Phthisiogenetic Considerations Based on Tomographic Analysis of 320 Consecutive Cases of Localized Pulmonary Tuberculosis in Adults

Abstract

“The discussion on morphological phthisiogenesis, involved as it may appear, is probably less complex than the facts themselves. At present, it is not possible to present more than possibilities and probabilities in phthisiogenesis and as substratum, some scant facts of morphology” (Max Pinner). A critical analysis of morphological phthisiogenesis has to be based on direct observations. The knowledge achieved from necropsies and experiments on animals is most conclusive. Continuous observations on patients have been gaining in significance since the improved x-ray technique granted more exact analysis of initial pathological changes. The introduction of tomography marks significant progress in this direction. The systematic combination of antero-posterior and lateral tomography allows a deeper insight into morphological details and at the same time presents new genetic and therapeutic problems. It enables the anatomical localization of specific changes according to the broncho-pulmonary segments and the recognition of pathological findings in the bronchial tree and particularly in its peripheral branches. Besides it yields a more accurate structural analysis of specific foci. We have used this method on a large scale and we can hardly imagine clinical work without it. It is the purpose of this report to present a roentgen-anatomic (tomographic) analysis of 320 consecutive cases of localized open pulmonary tuberculosis in adults and to evaluate in this way some phthisiogenetic aspects. The cases were examined in our hospital and in our associated institute Beth-Levinstein in Ramataim during the period from January 1950 until April 1952. Methods and Materials: All cases were examined tomographically according to the methods lately described by us. As a routine each hemithorax