By J. Smart (Auth.)

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3. Pneumothorax: from rupture of caseous nodule. 4. Caseous tuberculous masses in pleura. —Endobronchial tuberculosis is invariably present in the smaller bronchioles in infected area of the lung. Larger bronchioles and bronchi m a y be involved, giving rise to redness, oedema, superficial ulceration, deep ulceration, granulation tissue. The mode of spread in the bronchioles and bronchi is:— 1. B y direct implantation from infected sputum. 2. B y lymphatic spread along the bronchi. 3. B y rupture of a tuberculous gland into a bronchus causing a deep, penetrating ulcer.

Pulmonary tuberculosis shows an unexplained rise in numbers above age of 4 5 , in recent years. S E X . — I s not a factor. R A C E . — V e r y fatal to negroes. Jews, low mortality. E N V I R O N M E N T . — I m p o r t a n t . Bad hygiene, spitting, and ancillary factors, account for mortality in poor districts. General debility important. —Influences: (1) General, as in environment; (2) Special in certain occupations (see P N E U M O C O N I O S I S , p. 104). — PREDISPOSING TO I N F E C T I O N or to spread of a latent focus:— 1.

Shows dense shadow on affected side with lobulation of medial border, without crescent-shaped appearance of fluid. Rarely, detected early on mass radiography, without symptoms or signs. —Surgical removal. 5. I N M E D I A S T I N U M . — U s u a l l y in anterior mediastinum. If in lower part of anterior mediastinum symptoms of TUMOURS OF T H E BRONCHUS 35 shortness of breath—these tumours may at times be very large. —May present in suprasternal notch as lipomatous swelling. If lower down:— Inspection: Normal.

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