This paper is a review of patients with pulmonary tuberculosis at the Toronto Hospital, Weston, “adequately” treated and discharged by medical consent between January 1954 and June 1956. It is not an account of a study carefully planned in advance, but a retrospective report of results obtained by treatment then in vogue (namely long-term chemotherapy with at least two drugs, but usually three, for a period of one year, and surgical measures where these seemed to be indicated). The total number of all patients discharged during this time was 1,734. Of these, 850 were considered suitable for review in that they satisfied our criteria of adequate treatment. Six hundred and forty-eight were actually traced and of these 20 have relapsed to date (June 1958); 5 more were re-admitted because of recurrence of symptoms of pulmonary disease, but reactivation could not be established; 6 patients died of causes other than tuberculosis. The relapse rate is thus 3·1 per cent. The relapse cases were studied in detail. The ages ranged from 22 to 67 years and 10 of the 20 patients were aged 40 years or less at time of relapse. Eight were females and 12 were male patients. Sensitivity to drugs was complete in 11, unreported in 3, and in 2 patients tubercle bacilli were not cultured. Partial resistance only to one drug was encountered in the remaining 4 patients. Only one of the 20 patients had a resection (lobectomy) performed, but 3 had thoracoplasty as part of their treatment before relapse. It is of interest that in 4 patients resection was considered necessary but was not done for various reasons. This study seems to confirm tentative conclusions previously held by us regarding predisposition to relapse after treatment.

A case is recorded of renal damage, fever and drug rash following twice weekly viomycin treatment. At post-mortem the renal tubules showed necrosis.

Summary A case of laryngeal palsy following spontaneous pneumothorax is described. The possible mode of occurrence and the relevant literature is discussed.

Summary The value of scalene node biopsy as a diagnostic procedure in intrathoracic disease is established beyond doubt. The percentage of positive biopsies depends on the thoroughness with which the operation is carried out and is especially high in cases of sarcoidosis. The results of the present study bear out the author's previously published views on the lymphatic drainage of the lungs and give a guide to the question of which side should be explored. Right-sided lesions always give rise to pathological changes on the right. In cases where no lymph nodes are palpable, the right supraclavicular region should be explored irrespective of whether the lesion in the chest is on the left or right. Similarly, in bilateral lesions a right scalene node biopsy is advised. Only when the left supraclavicular nodes are palpable should this side be operated upon. A bilateral exploration is only justifiable where a right scalene node biopsy is negative and the case cannot be diagnosed by any other means.

Summary Chest disease and morbidity has been studied among a group of 31 persons (grain workers, oil and flour millers, flour packer) exposed to inhaling mixed vegetable dusts at work. Pulmonary fibrotic lesions or simple pneumoconiosis were found histologically in 4 out of 5 cases in which post-mortem examination was done. Radiologically, various types of lung damage (reticulation, micro-nodulation, irregular fibrosis) were encountered, conforming with the histological findings in 4 out of the 5 cases in which we were able to obtain post-mortem examination. Emphysema associated with this and other types of occupational lung disease has been discussed, and 10 cases of tuberculosis and 2 of bronchogenic carcinoma have been noted. Only in six cases were chest appearances normal.

(a) 85· per cent. of 446 patients who had thoracoplasty are satisfactory 1 to 7 years later. Another 4·3 per cent., now lost sight of, were well when last seen. (b) Such good results are unlikely in the future, if thoracoplasty is to be used mainly in cases unsuitable for resection. (c) The average age of tuberculous patients is increasing. Chemotherapy is prone to fail in older people and, where long-term chemotherapy has not converted the sputum, thoracoplasty is only moderately successful: it is wrong to expect brilliant results among salvage cases. These operations were carried out by Mr. M. Hickey, Mr. B. O'Neill, Mr. D. Kneafsey, Mr. H. Wingfield, Mr. K. Shaw.

Summary Although several enzymes have previously been tried therapeutically, cerase is the first to show definite antibacterial effect. Low toxicity and highly specific antibacterial activity facilitate clinical research, and the apparent anti-tuberculous activity in both animal and human cases justifies larger scale clinical trials, which are in progress. Besides bibliographical data, this article contains information about the pharmacological properties of cerase, and preliminary observations on its use in the treatment of human tuberculosis.