The main criteria for the diagnosis of early pulmonary tuberculosis have been such evidences of changes in the apexes of the lungs as alterations in resonance and breath sounds or, particularly, the presence of localized râles. Physical signs denoting a lesion localized below the apex have been considered indicative of processes of nontuberculous origin unless prolonged observation or bacteriologic study proves the contrary. These diagnostic principles have practically attained the dignity of a dogma in consequence of having been reiterated time and again in almost every paper and monograph on the clinical aspects of pulmonary tuberculosis that has been published for two or three generations. Nevertheless, investigations of the last five years have demonstrated beyond cavil that the doctrine that the clinician must seek early pulmonary tuberculosis in the apexes is far from being as firmly rooted in fact as has been almost universally accepted. The more carefully the truly
FISHBERG M, SHAMASKIN A. THE BENIGN COURSE OF APICAL TUBERCULOSIS. JAMA. 1929;93(2):108–110. doi:10.1001/jama.1929.02710020024011
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