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The greatest care and the most complete investigation,
clinical and radiological, as well as a complete bacteriological
examination of the sputum, may be necessary to differentiate these
cases.
In any case such cases are " a soil for a seed " and preventive
measures must be adopted to the full.
Industrial Lung Diseases.
These have been dealt with very fully in connection with
pulmonary asbestosis in previous reports.
It is astonishing what a large percentage of these cases subsequently,
often several years later, develop a superimposed lung
tuberculosis, and this indicates the real necessity for keeping such
cases under periodic observation.
Other dusty trades often produce chest symptoms, and the
industrial history is found to be of the greatest significance among
workers in such trades.
Spontaneous Pneumothorax.
The occurrence of a spontaneous collapse of the lungs in
apparently healthy persons has been observed among several
patients attending the Clinic. Subsequent observation has shown
that the air undergoes absorption and the lung re-expands as a
general rule, in the course of 6-8 weeks, the patient ultimately
recovering, without any further trouble having developed.
Whilst the initial symptoms are often alarming the ultimate
recovery is often very dramatic. Of course the possibility of a
recurrence has never to be forgotten. It is, however, of interest
to note that in an appreciable number of these cases tuberculosis
is not the cause of the trouble and does not develop subsequently.
Such cases, however, require to be kept under periodic
observation.
Cancer of the Lung.
A considerable amount of attention has been directed to the
apparently alarming- increase in the incidence of this disease.
Any person of the cancerous age (40-60) with chronic chest
symptoms, where sputum is persistently negative on examination
for tubercle bacilli, and who on examination is found to have