"Initial Foci", a Special Group of Minimal Tuberculosis. Prognosis and Treatment

1) "Initial foci" require to begin with, as a rule, no treatment but they must be followed carefully and x-ray photographs must be taken every month or alternate month. If the changes should prove stationary the interval between the control examinations may be increased to four to six months at the most, but they must be followed for many years. Should the individual spots be poorly delimited a progression may be feared earlier, for which reason control examination of such cases must be conducted particularly carefully. Should the spots show a tendency to coalesce or should fresh ones develop after some time, sanatorium treatment is required.

2) Prior to the introduction of chemo-antibiotic treatment only ordinary sanatorium regime could be considered at the beginning. If the progression nevertheless continued, the lesions increased or began to coalesce, artificial pneumothorax was induced with, if necessary, cauterization of adhesions. Artificial pneumothorax treatment was thus employed before the development of cavities. The fact that this was a correct method became obvious since the induction of artificial pneumothorax treatment had been delayed somewhat too long in certain cases at the beginning. [See FIGURE9,FIGURE10 and FIGURE11 in source pdf.]

3) Since the introduction of chemo-antibiotic treatment, I have, however, waited somewhat longer before commencing artificial pneumothorax therapy, because these lesions have proved strikingly sensitive to streptomycin. As a rule, good results have been obtained by administering 0.5 gm. streptomycin daily for three months. More recently, in cases of "initial foci" as with other forms of tuberculosis 12 gm. PAS have been employed daily in addition to streptomycin. No extra rapid improvement of the results have been observed since this combined treatment was commenced.

4) Streptomycin, as a rule, with or without supplement of PAS, compels the "initial foci" to regress. The cases must, however, be followed radiologically for a long period. Artificial pneumothorax is induced now only when the spots show a distinct progressive tendency and cause development of infiltration indicating caseation.

5) I have not allowed segmental operation to be carried out on cases of this early type of tuberculosis.