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found that careful bacteriological examination of the
sputum in several doubtful cases, and in those with
secondary infections, has proved reliable. Where concentration
methods have failed, repetition of the routine
procedure has been successful in establishing the
diagnosis.
(2) X-rays.
Many cases were examined by X-rays, and this
examination has been of great help, but is found to be
only of use when correlated with clinical examination. Tn
certain cases with no physical signs, or with very indefinite
ones, and with suggestive histories, X-ray
photographs have shewn definite evidence of the disease.
(3) Tuberculin.
Diagnosis by tuberculin divides itself into (1) subcutaneous
and (2) per-cutaneous. The sub-cutaneous
diagnostic tuberculin injections have been used on cases
in the Observation Ward only, and Koch's old tuberculin
(O.T.) has been used in every case, the doses being .0002
c.c., .002 c.c., .01 c.c. Of the 12 patients injected,
9 gave postitive reactions. The experience of the Von
Pirquet test (per-cutaneous) is that it is unreliable as a
diagnostic measure, even in children, except possibly
children in the age-period 1 to 5 years. This test was
applied to 105 children, and in 38 the result was positive.
A detailed clinical classification is set out in Table
IV., giving the special classifications introduced by Inman
and Turban with reference to pulmonary tuberculosis
patients.
It has long been recognised that, in any clinical
classification of patients suffering from pulmonary tuberculosis,
the essential fact to convey is a definite estimate
of the capacity of such patients to take exercise or to
work. This estimate must, of necessity, be based upon
easily-recognised factors, which again must not be capable
of being varied according to the judgment or point of
view of the observer. The purely anatomical classification
of Turban does not, in any respect, meet this requirement,
as no indication of the general condition or working
capacity of the patient is given, so that such a classification
serves no other purpose than that of academic interest.