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January 10, 1948


JAMA. 1948;136(2):110-111. doi:10.1001/jama.1948.02890190038009

Fibrous scars accompanied regularly by local anthracosis and emphysema and sometimes by fibrotic, caseous or calcific nodules are commonly found at necropsy in the apexes of one or both lungs. These have long been accepted as tuberculous scars. This interpretation has recently been challenged by Medlar,1 whose data warrant critical examination before the old concept is discarded.

Medlar analyzed data on 1,400 necropsies in cases of unexpected death in the Medical Examiner's Department of the Borough of Manhattan. Of this number, 141 were excluded from further consideration because of extensive pleural or pulmonic disease. The 1,259 remaining cases, in which 960 subjects were white and 299 were Negro, were analyzed according to race, age and apical scars in relation to presence or absence of tuberculous lesions. Calcified or caseous foci or tuberculous cavity in the lung, or similar lesions elsewhere, were accepted as diagnostic of tuberculosis.

Apical scars were

Medlar, E. M.:  Apical Scars; Their Etiological Relationship to Tuberculous Infection ,  Am. Rev. Tuberc. 55:511 ( (June) ) 1947.
Carnes, W. H.:  The Present Incidence of Tuberculous Infection ,  Bull. Johns Hopkins Hosp. 70: 101 ( (Feb.) ) 1942.
Steiner, P. E.; Stanger, D. W.; Bolyard, M., and Marcovich, A. W.:  The Quantity of Focal (Tubercle) Calcium in Human Lungs ,  Am. Rev. Tuberc. 49:129 ( (Feb.) ) 1944.