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Diagnosis of the complicated Primary Infection demands-—
(a) Tuberculin testing—
We employ the following methods:—
(1) Patch Test (Vollmer.
(2) Tuberculin Jelly, which I have found very
satisfactory. In 100 cases, with controls by
the Mantoux Test, 95% have been positive.
(3) Mantoux Intracutaneous Test. This is the
most reliable and is carried out where the
above tests are negative in a suspected case.
(b) X=Ray examination.
This is of great importance in the diagnosis and
management of the disease.
(c) Examination of sputum, gastric contents or faeces.
(d) Blood sedimentation rate.
All these methods are employed where indicated and are of
great value in diagnosis.
Non=Tuberculous Subacute Pulmonary Infections simulating
Pulmonary Tuberculosis.
The existence of an infiltration of lung tissue, giving rise to
radiological shadows almost identical with those of pulmonary
tuberculosis but not apparently connected with the tubercle
bacillus, is well known. In a consideration of the aetiology of
sub-acute pulmonary infections attention has been drawn to the
fact that many pulmonary lesions are now brought to light which,
before the days of adequate X-ray examinations, passed undetected,
and, while in most of these the nature of the disease is
not in doubt, in many the differential diagnosis is still a matter
of considerable difficulty. In other words, as has been repeatedly
stated, radiological diagnosis, no less than physical diagnosis,
has its limitations; nor does it always provide a short cut to
that understanding of the morbid anatomy of disease which can
be reachcd only by a synthesis of all the available data. We
are constantly seeing such cases at the Clinic, which could easily
be regarded as tuberculous, but where the negative bacteriology
of the sputum and the rapid resolution, following serial radiograms,
soon shows the nature of their course.
o ;
The role of the streptococcus in pulmonary infections of an
acute pneumonic or bronchopneumonic character, as well as