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July 13, 1946


JAMA. 1946;131(11):897-898. doi:10.1001/jama.1946.02870280023012

Tuberculosis in the adult shows a remarkable preference for the apical regions of the lungs. After the disease has become advanced in one apex it often involves the opposite apex months or years before lesions can be demonstrated in the lower two thirds of the lungs. The basal regions may escape involvement for a long time even though the patient constantly has a positive sputum and the entire lung is maximally exposed to infection. This contrast between the susceptibility of the apical zone and the immunity of the rest of the lung is peculiar to tuberculosis. Students of the disease have been puzzled and theories offered have not seemed acceptable to American authorities.1

By combining facts from anatomy, pathology and clinical medicine with data on the pressure in the pulmonary artery of human subjects, a theory of pathogenesis of apical tuberculosis has been developed which appears more convincing than

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