due to the fact that
the nervous mechanism of the secretory glands gets its most direct
disturbance in this area where the nerves leave the spinal cord to
become distinct innervation to these organs.
“Apart from the nutritive and general circulatory influence of
upper dorsal lesions we must consider the germicidal action of the
endocrinous secretions in devitalizing the specific bacterial agent in
tuberculosis. Undoubtedly these internal secretions have marked effect
in agglutinating the bacilli, thus enabling the phagocytes to perform a
larger duty.
“The correction of upper dorsal lesions, with due regard for the
pathological condition within the thoracic cavity gives a scientific
physiological and bacteriological therapeutic action in tuberculosis.
“=Other lesions= may and do demand attention and correction when
possible. But we must not lose sight of the fact that our specific
action comes from a corrected relation of the upper dorsals. In the
cloud of unproved theories and guesses in the literature of pulmonary
tuberculosis nothing seems nearer an established truth than that
it is a disease contracted in infancy, that it develops, later, in
those persons who retain the infantile type of chest—thorax of large
antero-posterior diameter in contrast with the lateral diameter.
“In the progress of the disease we do get a costal malformation giving
the ‘horse-collar’ thorax, with an apparent lesion of the osseous walls
of the thoracic cavity. But these lesions are the result of nutritive
changes brought on by the active infection already present; and are
not in any true sense, causative factors in the establishment of
pathological areas within the lung.
“The =osteopathic treatment=, then, of this disease is, manifestly, a
correction of a plastic posterior upper dorsal lesion. And where the
pathological lesion of the lung contraindicates forceful correction,
mobility of the area should be sought.
“The =general care= of the case should look to the normal functioning
of all organs, with emphasis on ease to the patient. The =diet= should
be what the patient can assimilate properly even though it be much less
than the amount a normally active person should ingest. =Altitude=
has a favorable effect in selected cases only. It is remarkable that
many cases recover in the extremes of the Rockies and the coasts of
California and Florida.
“No violent =exercise= should be undertaken on account of the possible
embarrassment of an already overworked heart and in consideration of
the possibly engorged pulmonary vessels. For these reasons, too, rest
in bed is advisable with temperature above 99° F. and pulse above 85.”
In =scrofula=, lesions will be found to the lymphatic glands, impairing
their innervation and function. The treatment is not to be applied
over the glands directly. First, it is necessary to locate the lesions
of the bones, ligaments and muscles or such tissues that would cause
disturbances to the glands, then readjust the parts. The object of
the treatment is to modify the soil conditions on which the bacilli
multiply, by correcting the local derangement of the tissues. The
entire body is not in such a depraved state that the bacilli will grow
and multiply wherever they happen to come in contact with the body;
tissues of any organ favor a receptivity for the bacillus only when
these local tissues are in a morbid condition. It is then our work to
aid nature in relieving obstructed forces that are causing such an
effect.
There are =general measures= which influence the tubercular process.
The diet of the patient should be nutritious. A diet of milk,
buttermilk, egg albumen and meat juice will probably be found best,
although many will be able to take ordinary food. The patient should be
out of doors as much as possible. Meacham[62] says “Fresh, pure air,
wherever found, is essential; elevation is an individual requirement,
an even temperature is not necessary and sunshine is important only
as it allows the patient to be out of doors. Exercise should not be
taken when the patient has a temperature above 99 degrees.” The dry,
even climate of the Southwest certainly tempts the patient to be out
of doors more than one with opposite conditions. Even when the patient
is greatly debilitated and weakened, insist upon his taking outdoor
exercises or rides. Gymnastic and methodical breathing exercises
are essential in widening and strengthening the chest. Bolles[63]
believes that the appetite should control the diet and forced feeding
be not insisted upon. Fasting, to test the sense of food desires, has
points well worth looking into, as gastric disturbances with a loss
of strength follow overfeeding. He also recommends deep breathing and
physical culture to elevate the ribs and increase thoracic expansion.
Outdoor sanatoria are being established over the country, in many
cases by state appropriation as, “the treatment of tuberculosis itself
has not been a satisfactory procedure except by climatic changes or
the outdoor treatment persistently applied.” (Halbert). The fresh
air treatment may be taken at home by sleeping in the open air or by
appliances fitted to the window of the room so only the head is exposed
to the air. The only factor is to get the air. The skin, as well as the
excretory organs, should be kept active. Always make it as comfortable
for the patient as possible.
The =fever= is indicative of the activity of the disease, so that
treatment to influence the process and to promote elimination is best.
Sponging with either cold or tepid water will be helpful. The =cough=
is a troublesome symptom. Attention to the underlying irritation is
demanded, although one cannot hope to influence, to any great extent,
the cough dependent on cavity formation. Catarrhal processes in the
respiratory tract can be lessened. Lesions that are acting as a cause
of irritation, will frequently be found in subluxated ribs or vertebræ.
The seventh and eighth dorsals are frequent sources of cough. The
tissues about the pharynx and larynx, and the hyoid bone, disturbing
the vagus and other nerves, should be carefully watched, also possible
reflex irritation from the abdomen and pelvis. =Night sweats= are due
to tubercular processes weakening the system and particularly lessening
nervous control. These will subside as the body is strengthened.
Sponging will be of service. Disorders of the =stomach= and
=intestines=, such as nausea, vomiting and diarrhea, require treatment
of the splanchnic area and regulation of diet. Considerable can be done
to relieve =tubercular laryngitis= by careful treatment of the larynx
and contiguous tissues. =Hemorrhage= is likely to be self-limiting.
Attention to the upper dorsal vertebræ and ribs and muscles will tend
to equalize the circulation. Rest and use of ice upon the chest, as
well as internally, will be beneficial.
McIntyre, in an article on “Fat Food in Consumption,” sums up the
treatment for tuberculosis in the following words: “The treatment,
then, for consumption should include rich, stimulating diet,
proportioned to the digestive power of the patient, containing an
excess of fats in most digestible form, of which sweet cream, fresh
butter and well-cured bacon are the best examples, and the free use
of pure drinking water, coupled with the promotion of blood flow,
respiration and elimination of waste by osteopathic means.”
Surgical measures may be necessary where glandular or other tissue has
broken down and is a menace to recovery.