The Classification of Pulmonary Tuberculosis and An Outline of Standardised Principles of Management

The Classification of Pulmonary Tuberculosis

and

An Outline of Standardised Principles of

Management

By

MILOSH SEKULICH

“In all science progress is the result only of a series of continuous efforts, often ignored or unknown, and the pretended discoveries are only the continuation

or the consequence of facts acquired, but insufficiently known or wrongly interpreted; the scientific prospectors are generally isolated, often repulsed, even at the moment when the ensemble of workers follows them and of ten forgets them.” Th. Tuffier, Paris, trans. Lawrason Brown, 1941.

Ever since the time of Hippocrates attempts have been made to classify tuber- culosis. Not until the 19th century was a clear clinical division made between acute

and chronic forms (Fournet, 1839); later there was a tendency to describe these forms

as ‘galloping consumption’ and ‘consumption’; to-day they can be accurately described,

not only on clinical grounds, but pathologically, radiologically and pathogenetically

as ‘malig nant primary’ and ‘advance secondary’.

The first clinico-pathological classification was by Bard (1898, 1927). He described four forms: parenchymatous, interestitial, bronchial, and post-pleuritic.

Bard postulated the still valid principle that every form must have ‘per son evolution, son pronostic, sa marche generate, une veritable unite lui conferant la possession d’une

certain autonomic’. This system has survived until the present day, but owing to the introduction of numerous morphological sub-forms, has become over-elaborated. It

remains confusing because it takes no account of pathogenesis.

The first pathological classification, based on a description of the pathological lesions, was by Albrecht (1907). The lesions were divided into three groups: (1)

indurating, cirrhotic, healing, (2) nodular (productive), and (3) caseous-pneumonic (exudative).

Another widely-adopted clinico-pathological classification was that of Turban

(1907). Here the basis was the quantitative extent of the lung lesions: three stages

were differentiated by physical signs. This system was supplemented by the radiologi- cal findings to form the basis of the official British and American classifications. Two

further factors, the degree of activity, and sputum findings were introduced into the

British classification; in America many changes in emphasis and other details have been

made in the last 50 years, some of them being admittedly retrograde.

The first pathogenetic classification was that of Ranke (1916, 1919). He believed that in its evolution tuberculosis, like syphilis, passes through three well-defined

stages.

Recently, Dufourt (1953) like New man (1930) has attempted to combine the classification of Bard and Ranke. He believes that the ‘cycle of the infection’ can

Ind. J. Tub., Vol. IV, No. 4.