The Focal Pulmonary Tuberculosis of Children and Adults

Evidence of tuberculous infection has been found in the lungs of all of fifty adults who have been examined. Approximately one-half of all adults have encapsulated lesions of the lungs or bronchial lymphatic nodes, whereas in one-third pulmonary and lymphatic lesions are firmly calcified and completely healed. Tuberculous pulmonary lesions of adults who have died of diseases other than tuberculosis are of two types: (1) apical tuberculosis similar to the usual type of fatal phthisis and unaccompanied by caseation, of the regional lymphatic nodes; (2) focal tuberculosis not more commonly situated in the apices of the lungs than elsewhere and accompanied by caseation (or calcification) of the adjacent lymphatic nodes. Focal pulmonary tuberculosis of adults is identical with the tuberculosis of childhood. It occurs in at least 92 per cent of all adults. It may be acquired between the ages of 2 and 10 years but in more than half of all individuals (in this city) makes its appearance between the ages of 10 and 18 years. Tuberculosis of children does not select the apices of the lungs, is accompanied by massive tuberculosis of regional lymphatic nodes, and exhibits the characters of tuberculosis in a freshly infected animal, whereas tuberculosis which occurs in the pulmonary apices of adults has the characters of a second infection. Almost all human beings are spontaneously "vaccinated" with tuberculosis before they reach adult life.