Prognosis and Treatment of Tuberculosis Among Children

¹ Minneapolis, Minnesota

1. Our observations on tuberculous children have been continuous since 1921. They have confirmed the fact that the primary type of tuberculosis is an exceedingly benign disease and differs from the reinfection type almost as though it were caused by a different etiologic agent.

2. Prognosis of primary tuberculosis per se is excellent. No method of treatment yet employed, including antituberculosis drugs and resection, has changed the course of primary tuberculosis in the human body.

3. Although primary tuberculosis per se is extremely benign, it sets the stage for all reinfection (clinical) forms of the disease by producing sensitivity of tissues to tuberculoprotein and providing tubercle bacilli for endogenous reinfections.

4. In infancy and early childhood, between 2 and 3 per cent of those who become infected develop endogenous reinfections resulting in meningitis and miliary dissemination which are usually fatal and in pneumonia which is often so. Beginning about 1947, antituberculosis drugs changed immediate prognosis in a considerable number of cases.

5. With the approach of adolescence, chronic pulmonary tuberculosis enters and thereafter is the predominating clinical form of the disease. Starting about 1920, methods of treatment, including pulmonary collapse, greatly improved prognosis and since 1947, antituberculosis drugs and resectional surgery have served as excellent adjuncts.

6. Emphasis must be placed upon the fact that the lion's share of the work responsible for the phenomenal decrease of tuberculosis among children was done before antituberculosis drugs became available. Although drugs have been valuable in the treatment of clinical cases, methods designed and used so effectively in prevention of initial infection remain the sheet anchor. Because antituberculosis drugs by present methods of administration have some undesirable qualities, it is recommended that among children they be limited to those with progressive clinical lesions.

7. The tuberculosis eradication accomplishments here discussed among persons in the first 25 years of life are phenomenal. The same methods continued with extension and increased intensity are capable of eliminating tubercle bacilli so none of the persons existing and continuing through this age period will be invaded by tubercle bacilli. Therefore, they will require no treatment. In order to attain this goal, a tremendous problem must be solved. This consists of finding all persons harboring tubercle bacilli, variously estimated between 30 and 50 million, and acting accordingly. They constitute the tuberculosis seed bed of the United States. It will require more time and effort to solve this problem and thus attain eradication than have been necessary for all previous accomplishments.