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Out of the Pages of History

Hans E. Einstein, MD, FCCP
Author and Funding Information

Affiliations: Bakersfield, CA 
 ,  Dr. Einstein is Professor of Clinical Medicine, Emeritus, Keck School of Medicine, University of Southern California

Correspondence to: Hans E. Einstein, MD, FCCP, PO Box 1888, Bakersfield, CA 93303-1888



Chest. 2001;120(3):696-697. doi:10.1378/chest.120.3.696
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The control and containment of tuberculosis in the industrialized world in the first half of the last century is one of the significant success stories of that time. This achievement was brought about by a number of factors—in particular, enlightened public health controls, the sanatorium movement (which isolated infectious cases from the community) and the overall rise in the standard of living in the industrialized areas. The treatment of the disease itself played a relatively minor role. The decline in morbidity and mortality from tuberculosis began long before effective antimicrobial therapy became available in the 1940s, and that availability caused only a very minor change in the already rapidly declining rates. Nevertheless, treatment was obviously of great importance to individual patients. No effective treatment had been available previously, and bed rest was practiced universally and relentlessly, based not so much on critical studies but rather as something to do when nothing else was available. The only aggressive interventional approaches of the day were those offered by collapse therapy, consisting of artificial pneumothorax, phrenic paralysis, plombages placed extrapropleurally, and pneumoperitoneum. This last was practiced widely but with questionable effectiveness. The article by Weissberg et al, in this issue of CHEST (see page 847), reviews a series of patients who were treated from the 1930s through the 1950s, who presented quite recently with residua of complications from the earlier procedures. This patient population came from Israel and represents a broadly based sampling from many areas and of multiple techniques. In this age of essentially nonsurgical drug treatment of tuberculosis, this study serves as a useful reminder of the significant successes many of these old procedures did indeed enjoy.

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