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fibrosis may receive considerable benefit. Tuberculous ulceration
of the larynx can be treated locally without detriment to the
patient. It is always necessary to examine carefully the chest
of every new patient. If sputum examinations and X-ray
examinations are insisted on whenever the slightest suspicion
arises, it will occasionally be possible to diagnose pulmonarytuberculosis.
I have in mind two cases who had physical examinations
of the chest with negative results before reference for
treatment and whose sputum was found to contain tubercle
bacilli.
Patients with haemoptysis often give difficulty. Where
tuberculosis has been excluded, the cause may be emphysema,
bronchiectasis, neoplasm, or heart disease. Bronchiectasis often
causes copious haemorrhages. I have found such patients to
receive much benefit from Ultra Violet light treatment, and no
increase in the amount or severity of the haemoptysis has been
noted. One man, with localised bronchiectasis at the right base
and having copious haemorrhages which had reduced him to a
very weak state, has received so much benefit from Ultra Violet
light that consideration is now being given to the advisability
of lobectomy. The periods of active bleeding must be controlled
by the usual sedative treatment and rest in bed, but the intervals
of freedom from hæmoptysis can be safely used for Ultra Violet
light treatment.
As a general rule the chest can be exposed to the direct rays of
light with benefit, but where it is known that quiescent tuberculosis
exists, a margin of safety can be secured by covering the
chest, and exposing the rest of the body.
It is inadvisable to treat as ambulant cases, patients with
heart disease, where there are signs of failure of compensation.
Cases of acute and sub-acute rheumatism should not have Ultra
Violet light treatment. In convalescence the treatment is of
great value in restoring vitality, and in reducing the chances of
sequelæ. Mild rheumatism and mild chorea are often cured by
treatment. Cases with valvular lesion should be excluded from