7.3.4: *Illustrative Cases*

Hawes, John B. 1913. Early Pulmonary Tuberculosis: Diagnosis, Prognosis and Treatment. New York: William Wood and Company. 69-72.

1. Incipient case, favorable course ending in apparent cure.

HISTORY: X.Y., m. 28, s. Bank clerk. Dec., 1910. This patient was a strong, healthy young man sent by his family physician to a throat specialist, who in turn referred him to the writer. The patient’s older brother was said to have shown definite signs of early tuberculosis while at college, away from home, but the process apparently cured itself without interruption of college work. The rest of the family history is entirely negative. Previous to college, while in preparatory school, as well as in college, the patient has led an active athletic life, loving outdoor sports, shooting, riding, etc.

// the before and after method //

// activates preconceptions of health and illness //

// it facilitates ideologies of health that depend on normalcy //

// and sees symptoms as aberrant //

Recently, owing to illness in his family he had been under severe strain physical and mental. Three months ago he caught cold and raised a mouthful of blood. At present, aside from very slight cough and sputum in the. morning he feels perfectly well in every way.

PHYSICAL EXAMINATION : The patient is a tall, spare but strong, healthy looking young man, evidently an athlete. Slightly pale. Temperature and pulse normal. At the left apex above the clavicle there is slightly diminished resonance, slightly increased whispered voice, and after cough a few crackles. The rest of the physical examination is entirely negative. Sputum shows a very few tubercle bacilli.

This patient went at once to the Adirondacks and there spent the winter and following summer under a strict régime. One year later he returned to his old work as a bank clerk in the city and has kept at it ever since. He is now perfectly well in every way; his lungs show no rales or other signs of activity, he has no cough or sputum. He reports for observation every three to four months.

This is a type case, easy to recognize and very amenable to treatment.

// generalization for diagnosis and treatment //

The process is entirely localized in the lungs as shown by absence of constitutional signs or symptoms of any kind. This class of case, if treatment is instituted at once, is the most favorable type for ultimate cure.

// it is a version that seems most curable //

This case also shows the value of a careful family history as giving an idea as to prognosis.

// family history, brings with it notions of genetics //

// of one family being stronger than another //

The fact that one brother developed tuberculosis and cured himself without any radical change in methods of living is significant and hopeful.

// that resistance is hereditary //

// that intervention may not have been necessary //

// that those without these genes are ‘inferior’ //

// that they could not survive when infected //

1. Direct family infection. No resistance. Rapid course. Death in seven months.

HISTORY: A.B., f. 19, s. Bookkeeper. April, 1912.

This patient’s father has had chronic phthisis for some years, but has lived at home and to a certain extent kept on with his work. He is an intelligent man and has used every possible precaution to prevent infecting others. One brother has pulmonary tuberculosis at present, now more or less arrested; one sister has tuberculous glands; one brother and one sister have died of tuberculosis.

// the family is all sick //

// and she does not appear healthy to begin with //

Up to three weeks ago the patient felt perfectly well and strong in every way and attended to her work regularly. Three weeks ago she came down with the grip, stayed two days in bed, but after a week returned to work. Her cough continued and she lost in weight and strength. A few days ago she raised one small clot of blood. Appetite poor.

PHYSICAL EXAMINATION : T. 100.8. P. 120. Flushed. Looks sick. On examination a fairly extensive process was found at both apices. She was at once admitted to an excellent sanatorium but despite the best of care and treatment the disease steadily progressed and led to a fatal ending seven months later.

// strange how little about the care is here //

The striking feature of this case is the marked lack of resistance to tuberculosis as shown by the rapid and violent course of the disease.

// it is implied that there is a genetic failure //

// not the failure of the ‘excellent sanatorium’ //

// from which we get no details //

It also clearly shows the great difficulty in preventing the spread of the disease, where a patient is allowed to continue in the intimacy of home life, no matter what precautions are taken. This patient and her brother and sister undoubtedly contracted the disease directly from their father. It further shows the great importance of examining other members of the family. Had this been done in this instance the result might have been quite different.