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69'
is the general opinion that no culture medium method
in common use equals the guinea pig inoculation in
sensitivity for small numbers of tubercle bacilli, so that
this may have to be used as a final resort.
Methods employe-d when no sputum is available.
Since many patients swallow a part of their sputum, and in
children probably all their sputum, it may be possible to demonstrate
bacilli from swallowed sputum in the faeces or gastric
contents, and occasionally directly from the larynx by the laryngeal
swab. Such methods then as (i) examination of the faeces,
(2) gastric wash, more particularly applicable in insitutions, and
(3) laryngeal swab, may have to be used; so that before a
patient can truly be regarded as having a negative sputum, complicated
procedures may be required which involve careful
co-operation with bacteriological experts. These methods, either
singly or completely, may be required to be employed for our
patients.
Thoracic Surgery.
The work in this sphere from the point of view of treatment,
continues to increase, and we are at a very grave disadvantage
because of the enormous waiting list for major and minor surgery
at all the chest hospitals. Some of our patients for thoracoplasty,
have had to wait over a year before this could be carried out.
This is due to some extent, to the shortage of thoracic surgeons
throughout the country, and a shortage of beds for this work. It
might be well worth considering, in the near future, doing the
minor surgery, such as cauterisation of adhesions, phrenic crush,
etc., in the theatre which already exists at the sanatorium. This
might involve collecting a series of cases from 4—6 times a
year, so that a thoracic surgeon can come out and have a '' field
day " at the sanatorium once every 2—3 months to complete this
work. It might also, in the patient's best interests, involve the
addition of a Resident House Physician, as complications in these
cases some times arise. Certainly, it is worthy of serious consideration
by the Public Health Committee if we are to solve this
very difficult problem.
Occupational therapy department.
Since materials are becoming more readily available it is
now possible to give a varied type of work to the patients who
are attending the classes which are held here regularly every