298 A HISTORY OF NATIONAL TUBERCULOSIS ASSOCIATION 



companied by breath changes and other signs should be an indication for rejec- 

 tion. The more active and recent the chronic lesion the less marked the breath 

 changes and the more conspicuous the rales." 



"True miliary tuberculosis is not likely to come to the attention of the 

 military examiner. The peribronchial type is common and frequently not 

 recognized. In the adolescent the peribronchial tuberculosis may be extending 

 from the deep lung without as yet developing a superficial focus. It may be 

 manifested only by the presence of distant rales with or without slight changes 

 in the breath sounds which are of a slightly bronchovesicular quality. If the 

 case is well marked there will be impairment of expansibility of the affected 

 side and increased vocal resonance. Less pronounced cases are distinguished 

 from chronic bronchitis only by the character of the rales (coarser in bron- 

 chitis) and by their typical distribution." 



"A definitely demonstrated tuberculous lesion of more than insignificant 

 size below the apex is cause for rejection whether such lesion be active or 

 inactive. ... No examination for tuberculosis is complete without 

 auscultation following a cough." 



"The Method of 'Expiration and Cough.' -It is best executed as follows: 

 Starting from the state of rest of the lung the subject forcibly expels the air 

 from the lungs, reserving the last portion of the expiration for a short cough, 

 after which inspiration immediately follows, but only enough air is inhaled 

 to return the lung to the state of rest. The idea is to diminish the size of the 

 bronchi as much as may be by expiration, then to cough to stir up forcibly 

 such fluid as may be present in them. The moisture is more likely to be 

 moved by the current of air and so produce rales when the tubes are of their 

 least caliber. This procedure should invariably be employed in examinations 

 in order to determine the activity of lesions found by other signs and also to 

 detect the existence of fresh disseminated tuberculosis." 



"The presence of tubercle bacilli in the sputum is cause for rejection." 



"Tuberculin. It is well recognized that a positive reaction to tuberculin, 

 especially in the young adult, is not a proof of the presence of active clinically 

 important tuberculosis. Tuberculin only demonstrates activity of the tuber- 

 culous process in the clinical sense when it can be shown to produce a focal 

 reaction. Such reaction is not without danger. Since, therefore, tuberculin 

 rarely leads to a correct diagnosis and may do injury, its general use in the 

 diagnosis of tuberculosis in examinations for enlistment is prohibited." 



"Resume of Indications from X-ray Negatives. The X-ray shows: I. 

 Tuberculous disease confined to region of hilus in deep lung. 2. Extension 

 upward toward apex or downward and outward toward base, confined to deep 

 lung. 3. A fine line or two extending to apex with or without small focus or 

 foci there condition not determinable by physical signs. 4. Clouding of 

 apex without marked lines from hilus, probably largely pleuritic. 5. Well- 

 marked lines extending to superficies of apex, usually, but not necessarily, 

 with foci there lesion accessible to physical examination. 6. Lines extending 

 toward shoulder as well as apex, (a) If confined to deep lung may mean 

 early and now obsolete exacerbation. (6) If extending to superficies denote 



