A series of controlled studies carried out at the Tuberculosis Chemotherapy Centre have revealed that ambulatory chemotherapy for tuberculosis based on a well-organized clinic service for a
year, is virtually as effective as sanatorium treatment for the same
period, not only in the immediate therapeutic response in terms of
overall radiographic improvement, cavity closure and sputum conversion
(Tuberculosis Chemotherapy Centre, Madras, 1959) but also
in the likelihood of relapse in a subsequent 4-year period of follow-up
(Dawson et al, 1966). Further, principally owing to the rapid sputum
conversion of patients receiving effective chemotherapy there was no
increased risk of contracting the disease to close family contacts of
the patients treated at home, the main risk to them being before
treatment had begun (Andrews et al, 1960; Kamat et al, 1966).
These studies also clearly showed that the traditionally held virtues
of sanatorium treatment namely, prolonged bed-rest, good diet, good
airy accommodation, nursing and isolation were remarkably unimportant
provided adequate chemotherapy was administered. There
have been 5 other controlled trials based on random allocation .
reported in the world medical literature which compared either sanatorium
treatment with clinic treatment (Tyrell, 1956 ; Bell, 1960) or
rest with ambulation (Kay, 1957 ; Tuberculosis Society of Scotland,
1960; Wier et al, 1957 ; Wynn-Williams and Shaw, 1960) and not one
demonstrated any advantage either of sanatorium treatment over
clinic treatment or of rest over ambulation. Because of these
findings and because of the gross shortage of hospital beds for tuberculosis,
ambulatory chemotherapy for the major or the entire period
of treatment has become the accepted practice in the tuberculosis
control programmes in India as well as in many other developing
countries of the world
