The Place of the Sun in Treating Tuberculosis

Heliotherapy is not indicated in all cases of tuberculosis. The majority of patients with this disease should never use it. In general one may say direct sunlight is indicated in cases of extrapulmonary tuberculosis and contraindicated in cases of pulmonary tuberculosis. It is not a sure cure for any type of tuberculosis, but is often, especially in some of the extrapulmonary cases, a very valuable—or even necessary—aid. Since it is not in itself a cure, it should never be used routinely or to the exclusion of the usual standard therapeutic measures of rest, fresh air and good food. It should never be forgotten that the direct rays of the sun are extremely powerful, and that, carelessly administered, they can do great harm. Direct sunlight, in the same amount, affects patients differently—especially in the beginning of its use, than almost any other remedy with which we are familiar. It must be used, therefore, in every case, not according to any hard and fast rule, but according to the individual reaction. It is of the greatest value, and may be practiced with the least chance of doing harm in pure extrapulmonary tuberculosis, that is, in the so-called surgical tuberculosis without pulmonary lesion. It is of great value in extrapulmonary tuberculosis with coincident pulmonary lesion; but in giving it here one must be far more careful than in the uncomplicated surgical type. It is of great value in hilum gland tuberculosis, and in this type should invariably be used. It may be of some value in an occasional case of the proliferative type of pure pulmonary tuberculosis; but here it must be employed with the greatest caution, lest it transform a favorable, stationary, or healing lesion into a rapidly progressing and fatal one. Ordinarily the benefit to be expected from its use is too slight and the danger is too great to justify the risk. It is never of value, and is usually actually harmful, in the exudative type of pure pulmonary tuberculosis, as well as in all acute types; and in such cases, therefore, it ought never to be used. Finally, whenever heliotherapy is used in tuberculosis the patient should always feel as well, or better, both during and after his sunbath; if he does not, it should be discontinued, for this means danger.