Detection of Tuberculosis
J. Maxwell · BMJ · 1942
Detection of Tuberculosis SIR,-Dr.G. Jessel's comprehensive letter on the above subject (April 11, p. 477) makes reference to the manifesto of the N.A.P.T., and some points in his criticism require a reply.1.This manifesto was intended chiefly for those interested in tuberculosis but without a professional and intimate know- ledge.Editorial space nowadays is limited, and statements had to be brief and more curtailed than would have been the case in a memorandum intended solely for doctors.Nevertheless, we do not think there is any inaccuracy in the manifesto, and it has elicited a very large volume of interest and correspon- dence from doctors, councillors, local authorities, trade uinion officials, and others throughout the country.2. It would be generally agreed that active pulmonary tuber- culosis will be found almost invariably associated with some form of constitutional disturbance, if the clinician can have his patient under continuous observation.But that is very different from sa-.incg that these very early changes always give warning to the patient.Every day we see tragedies where the symptoms are so slight or transient that they are mistaken or ignored.3. We have not claimed that x-ray examination of the chest alone must infallibly detect pulmonary tuberculosis, nor do we think that mass radiography per se is a final solution to the prob:em of early diagnosis.But a miniaturephotograph should lead in all doubtful cases to a more complete examination with a larger film, and this should go hand in hand with a full clinical overhaul.Radiology of healthy people should be a signpost leading us to more intensive methods in those who require it.4. We regard re-examination at regular intervals and careful comparison of the films as highly important.Once again, this will not achieve results unless it goes with a careful clinical examination, but we would not accept mere observation or study of body weight as conclusive, as Dr. Jessel seems to suggest.5. Most of us would agree with Dr. Jessel that further research is necessary not only to determine the type of appara- tus best suited for this work but also to classify further the types of early lesion which present no symptoms and consti- tute a very important section of the potential tuberculous population.We regard the wise extension of the use of x rays as the most modern and effective method of advance in finding pulmonary tuberculosis at an early and curable stage, but x rays, of course, do not replace other clinical and administrative methods.The volume of letters the National Association for the Prevention of Tuberculosis has received from all parts