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tuberculous lung infiltration. It has been observed, however,
that despite the expectoration of thick mucopurulent sputum,
tubercle have been persistently absent, and after close investigation,
these cases have proved to be due to areas of chronic Focal
Pneumonia or Broncho-pneumonia of a non-tuberculous aetiology.
This goes to show the necessity for the greatest care and closest
possible supervision of some of these difficult atypical cases.
They are by no means uncommon, and the utilisation of every
new method of investigation that is likely to be of value is necessary
before a patient is condemned to the very responsible diagnosis
of pulmonary tuberculosis, and all the privation and suffering
that it often entails.
The diagnosis includes the recognition of the presence, extent,
character and activity of the disease. In point of fact, increased
experience goes to show that the interpretation of shadows on
X-ray films with the Roentgen Tube requires as much care and
attention as the older clinicians paid to the Stethoscope.
Despite the pitfalls which can be associated with even the
most perfect and technically satisfactory radiographs, it can be
said with emphasis that the detection of tuberculous lung disease
is infinitely more trustworthy now than in pre-radiological days.
Newer Methods for Discovering Tubercle Bacilli in
Sputum:
Culture Method: By the use of Jensen's medium a growth
may be obtained in 2—3 weeks, where the ordinary carbol fuchsin
method, and even the concentrated antiformin methods are negative.
In suspicious cases, where the sputum is persistently negative,
this method will sometimes give a positive result. Its proved
value is such that it is now being utilised in suspicious cases.
Methods of Assessing the Activity of the Disease.
The Clinical manifestations of activity, such as those of
temperature, pulse, physical signs, nature and quantity of sputum,
and X-ray appearances are all utilised.
The Blood Sedimentation rate has, however, proved to be a
most valuable additional aid, and although adequate facilities are
not yet available, it is hoped to ensure increasing use of this