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cases, to inspect the lungs under the X-ray screen. This is necessary
not only to ascertain the degree of collapse of the affected
lung, but what is of equal importance, to enable us to keep a constant
check on the sound lung.
It is very probable that the number of refills will tend to
increase, as the more I see of Collapse Therapy, the more I am
convinced that it offers the best chance of recovery to patients
with acute disease, limited to one lung. Especially is this the case
in the class of patient attending the Dispensary. While freely
acknowledging the great benefit to patients of a course of routine
sanatorium treatment, we cannot ignore the fact that relapses are
common. This is not surprising when we contrast the life of a
patient at a sanatorium, with its abundant supply of good food
and fresh air, and the life he may have to face on his discharge.
The home is probably overcrowded, and the economic conditions
of his family often compel him to commence work before he is
really capable of this. It is in these cases that Collapse Therapy
has proved to be of such value in that the risk of breakdown is
considerably reduced.
In the inauguration of the Artificial Pneumothorax Clinic and
the subsequent routine work of the new department, I am most
indebted to Dr. Temple Clive, whose previous experience in this
class of work has been such an invaluable help.
The number of patients X-rayed shows an increase of 252 over
the figures of last year. If we are to detect tuberculosis in its
earliest stage, we cannot afford to neglect taking an X-ray picture
of any patient with symptoms even remotely suggesting tuberculosis,
whether we are able to find any evidence of disease on
clinical examination of the chest or not.
In this connection I would point out that it is now our practice
to X-ray all patients referred to the Department by local doctors.
If the symptoms or the general condition of a patient are sufficiently
suggestive to the family doctor, who should, from his
previous knowledge of the case, be in the best position to judge, I
think it rather presumptuous on our part to refuse an X-ray
examination even in the absence of clinical signs of disease.
Owing to the advance in recent years of X-ray technique and
consequently our ability to detect tuberculosis in its early stage,
it is disconcerting that such a large proportion of our cases are in
an advanced state when first diagnosed. Out of 167 new cases
notified as tuberculous during the year, 78, or less than half, had
early disease, while 37 were in an advanced state and 52 were
moderately advanced.
This regrettable state of affairs is, in my opinion, almost entirely
due to the insidious nature of the onset of tuberculosis in the