PRIMARY PULMONARY TUBERCULOSIS

Abstract

In 1876 Parrot announced the results of his investigations of the relationship between changes in the bronchial glands and prior lesions in the lung and referred to the glands as being the mirrors of the lungs. Whenever a bronchial gland, he stated, is the site of a tuberculous lesion there is a similar lesion in the lung. Kuss, in his thesis of I898 , refuting the theory of tuberculosis being an hereditary disease, quoted Parrot and described his own series of autopsy findings, corroborating those of Parrot. Apart from its historical interest this thesis contains much valuable material regarding the pathogenesis of tuberculosis. Kuss was one of the first to call attention to the possibility of post-primary types of tuberculosis having their origin in an endogenous infection. Reference is made to the evidence, produced by Loomis, of live bacilli persisting in bronchial glands over a long period of time. Loomis had injected rabbits with extract from bronchial glands of individuals who had died from causes other than tuberculosis. In eight out of thirty cases the animal developed tuberculosis. The eight positive results were obtained from glands in adults 3 ~ to 7 ~ years of age. 'One of the most frequent causes of phthisis', Kuss states, 'is the existence, in the mediastinum, of a latent caseous focus of which the individual is the carrier, perhaps since his infancy.' E. Albrecht, in his thesis of i9o7, adopted a point of view similar to that of Kuss, not only regarding children, but adults as well. Ghon, in I912, published his book on the primary lung focus. He acknowledged the work previously done by Parrot, Kuss, the Albrechts and others; described the primary lung lesion in children, in its various forms found at autopsy, from caseation to calcification, and the associated glandular and other changes. Later, Ranke described the combined primary lung focus and its lymphatic component as the 'primary complex' and advanced his concept of a three-stage division of the disease analogous to syphilis. Though most investigators refuse to accept this comparison with syphilis, his term 'primary complex' has received general acceptance. The term includes the whole evolutionary process from the early active stage to the stage of calcification or ossification.