The Role of the Bronchial Tree in the Pathogenesis of Pulmonary Tuberculosis

¹ Waverly Hills, Kentucky

1) The normal bronchial evacuation mechanism is briefly reviewed.

2) This normal bronchial mechanism may be truly as effective in protecting the individual from tuberculous reinfection of exogenous origin as the lymphatic system is effective in preventing reinfection from primary foci situated within the lung.

3) The mechanical failure of the bronchial tree to cleanse itself of infectious exudates plays a leading role in the pathogenesis of pulmonary tuberculosis.

4) Certain factors which might have a definite influence on the retention of infectious exudates within the bronchial tree are discussed as follows:

(a) Physical obstruction and developmental abnormalities.

(b) Degree of allergic response to reinfection.

(c) A difference in functional ability of the bronchial tree in apex and base of the lung in determining localization of pulmonary tuberculosis.

(d) Alteration of the normal functions of the bronchial tree following collapse therapy and its effects on the drainage mechanism.

(e) The effects of pathological changes within the parenchyma or within the interstitial portion of the lung on the evacuation mechanism.

5) Exogenous reinfection tuberculosis is no doubt much more common in all age groups than generally believed.