The general treatment consists in combating the adverse influences that have been mentioned as increasing the liability to tuberculous infection. Within recent years the value of the “open-air” treatment has been widely recognised. An open-air life, even in the centre of a city, may be followed by marked improvement, especially in the hospital class of patient, whose home surroundings tend to favour the progress of the disease. The purer air of places away from centres of population is still better; and, according to the idiosyncrasies of the individual patient, mountain air or that of the sea coast may be preferred. In view of the possible discomforts and gastric disturbance which may attend a sea-voyage, this should be recommended to patients suffering from tuberculous lesions with more caution than has hitherto been exercised. The diet must be a liberal one, and should include those articles which are at the same time easily digested and nourishing, especially proteids and fats; milk obtained from a reliable source and underdone butcher-meat are among the best. When the ordinary nourishment taken is insufficient, it may be supplemented by such articles as malt extract, stout, and cod-liver oil. The last is specially beneficial in patients who do not take enough fat in other forms. It is noteworthy that many tuberculous patients show an aversion to fat.
For the use of tuberculin in diagnosis and for the vaccine treatment of tuberculosis the reader is referred to text-books on medicine.
In addition to increasing the resisting power of the patient, it is important to enable the fluids of the body, so altered, to come into contact with the tuberculous focus. One of the obstacles to this is that the focus is often surrounded by tissues or fluids which have been almost entirely deprived of bactericidal substances. In the case of caseated glands in the neck, for example, it is obvious that the removal of this inert material is necessary before the tissues can be irrigated with fluids of high bactericidal value. Again, in tuberculous ascites the abdominal cavity is filled with a fluid practically devoid of anti-bacterial substances, so that the bacilli are able to thrive and work their will on the tissues. When the stagnant fluid is got rid of by laparotomy, the parts are immediately douched with lymph charged with protective substances, the bactericidal power of which may be many times that of the fluid displaced.
It is probable that the beneficial influence of counter-irritants, such as blisters, and exposure to the Finsen light and other forms of rays, is to be attributed in part to the increased flow of blood to the infected tissues.
Artificial Hyperæmia.—As has been explained, the induction of hyperæmia by the method devised by Bier, constitutes one of our most efficient means of combating bacterial infection. The treatment of tuberculosis on this plan has been proved by experience to be a valuable addition to our therapeutic measures, and the simplicity of its application has led to its being widely adopted in practice. It results in an increase in the reactive changes around the tuberculous focus, an increase in the immigration of leucocytes, and infiltration with the lymphocytes.
The constricting bandage should be applied at some distance above the seat of infection; for instance, in disease of the wrist, it is put on above the elbow, and it must not cause pain either where it is applied or in the diseased part. The bandage is only applied for a few hours each day, either two hours at a time or twice a day for one hour, and, while it is on, all dressings are removed save a piece of sterile gauze over any wound or sinus that may be present. The process of cure takes a long time—nine or even twelve months in the case of a severe joint affection.
In cases in which a constricting bandage is inapplicable, for example, in cold abscesses, tuberculous glands or tendon sheaths, Klapp's suction bell is employed. The cup is applied for five minutes at a time and then taken off for three minutes, and this is repeated over a period of about three-quarters of an hour. The pus is allowed to escape by a small incision, and no packing or drain should be introduced.
It has been found that tuberculous lesions tend to undergo cure when the infected tissues are exposed to the rays of the sun—heliotherapy—therefore whenever practicable this therapeutic measure should be had recourse to.
Since the introduction of the methods of treatment described above, and especially by their employment at an early stage in the disease, the number of cases of tuberculosis requiring operative interference has greatly diminished. There are still circumstances, however, in which an operation is required; for example, in disease of the lymph glands for the removal of inert masses of caseous material, in disease of bone for the removal of sequestra, or in disease of joints to improve the function of the limb. It is to be understood, however, that operative treatment must always be preceded by and combined with other therapeutic measures.