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THE POPULAR SCIENCE MONTHLY 



bacilli have been found in the sputum. - Moreover a microscopical prepa- 

 ration showing the stained bacilli must be submitted in substantiation 

 of the diagnosis. The tubercle bacillus rarely appears in the sputum 

 until the disease is well advanced and there has been a certain degree of 

 destruction of lung tissue. To limit the diagnosis to such cases alone 

 as show the bacillus allows numerous cases to pass free in which the 

 clinical diagnosis is practically certain. 



In this connection it is to be recalled that many deportation cases 

 diagnosed as tuberculosis are referred to the medical officers for exami- 

 nation to determine if the disease existed or was due to causes existing 



Italians. 



at the time of landing. In these cases it is customary for the certificate 

 of tuberculosis to be based on a clinical diagnosis alone with no demon- 

 stration of bacilli in the sputum. This is the case even though the 

 deportation of a tuberculous alien is a far more severe and radical pro- 

 cedure than to exclude such an alien at first. 



It would be more effective to hold for hospital observation all cases 

 presenting clinical evidence of pulmonary lesions, and to allow diagnosis 

 in such cases as after careful and repeated examination showed a definite 

 lesion, perhaps using the tuberculin reaction as an aid in selected cases. 

 In other words, if the diagnosis of pulmonary tuberculosis could be made 

 by a competent and careful physician, even though there were no bacilli 

 in the sputum, the case should be certified as tuberculosis. 



