A Pathologist's Recollections of the Treatment, Investigation, and Control of Tuberculosis

A PATHOLOGISTS RECOLLECTIONS OF THE TREATMENT, INVESTIGATION, AND CONTROL OF TUBERCULOSIS ESMOND R. LONG, M.D.* The last fifty years have seen great changes in the prognosis and treatment ofpulmonary tuberculosis, once the most widely fatal ofall human ailments, a disease that has cost the world heavily in lives and health, expense of prolonged medical care, and personal and family sacrifice. The story ofthe decline in tuberculosis is colorful and dramatic and fortunately has been put on record in many accounts that are inspiring as well as informative . My own interest in the diseasehas coveredall ofthat half-century. I have spent a large part of my life on matters related to it in one way or another , not the least of which was some personal experience with it as a patient. In the light of all that has happened since, I can only count that experience as an event of great good fortune. I. Initiation in Tuberculosis My first knowledge that I had tuberculosis came on a summer afternoon when I suddenly coughed up several mouthfuls ofblood while playing a desultory game of tennis on a University of Chicago tennis court. The shock settled a growing problem. I was a second-year medical student and candidate for the Ph.D. degree in pathology. I enjoyed my work and was ambitious to learn, with good example all around me, but for some hitherto unexplainable reason was profoundly and increasingly tired all the time. Never since have I been so weary. That I was playing tennis when the break came may seem absurd, but in 1913 exercise was a first line oftherapy for many vague ailments, and I was too fond of sport not to give it all the trial I could. I did worse things before I was through. * Pedlar Mills, Virginia. 24 Esmond R. Long ¦ A Pathologist's Recollections of Tuberculosis Perspectives in Biology and Medicine · Autumn 1961 II. Education in Chicago How I came to be there at all can be told fairly simply in retrospect. I had majored in chemistry at the University ofChicago, with an indefinite expectation ofbecoming a chemist, relying on chance and developing interests to determine what kind. My selection of chemistry was natural. My father was professor ofphysiological chemistry at Northwestern University Medical School, and I had spent many hours taking the equivalent offreshman chemistry under his instruction. He was intimately acquainted with Julius Stieglitz, John Ulric Nef, and others under whom I studied later at Chicago. Stieglitz in turn was a close friend of H. Gideon Wells, of the department of pathology at the university's medical school, who happened to be in need ofa chemical assistant about the time I graduated from the university. Stieglitz recommended me, Wells stirred my enthusiasm in explaining the work, and I accepted happily. The post was humble but ofgreat potential opportunity. Before recounting how I spent the first two years ofan ultimately long and cherished association with Gideon Wells, I should say something about the background ofthe limited attainments I brought to the position. I was born in Chicago in 1890 and grew up in a suburb, Auburn Park, which my parents hoped would become a progressive one in the fastgrowing city. It failed to do so at the time but had other advantages. My mother, with a deep interest in cultural resources, started me on literature and languages at an early date with home tutoring and my father kept the ideal ofa life ofscience in front ofme all the time. There was a fair grammar schoolnearby, with an excellent teacher in the formative eighth grade, to whom I am lastingly indebted. Best ofall at the time, we were not far from the Morgan Park Academy, a secondary school ofthe University of Chicago, in which instruction was excellent. I was deeply influenced there by my teachers in English and Latin and, indeed, for a time I thought I would be a Latin teacher. I was thoroughly disabused ofthat notion, however , when I took an undistinguished part in a gathering ofstudent representatives from regional schools in a large one-day competitive examination . I entered the University ofChicago in 1907, developed an abiding interest in history, and ultimately...