Nature of disease.

Tuberculosis (usually known as T.B.) is the disease caused by the Tubercle Bacillus.  This Bacillus can infect almost any organ in the human body, Bone and Joint, Kidney, Brain etc if blood borne, and lungs and alimentary tract if inhaled or ingested.  The disease can occur in several sites simultaneously, but at present, lung infection predominates resulting in Pulmonary Tuberculoses; a chronic Pneumonia.

T.B. is a chronic disease, taking many months or years to establish itself, and likewise the treatment is long, rarely less than one year and more usually two to three years.  It being a chronic disease the patient is affected generally, as well as having localized symptoms at the infection site.

General.

40 years ago Tuberculosis (T.B.) was a dreaded killer, much as Lung Cancer is today.  Today very few persons die of T.B. although the Bacillus is the same, and will still kill if left untreated.  This improved outlook for T.B. patients is due to several things.

But the public idea that T.B. has gone, is mis-informed.  The number of new cases of T.B. at Rushden Hospital for 1975 is 50.  This is higher than previous years.  Of this 50, 34 are Pulmonary T.B., the remaining 16 being in other sites.  T.B. is more common in Males but the ratio is tending to even out.

Pre-disposing factors.

Smoking, air pollution, dusty work, chronic illness, over work and over tiredness, poor housing and diet etc.  These render the patient more likely to get T.B. but are never the cause.  The Bacillus must be caught either from a person who has active T.B. or in the case of Bovine T.B., from the milk of an infected cow.  Usual male patients are 25 to 40, married, young family, doing extra work to ‘make ends meet’, may have dirty dusty job, usually smokes.  T.B. is a Social disease as opposed to Lung Cancer, which is self induced.

Symptoms.

Lassitude, cough, sputum, with blood sometimes, weight loss, poor appetite, mild breathlessness, pain if Bone and Joint T.B.

Diagnosis.

Via G.P. to Chest Clinic, admit Rushden Hospital.  Tests will include X-ray, sputum for AFB, Blood, Tine, general examination, symptoms and history.

Treatment.

The three main Anti-T.B. drugs are INAH, Rifampicin, Ethambutol.  Two or three of these drugs are given daily in courses of two months, with assessment at the end of each course, one to three courses given in Hospital, then may need up to two years’ chemotherapy at home.  Apart from drugs, rest, good high protein diet, avoid any lung irritants including smoking, are all needed for full recovery.

Nursing.

Nurse with other T.B. patients and away from Non T.B. patients, but not fully isolated or barrier nursed.  Keep on bed rest for first few weeks then gradually increase activity.  All crockery and cutlery are boiled after each use.  Linen handling kept to minimum, collect and burn all sputum.  Drugs must be given regularly, and not missed out for odd days if the patient feels unwell otherwise drug resistance will occur.  Observe patient for any drug reactions, i.e. rash, pyrexia, vomiting, dizziness, mental changes etc.  Note any domestic problems as these are frequent owing to the long stay the patient has in Hospital.  Get the confidence of the patient and ensure that he has regular visits from the Social Welfare Officer.  Patients in for six months become part of the ward ‘Family’ and are best considered such.  Your ward is their home for quite a long time.