bacilli have been found in the sputum. Moreover a microscopical preparation 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 examination to determine if the disease existed or was due to causes existing
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 demonstration of bacilli in the sputum. This is the case even though the deportation of a tuberculous alien is a far more severe and radical procedure 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.