The evolution of tuberculosis in man
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Three fundamental types of tuberculosis may be recognised, and these occur in man independent of individual factors such as age, race, constitution. These types are: primary complex, disseminated tuberculosis and isolated pulmonary phthisis.
A fully developed disseminated tuberculosis and isolated pulmonary phthisis exclude each other. The lung lesion occurring in disseminated tuberculosis is fundamentally different from isolated pulmonary tuberculosis, although disseminated tuberculosis may be chronic and cause positive sputum.
If hæmic dissemination precedes isolated pulmonary tuberculosis, which is often the case, dissemination must remain abortive.
The abortive hæmic lesions are often the source of an isolated bronchogenic phthisis (endogenous re-infection).
Restriction of the process to the lungs, formation of unilateral infiltrations with tendency to liquefaction and bronchogenic spread, are due to a partial immunity which was produced in rabbits treated with killed virulent or living avirulent bacilli. Virulent intravenous infection, followed in normal animals by acute miliary generalisation, led to the typical early pulmonary condition of the human adult in the treated animals.
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