Chairman Lincoln:We will try to stay as close to the subject matter as possible and then if we have time and you want to go off into other subjects connected with tuberculosis, we can. I think there is plenty of material for discussion in early diagnosis and the treatment of the early phases of tuberculosis, that is, primary and postprimary tuberculosis. This will take up our time without going into the discussion of chronic pulmonary tuberculosis, since that is not a form of tuberculosis which is common in children.
Specific therapy has changed the attitude of pediatricians to tuberculosis. Formerly a pediatricians took the attitude that the great majority of children who had primary infection, evidenced by positive tuberculin tests without or with positive x-rays, would get better without ever having any symptoms; that a few of them might develop complications such as tuberculosis of the cervical nodes, or of the bones or joints, which could be turned over to a specialist and not be seen again by the pediatrician. A few cases would develop fatal complications such as meningitis or miliary and promptly die. Therefore, there was little of interest to the clinician in the story of tuberculosis in the child. As recently as 5 years ago, just before chemotherapy, I talked to pediatricians in many teaching centers and I was repeatedly told that the diagnosis and the care of tuberculous children was a minor problem and that tuberculosis was practically never seen in their services.
Since chemotherapy there has been a new interest in tuberculosis and I think this is shown partly by this round table discussion.