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March 27, 1926


JAMA. 1926;86(13):946-947. doi:10.1001/jama.1926.26720390001013

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Among others, we classify tuberculous patients as open and closed cases, based on the presence or absence of expectoration. Our recent observations made on two patients of the Mount Pleasant Sanatorium make it appear doubtful whether this classification based on apparent absence of expectoration is justified. In having done so, we failed to recognize that apparently closed cases may be in fact open cases and a source of infection.

We succeeded in demonstrating the presence of tubercle bacilli in the spray of two of our recently admitted patients in the absence of any expectoration. There was an extensive tuberculous involvement present in both of our cases, of acute and subacute character, respectively. The patients were advised to report immediately the slightest amount of expectoration and though our observation covered from four to eight weeks, we were unable to obtain a sputum specimen for examination.

We used the following simple technic:

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