346 SCIENCE PROGRESS 



When early maturity is reached, the struggle for existence 

 becomes keener : overworked and underfed, shielded in many 

 ways from the invigorating influence of sunlight and fresh air, 

 both sexes then frequently succumb to the acute forms of 

 pulmonary tuberculosis. 



Two factors inseparably correlated and mutually inter- 

 acting, namely a virulent infective strain coupled with a 

 greatly diminished resistance on the part of the host, are 

 responsible for the grave form of the disease met with under 

 these conditions. 



By far the greater number of such cases of tuberculosis are 

 pulmonary and the distribution of the lesion usually at the 

 apices of the lungs may be accounted for by an hypothesis 

 similar to that above invoked to explain the distribution of 

 miliary tubercles in the lungs. 



It is noteworthy however that in the common inhalation 

 form of pulmonary disease the lesion is not always accurately 

 at the apex of the lung but situate slightly below and to the 

 outer side. 



The areas of lung affected earliest in the various lobes 

 correspond also with accuracy to the distribution of the main 

 bronchi, as has recently been pointed out by Dr. Lees. 



Diagnosis of Tuberculosis 



Pulmonary tuberculosis in very many cases is amenable to 

 treatment and for this reason early diagnosis is of the first 

 importance. No surer method exists than the finding of 

 tubercle bacilli in the expectoration of a phthisical patient but 

 it is always to be feared that the disease is firmly established 

 when bacilli are present in sufficient numbers in the sputum to 

 be detected. 



Many tests have been devised to ascertain the presence of a 

 tuberculous lesion : all are open to objection, particularly in 

 view of the extreme variation in response which individual 

 patients show and the consequent difficulty in forming an 

 accurate estimate of the extent of the lesion, the activity of 

 the infecting agent and the degree of response of the patient. 



Most of the tests are not without risk, in that they are either 

 productive of immediate harmful effects or so lower the general 

 resistance of the patient that they may reactivate foci of the 

 disease previously quiescent. I have personal experience with 



