Hewat, Andrew Fergus

2018-09-13T16:00:22Z

2018-09-13T16:00:22Z

1925

In conclusion, it may be stated, that the above study includes a short anatomical and pathological review of the glandular system of the neck and thorax, with special reference to tuberculous infection. Thereafter, short reviews are given of certain methods of clinical investigation, followed by a full description, with radiograms in most of the CASES, of 61 healthy schoolboys. These results have been examined in the light of LREYE;`R'S tables, and deductions drawn therefrom. In the course of this study and analysis,it has become obvious,that the clinical investigation of the glandular system is of paramount importance, when looking for evidence of Tuberculous Infection. It has, also been seen,that considerable variety of radiographic appearances could be demonstrated. These appearances however, could not be co- related to any definite physical signs. There is considerable variation, within certain limits, of both physical findings and radiograms, in boys who are perfectly fit, in the sense that they are able to carry on the normal mental and physical activities in a school where they are well housed, well fed, and well educated. This corresponds to the findings of the American Committee of three Clinicians and three Radiologists.

A study of the cases in relation to the PIRQUET reaction has shown that the boys who give a positive reaction are, on the whole, more sturdy than those who do not, when analysed from the weight, stem length and chest measurement point of view, in respect of vital capacity readings.

Perhaps the most striking, individual finding has been the difference obtained by spinal auscultation from that recorded by other observers. It will be noted in the present series that "whispered voice" and "bronchial breathing" terminate at a lower spinal level than is usually recorded,in almost every case here reported.

Another general observation with which I have been impressed, may be noted. When this study was begun I hoped that some standard deviations might be discovered, to co-relate PIRQUET reactions, radiograms, vital capacity readings, and the results of physical examinations. This has not been so. DREYER'S tables have not corresponded in the younger boys, and marked individual deviations have been present all along the line.

This irregularity of result shows again, quite clearly, the old truth that assessment of physical fitness, or the evidence of tuberculous infection or disease, cannot be determined by one isolated observation. Of set purpose one vital question in the clinical investigation of these cases has been omitted - viz: the previous history. It is borne in on one, more and more, that the determination of physical fitness, in relation to tuberculosis, can only be found by a complete review of the whole individual situation. The final opinion can only be expressed by the physician, after a due sifting of all the evidence placed before him, derived from the case history, clinical examination, and results of special tests.

Finally, it appears clear to me, that tuberculous infection in school children, requires close study and full investigation, both by clinical means and special tests. One is apt to be lulled into a sense of false security, at this age, because of the admittedly low mortality from tuberculosis. It is - as it were - a transition stage between the primary and secondary phase of tuberculosis. It is, therefore, the best time to carry out anticipatory measures when resistance is normally good, and a degree of disciplined life is being carried through. .Evidence of infection must be searched for, as it is not the age when a patient comes to the physician on account of ill health.

http://hdl.handle.net/1842/32417

The University of Edinburgh

Annexe Thesis Digitisation Project 2018 Block 20

Tuberculous infection in industrial school children: a clinical study, embracing the physical examination, vital capacity, and radiograms, of a group of sixty boys

Thesis or Dissertation

Doctoral

MD Doctor of Medicine