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indiscriminate use. In fact the indiscriminate use of, for example,
an artificial pneumothorax which is contra-selective, is fraught with
danger and the so-called "black-lobe" and pleural infection with its
grave sequelae are all too frequently encountered.
Collapse Therapy Refills.—There has been a very substantial
increase of pneumothorax refills during the year.
1944 1945 1946
483 331 545
Moreover, pneumoperitoneum refills are now a regular feature as
well as paracentesis of the pleura for diagnostic purposes.
Problems in Diagnosis.—Of the 1,413 new cases which have been
examined during 1946 only 14.4 per cent. were proved after complete
investigation to be tuberculous. In other words at least six out of
every seven cases seen are, after complete investigation, found to be
cither free from disease, or have some disease, of the lungs heart or
other organs. This raises a large number of diagnostic problems, and
in this connection special emphasis must be made on
Cancer of the Lung.—We have encountered all too many of
these cases during the year and there is real evidence to suggest that
this disease is increasing appreciably. The disease may not necessarily
be one of old age, although cough, haemoptysis and wasting are very
suspicious symptoms, especially in males in the 40-60 age period and
beyond, but early symptoms are often slight.
Early detection can be made by early X-ray of the chest, aided
by bronchoscopy, blood examinations, sputum examinations,
tomography and brochography. This of necessity involves first-class
X-ray and pathological facilities which must be at the service of the
chest clinic. Removal of the lung in cases detected in the early stages
is a life saving device and we have had several such cases returning
subsequently to work.
Occupational Therapy, Vocational Guidance and Rehabilitation.
This is an important aspect of our work and is never lost sight of
in maintaining the morale of our patients. Modern treatment is not
complete unless it is integrated with a well planned programme of
rehabilitation designed to assist the tuberculous subject to be reinstated
into the social fabric as a useful, self-supporting and selfrespecting
member of the comunity. The need for a proper explanation
to each patient on the transmission, diagnosis and treatment of