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a clinical point of view, because light is good and more accurate observations
can be made. From a "preventive" standpoint, the examinations
are best done at home because an inspection of the general conditions
there can be made at the same time. The health visitors make arrangements
for the examination of contacts, either in the homes or at the dispensary.
Generally speaking, no objection is raised to those examinations,
although it is sometimes difficult to impress parents and other relatives
with the usefulness of the procedure. The number of contacts examined
by the tuberculosis officer increased from 139 in 1919 to 221 in 1920.
Further progress has been made in this direction and the number should
be considerably greater in 1921. The measures described in the previous
paragraph as to "following up" are carried out in regard to contacts
who have been examined.
(vii) Special Methods of Diagnosis and Treatment.—Clinical observation
and the correct interpretation of physical signs by an experienced
physician are the best methods of estimating the condition of a patient.
In cases showing but slight symptoms and indefinite signs use is made
of radiography, both by screening and photograph. The Council has
sanctioned an expenditure which permits of one case being radiographed
each week. The radiography is not done at the dispensary but the radios
are made by a skilled radiographer and the plates are sent to the dispensary
where they form part of the clinical records. Some thirty cases
were radiographed in 1920. Extremely valuable information has thus
been obtained which, in 28 of the cases, confirmed the provisional diagnosis.
It would be a profound mistake, however, to assume that in every
case where the radiogram shows well marked peribronchial fibrosis, the
patient is suffering from active tuberculosis.
In cases where a definite diagnosis cannot be made at the first examination,
a temperature record is begun. In a few cases four-hourly temperatures
are taken. The health visitors instruct the patients in their own
homes in correct temperature taking. The thermometers are the property
of the Council and are "lent" to patients. A list of them is kept and they
are called in when no longer required. During observation periods
patients report once a week, bringing their temperature records. Temperature
is an important means of gauging the activity of the disease in
early cases.
Diagnostic injections of old tuberculin and Von Pirquet reactions have
been employed to a limited extent. Neither method gives much indication
of the activity of the disease. In point of fact, it is in the quiescent
cases where the application of the test is useful and further—it is of greatest
import when the result is negative. If repeatedly negative, tuberculosis