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November 20, 1937


Author Affiliations


From the Tuberculosis Division of Grasslands Hospital; chief clinician. Dr. John M. Nicklas.

JAMA. 1937;109(21):1693-1698. doi:10.1001/jama.1937.02780470015005

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My purpose in this article is to draw the attention of the medical profession to a paradox that is occasionally encountered in comparing the roentgenologic and the clinical appearances in certain cases of pulmonary dissemination of the tubercle bacillus. A roentgenogram of the lungs invaded by such a dissemination will show miliary seeding throughout both lungs and the roentgenologist will justly report "miliary tuberculosis." The clinical picture, however, while that of miliary tuberculosis in some cases, will show very little to justify such a diagnosis in others. Though the phthisiologist is familiar with this benign type of hematogenous tuberculosis and the theories of its pathogenesis, the condition is frequently puzzling to the general practititioner, who is usually the first to see the patient. Indeed, having received a report from the roentgenologist that the patient is afflicted with miliary tuberculosis, he is apt to give a grave prognosis only to find

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