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84
Note upon Classification of Patients suffering from Tuberculosis.
Memo. 37/T (Revised).
For the purpose of the Annual Returns required under this Memorandum,
and of the case records necessary to enable these returns to be completed,
the following system of classification of cases and of recording results should
be used: —
I.—All patients should be grouped according to their sex and age;
patients under 15 years of age should be classed as children, and those
of 15 years and upwards as adults.
II.—Patients should then be classified according to the organs or parts
affected as follows : —
(1) Pulmonary tuberculosis (including tuberculosis of the pleura
or intrathoracic glands).
(2) Non-pulmonary tuberculosis.
Patients suffering from both pulmonary and non-pulmonary
tuberculosis should be classified as pulmonary cases.
III.—Patients suffering from pulmonary tuberculosis should be divided
into—
Class T.B. minus, viz., cases in which tubercle bacilli have never been
demonstrated in the sputum, pleural fluid, faeces, etc., and
Class T.B. plus, viz., cases in which tubercle bacilli have at any time
been found. It should be noted that a patient originally in Class T.B. minus
must be transferred to Class T.B. plus at any stage in the course of treatment
if and when tubercle bacilli are found, while on the other hand a patient who
is once placed in Class T.B. plus can never be included in Class T.B. minus.
Class T.B. plus should be further subdivided into three groups as follows: —
Group 1.—Cases with slight constitutional disturbance, if any; e.g.,
there should not be marked acceleration of pulse nor elevation of temperature
except of very transient duration ; gastro-intestinal disturbance or emaciation,
if present, should not be excessive.
The obvious physical signs should be of very limited extent as follows :
Either present in one lobe only and, in the case of an apical lesion of one
upper lobe, not extending below the second rib in front or not exceeding an
equivalent area in any one lobe; or where these physical signs are present in
more than one lobe, they should be limited to the apices of the upper lobes,
and should not extend below the clavicle and the spine of the scapula.
No complication (tuberculous or other) of prognostic gravity should be
present. A small area of dry pleurisy should not exclude a case from this
group.
Group 3.—Cases with profound systemic disturbance or constitutional
deterioration, with marked impairment of function, either local or general,
and with little or no prospect of recovery.
All cases with grave complications {e.g., diabetes, tuberculosis of intestine,
etc.), whether those complications are tuberculous or not, should be
classified in this group.