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62.
in diagnosis, besides being helpful in determining extent
of disease not revealed by ordinary external examination,
often showing the presence of fresh and isolated foci coexisting
with older or fibrous patches.
It is possible that the number of X-ray examinations
will tend to increase, for it seems only natural that any
help towards earlier diagnosis should be both welcomed
and warranted in the campaign against tuberculosis.
Certain authorities even consider that every adolescent
on leaving school should be examined under the
X-rays and skiagrams taken, in view of the fact that
phthisis is only a secondary, or manifest phase of a more
or less universal early "infection" with the Tubercle
Bacillus during the first few years of life. Under existing
arrangements however such a complete system is
certainly impossible; and it would entail the provision
of an X-ray plant and operators for Dispensary work
entirely—a department, which, although admittedly of
the highest value, would require considerable expense
to initiate.
Institutional Treatment.
The London County Council continues to be the
authority responsible for the provision of Sanatorium
treatment. Such cases considered to be in need of this
are recommended by the Tuberculosis Officers to the
Medical Officer of Health of the London County Council
by whom the necessary arrangements for admission are
made.
In the great majority of cases, recommendations are
accepted by the London County Council for admission,
though it occiv ionally happens that a heavy waiting
list at head-quarters may defer or cause non-acceptance
of a recommendation to some special institution.
This may refer specially to those with disease of a
certain type or stage; or to such patients who have
already completed a course of Sanatorium treatment
within a reasonable period. During 1928, institutional
treatment was provided for 203 persons, and a reference