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83
The prognosis in a given case depends not upon the extent
of the local lesion, but on the degree of intoxication of the
system, and this well-known fact is recognised in what is
known as Philip's Classification, in which the amount of
systemic disturbance is indicated by certain specific
symbols added to the numbers of the respective anatomical
stages. This is a step in the right direction, but .10 reliable
indication is conveyed of the patient's capability of
undertaking work. No standard factors are given
whereby an estimate of the degree of systemic or autoinoculation
resulting from any such muscular effort can
be made, and, failing such factors, different observers may
very easily give widely varying reports. The clinical
classification devised by Inman is found to meet all
requirements, as the sorting out or selection of cases for
sanatorium, tuberculin, or other treatment is invariably
effected by clinical methods. Further, in such classification,
everything of an empirical nature is eliminated and
the incontrovertible standards (temperature, rest, exercise
or work) are adopted. Inman's classification is as follows:
Stage or
Class.
I.
II.
III.
Clinical.
Resting febrile,
Ambulant febrile,
resting afebrile
Ambulant afebrile
Pathological.
Excessive auto-inoculations
occurring spontaneously.
Excessive auto-inoculations
inducible by exercise.
Appropriate auto-inoculations
inducible by exercise.
To demonstrate the value of this method of division,
all cases coming under stage or class III. (Inman) have
been sub-divided into the three stages or classes of
Turban (see Table IV.). Assuming that the greater the
local lesion, the worse the general condition of the
patient, the cases tabulated in this Report under stages
2 and 3 of Turban would be reckoned as hopeless,
whereas the reverse is the case.
(2) Clearing House and Centre for Observation.
When the diagnosis has been made, the Tuberculosis
Dispensary, or Clinic, serves as a "Clearing House,"
through which persons, suffering from the various types