結核研究の今昔 : 臨床面
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概要
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It was a long roundabout way extending nearly a century since the discovery of TB germs to thedebut of therapia sterilisans magna. Robert Koch was keenly enthusiastic in the search for “antituberculous drug” rather than for “anti-bacillary drug.” It was, as it were, a wrong fastening of thefirst button, leading to a successive wrong fastenings of the following buttons. In fact, it gave birthto a myth “No effective drug for TB, ” then came the second myth “Cavity is the cause of incurabilityof TB, ” finally developed into the third myth of “Prevention is better than treatment in TB.” Sucha history was an unconditional surrender of therapeutic medicine to TB.<BR>In 1944, at the time when SM was first discovered, medical treatment for TB as an infectiousdisease came finally upon the highway. Because of the necessity of the evaluation of various therapeutic approaches, more objective and scientific methods had been introduced to clinical medicine.<BR>Along this line, objective classification of chest X-ray findings, standards for the evaluation of clinicalefficacy, controlled trial for the comparison of effects of several therapeutic methods, etc. have beendeveloped successively.<BR>Clinical medicine is in itself human-oriented. It was the immaturity of clinical medicine whichinterfered to attain this goal. For example, “fresh air, rest and diet therapy” which had been advocated as a royal road to recovery for more than a century; collapse therapy and lung resection whicheffectively challenged for the cure of the cavity; and even “long-term chemotherapy” of previous days;all these could not be appreciated highly as they were not human-oriented. The myth “TB germscannot be sterilized by a drug” still survived.<BR>However, the advance of short-course chemotherapy broke this myth. Now, newly detected TBpatients are cured without restraint from time and with brilliant hope of quick recovery whileenjoying ordinary human life. It was indeed a long journey to reach the present status.<BR>Nevertheless, the success in chemotherapy has brought about an illusion in the mind of peopleas if they have solved all TB problems completely. Although kmany problems yet remain to be solved, short-course chemotherapy overwhelms all the problems like a bulldoser. Will that be all right? Asa clinician, we have to find out and investigate prudently unsolved problems.
- 日本結核病学会の論文