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Chest Service.
38
Problems in differential Diagnosis.—The large number of
Chest cases referred during the year as suspected cases of Pulmonary
Tuberculosis which have proved on investigation to be due to diseases
of the lungs other than tuberculosis is noteworthy.
Cancer of the Lung continues to figure high in the list in the
40-60 age period. Some of these cases in their early stages are
amenable to Thoracic Surgery. Several such cases have been
successfully operated upon during the year, and such operations as
lobectomy and pneumonectomy are now a not unusual procedure.
Streptococcal Infections of the Lungs.
The possibility of a non-tuberculous inflammatory reaction of
the lung closely simulating pulmonary tuberculosis has constantly
to be borne in mind. I have now come to recognise a clinico-radiological
group in which a streptococcus viridans has been a constant
bacteriological finding in the sputum in which tubercle bacilli have
been conspicuous by their absence. Such cases referred by various
observers under the heading of "Pneumonitis", "atypical pneumonia",
"Disseminated focal pneumonia" have been a not unfrequent
experience during the year.
' 'Virus Pneumonia''.
Attention should be drawn to the increased frequency of this
condition which may in some cases closely simulate pulmonary
tuberculosis. The rapid resolution of the lung infiltration is in
striking contrast to that of lung tuberculosis, and wherever a suitable
sample of sputum shows repeated absence of tubercle bacilli this
condition requires to be borne in mind.
Progressive Primary Tuberculosis in adults, even where
the initial phases of the disease present all the intense and violent
symptoms of the fatal cases, may sometimes show complete recovery.
It has to be remembered that there is an apparent increase in the
number of persons reaching adult life without becoming tuberculin
positive. Hence the significance of the Primary infection in such
adults with a progressive lesion which is often not associated with
symptoms. Further clinical research on the question of primary
tuberculous infection in adult life and its clinical behaviour is bound
to result from an increased clinical experience of the condition.
Serial Mantoux testing of children and young adults together with
routine serial chest radiography should help in this direction.