Sun-Bathing in Tuberculosis, its Use and Abuse

By BERNARD HUDSON, M.D., M.R.C.P., Swiss Federal Diploma.

DAvos, S~,V1TZERLAND.

The light and heat of the sun is a therapeutic agent of very great and unquestionable power, but as with other methods of treatment, which are harmfi~l when used to excess, the duration and condition of the exposure of a patient to sunlight therapy must be carefully controlled, especially with tuberculous patients. In some conditions heliotherapy is of the greatest value, but in others its employment is definitely dangerous.

Sun and light bathing is now admitted to be a most valuable and satisfactory method of treating the majority of cases of surgical localized tuberculosis (i.e. tuber- culosis of bone, joints, glands, and serous membranes) ; and especially in young people and children on account of their reactive power being much greater than in those of advanced years. Dark-haired subjects, because they pigment easily, react, as a rule, the best, and it seems probable that those who pigment well derive the most benefit. Fair-haired people tolerate the sun with difficulty, as they are liable to burn, instead of to pigment. Those whose hair inclines to red are even more difficult, whilst albinoes do not tolerate the sun at all.

Open tuberculous lesions, in connection with bones and joints, i.e. fistulae and sinuses, often heal in a remarkable manner under the sun's rays, and sun-bathing often greatly benefits Other conditions (not necessarily tuberculous) such as open empyemata, sinuses, ulcers, and other septic conditions. In children, pre-tuber- culous conditions, such as tracheal and bronchial glands, bronchitis and asthma, adenoids, and general bad development, all prove amenable to the sun cure, often making remarkable progress. Cases of lupus often improve with this treatment, as do many other chronic skin affections. It must be emphasized that in each case treat- ment must be carefully graduated and controlled, and be under the supervision of a medical practitioner.

Sun treatment whilst of the greatest value in the above conditions is, generally speaking, of small avail in tuberculosis affecting the lungs. Such tuberculosis remains, as a rule, unlocalized, being scattered more or less widely throughout the soft tissues of the lung, often with no real delimitation, and in such cases injudicious exposure to the sun, especially to the heat of the sun, is definitely dangerous, an auto-mnoculation easily being set up, which, owing to the structure & t h e lung, may be impossible to Control. Vascularization of the diseased areas, accompanied by rise of temperature, increase of.sputum and bacilli, and even haemorrhage, may occur. It is not too much to say that in pulmonary tuberculosis, injudicious exposure to the sun may easily turn a quiet inactive case into one of serious activity. Heliotherapy, however, may be tried in those pulmonary cases where the tuberculosis is of single focus or localized, thus approximating in character to one of surgical tubercle,

November x937 TUBERCLE 73

especially in the absence of fever or .active symptoms. In these cases tile condition has become more or less stationery, though there is still a little sputum, with perhaps a few bacilli, and a course ofsun baths may be tried under careful supervision, so that healing may be stimulated with a cessation of sputum and tubercle bacilli. Other chest cases which may derive benefit from the sun are chronic pleurisy, with much thickening and adherence,where the affection is not intrapulmonary. The thickening and adhesions may be absorbed, the lung re-expanding again and functioning properly.

Generally speaking, then, where tuberculosis is of the scattered type, and especially if the patient shows a liability to fever, either periodical or continuous, or a tendency, on exertion, to auto-innoculation, exposure to the sun should be strictly avoided, as being likely actively to precipitate the spread of the condition. Sun-bathing may, however, be tried as an additional stimulus when a patient, whose progress is slow, is becoming cured.

When sun baths arc being taken a good circulation of air all round the patient is imperative, especially in pulmonary cases. Sun-bathing does not consist in being baked by the heat of the sun on a confined balcony, only open at one side. The patient must be so situated that air circulates freely all round him, so that a regular cooling is going on continuously. What is really required is not heat, but the light of the sun. In the opinion of the present writer most of the ill-effects of uncontrolled sun-bathing are due to heat.

Holiday-makers should be warned against the indiscriminate use of sun-bathing. The skin should be gradually accustomed to the sun, starting with exposure of a few minutes only, and slowly working up. The head and neck should ahvays be covered. Undue burning, fatigue, headache, or lassitude all show that exposure has been un- duly prolonged, and the time should be cut down. The aim of sun-bathing is not burning, but pigmentation. The uncontrolled, and ignorant use of sun-bathing amongst holiday-makers has, without doubt, brought to light many a case of latent, quiescent tuberculosis of the hmgs, which might otherwise never have been suspected. Auto-innoculation may occur in such cases, being followed by fever, the appearance of sputum containing tubercle bacilli, and even haemoptysis.

SUMMARY

I. In the sun we have a very powerful means of treating certain affections, especi- ally beneficial to cases of surgical localized tuberculosis, and certain other chronic surgical conditions, not necessarily tuberculous.

2. Patients with pulmonary tuberculosis should never be allowed to sun bathe, as this is definitely dangerous. But sun-bathing may be prescribed : (I) when tuber- culosis approximates to the surgical type, being quiet and localized; and (2) in chronic pleurisy.

3- Indiscriminate sun-bathing can certainly light up an unsuspected, latent pulmonary focus.

4. Sun-treatment consists in the gradual exposure of the body to the light, not the heat, of the sun, and sun-bathing does not mean getting baked on a stuffy enclosed balcony. And patients should be surrounded by a proper circulation offree air.

5. Sun-treatment should ahvays be supervised and comrolled by a medical practitioner.