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at ar F wee fest at wert ea a Mt ae am at areaT #1 aig. wt avena—-anra pio mer 22a a art at fast amr atm freee vat drat aa vit art cite ag art Fora: tu set avr were TET 2 aafae ararg Sree oad & fe dig a are aat aren ate antiiet a A aH 2 frat amr dt arfan, wet et ae ore ara fae ZY faa 21 farce a fraeit are aatetet are arf sqactit ar avery ae at oer are ae fever afer. faef-frdt ethit at macr hat ad % fac Atsacaem 31 Teg Ta A a aT ang. aa fae ot at omar afar adi @) (aver 234 9 92) arnt,{vr ee] wament——sfarra, fara vite aetfan fete mts tafe Ser eit cori er, Sy nerete ext, ote dro weet, efron eeemer der ataata, frre vam tie, rant Peaara fede, toe tay, tio we aa © safc uae quo ate, vito Haft, site eae Ao aay witemieURAL Fl AGES write aredtat at wafgere ata a ar confers Secret serra ster sentir agate Fret eres, areata fer, seat feet (a aT 2) & dee aa afer mde B apiea Sanda cof engine, aga fafa STE aa ugtfrenaa gra & geet gq faaengt Sa & arg mgde-anq afefaa 1 wae Aer Bg fester eet & fr foe 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aqea oft feof an fader wet gq amafernar (Fhe) fara Hag darn ETB: Heredity—Pulmonary tuberculosis certainly occurs with undue frequency in certain fami- lies. Since the direct transmission of the tube rele bacillus to the infant is extremely rare, two explanations seem possible—(1) Children born of tuberculous stock may inherit an increased susceptibility or diminished resi- stance, the tuberculous diathesis; or (2) they may contract tuberculosis on account of their exposure to massive infection in early life. (P. 1249) apesafe cme faferr & gare sare a afare dat Foret snare) aaifas ar Fara came & May a feats ear meiromara & 1 aT gH aT ei a Tee HT aT wrt €—(¢) gett mere at dof a rem af amen (sad are F aya aa eT aeraT) H afe, frat awa (adtereafia) & gre et at aaa gia et; wat (X) aa Ha ae wrat-ferat & aerh we ET MYA (sea) FATT Hamer Fore ad ZI feared Fee Foot aparareaaT F eEOT FT aT areea At Ha-aghe ar fara fora 2 we HET a A marked family suggests an unfavourable course, though this (P. 1267) iat gear afirie a, at ser: Oh mare eat gt waft eae wears A eS TT EI are, incidence generally rule is not invariable.ape & at fra &: Heredity—The disease undoubtedly occurs in families, and in some rare instances infants may be born with tuberculosis. (P. 155) gern: fafa a a gad Too oat &1 0G fer gerdt Hava re TT matt at Zt see Rae eT ATO SAAT ATT ETT Strarepsit ar ear AAT STAT & 1 ae fara ¥ wre ar ae a tt xeon Z fe: far find a, fava: etait a, ter wee ara at, set Prare prem Ser GA: SHE aT F od afta aot ar mare ata aa Ha ara 21 fara: Marriage often leads to a break-down in arrested cases, especially in women, and induces more rapid spread of active lesions. (P. 1267) ment Te arora aT ara sale ge aya Conjugal infection is a very real danger, which has been under-estimated in the past. (P. 155) arate darn marr wet watt et aa oe caer ager go ater adi wat art wade var sat ata aed are worn que et seu a ere fe: ott a ger meret eh, AT eae wor Hares fay amatagr tar 2, aera aaa (caer Ae aT eft) at Gaara ae at Ewes, tara oT seem aaa Grege Sfefeafa sera eT TC TF fae sedi ato aterar wfrw wer aay Bat 8, wire Prenat at atat weit ai, at ae aha aa dat FA cee dae sIGET feheafet at waa att ot Et Et agent ar father: sata aa SB . greta anette oafea, era WIC AAT OT wedi & gare em S whreoe at Prac we ET wea, "Xe Rare ieee BS ¥ Sige ot sad qa ae ge Ge arent | age (fare) & sfeanre wer Fit & are ava: waar at ee fear fe gee det a, a sh qa acme afer) sae ett tifteht at, at sat aT aga ert afta fear 2) were Fea Tat awe sade ma gat 1 way ae Fat e-— marcaty amare aisarPraaareae: | Phaced atarie gai afeatiq dated Proqed Preaper Arar 1 aarmararente feataghogartt +1 =-nqeqfA Ho 2 ~-#E gat ad ct meta, ana, Hs, 94 ate aren & aga a, Teg saa amg Pare a tar @, sam gerdart 4 ati at, sad eareara a Bt, gat adit 1 ab-ag ata di, waa ga a, ata, wma (aaot-fanre), wren, fers whe Bs ET HF Ge a, Tr ste fare a wea wafer fare S aqaa-fae ea var mem Pratt me Tre art ark fat ear aed git, eaar ofear aa oe A ae aT wea LL Tea hae aT Fa a arrarrennfacsy qe weadreatt 11 a aaa sacaq qadtars sfefat i ra maadt ae marae aa aT feqne ea, Tey A ada a at Bat afer wom ie ag wferar Shae gare ate Frans Fifa, fest a wafer ater svar ari oof, or ante at at era afer A ca BR dat feare a wade) Fa dt aaa ga oH eat a ATT fase at avi wafer frat at afata garer sere. ‘i (arraga) 3 owen 1 fine 3 war, Pears Berar tr ea aaa Ese ter at ara fant are fare st aren a at) weer & arg fafir Hafeta at sere ara at var ate SF at ReSON: Sh ESSE DION, S80 ace at soptaat at afer dt ag ar fe fafa ote aeaey adt aera we fed wT; TX TAT Ba at fara at reer ga, wearer eA Te aT cea are Tea areer oT aT. . ae TT aaa ar at mat! oat, ae at thea rc wafinor, meré anf gah are feb ae ga ae ofata atte errant arpa F fay aia fem am er wa ae adi @, oie aa aT wal at det fgg Foe 21 zea et a rand faa a ae tata fae Cra AT ant er} art atewe sat feat are at fact % art ars feat om, 95 yet AAT! sarer ae 8 fs Farr gat ee ay anf ae (wer set aa tit A aeHr) at, sae PraTe- aaa adh wer ate dr & acta at wt ona 2) he ate ger siinfreara, sivivar, dasa, are ar sen (weenie) fe mao dae war 2, at sat serrétar # 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1 waarrea 4 area & ferear a waster aT aim a) ea; ae FT dae Aa Fa feet a edaraaraat %@ oTet #1 Omer safe aie fre—aer vga ari oe farare ae ge wt af am Pri mart eT reaaT TT, aT fret aero fat (t) gt ot: afer a dar (3) are mr ater a agai dtr (3) am a Rea oz or amera dat (¢) weargarrng 7 sat (4) afew a mar sin wet oe at ardfee are azar 1 sréfien weredi H—(¢) uPreiz, (2) vara at atari ara, (3) fee aT deartiaraat deere, (+) afersife aie ware tt afta aT aaa eq fare oT wera & taestaa—— za thr a ary ert a at fersat on facie carr 8 ve ae TTT AT cara waar 81 sfaeara @ ait dior 21 ary Hone, art Hae FY er za AF (&) frfeeara—(farar freaat 2) 1 (%) agay (are frvaat 21) (3) faaa—arridt ae fieraar 2, fia ( ( ( ( crretan—art fafa we Presa 21 wt met Free at aaa aH fracrar @, Fat are at aera: fafeaarfe ach ar gata 81 dar gat cranfedt ata at fasta at fag @1 I—~ LEG 98ent fifrera far vt ter war & fe era Oa a Bt TT fafrors wan Afra awa sera wt Rag, ae wrt wie gia ard Odi at qa a ar 21 ya ot Patrerarar a ty anager Ofrat ar fafa wet er waa fara 8 SA rere aitafaatT aa ae ah feat at weg ate tm fafrrrrrers ya ar TH saree fata— qari ners 21 Bari & wie faofedt a eames ayrat dra fafeeaat § oe Before Se fern aefar Fo cher wa fark ¢ wftera a farét ramet fret ret um sfrz aa tr fadon Faery “iorefece” fared & fa, Fa FAT H Loos Fay HT aTeT AAT, aera Wa fear ar) et H soo afay acter oma: Tope ar faa eee aaa Paes ara qe area eat tat afer | (2) faarsaz, eeqion, apitfra, sate, tnfaar, ara, art att, sisters, get smitr tt, We, graeme ( set), ead, moma, wae, aad, wate, rae eaeie ar ae ware B ake ae te ek ga a wet? (3) Sit & ofeare Fo oat Pret a ar tr por an am at? eh cet erawes Ofna & as Fagan ra? (3) ait af safer, are, anit ar great & varet ar af artarar maar afew aT atefeas farar ¥ gar gar at adt 2? (¢) sae ort ar fee ARATE aaa, ofa at erat arn (satan & va WIE srt aE), erat aft Raa, zartaga dar gat ga-ttar sep farmer, eee azar wr Bre afew gat ahs wert af sheate frat gare: ara ortifoe soma Gol Feat rer Tedt BHT ATA aT Yoo & tov fait am arate ora 2, wet TT a att ara @, srecara atdl aefers sacar a ys, fac ag fell Feng ee A art @, get width sare afies we ater @ ste oT are frat ant At ater a oa 21 (x) we at ward oe ae aya Gee fread @, eH THs BET Tee e, Hote aT A TetAT wet Te aH F ster seta TT 1 (&) meat (a-firer) are Gaga a fre aa oe een a ont 21 exearaear H gagat arqaat faa aa oe faa feet care at ara aa vedi fg; ane amdtat ae wah ve ote (9) eadtn a oder & faq waar Oe Sree HWE, Rk TET aT AHR HUET TE TTC ame at eter ae fret eat afer, ea a mr TC a in foi aed FIAT fat ZA (5) qadt ef $ aamer BA oe a ifs ari feito Fert ay ore 8 (&) samet Ot at aver ert car Hq FT waa eat att B 1 (to) afe afaanfer ox att ste 3 var says 1 se area Het A caf we at TG, pegs ferent. vat} feetaar at, wrear ai arate cafe grt 8 ara, att oa eB aret wet a 24 ware a4 oe dt Gaga aera & safer a, areas F gypa at fasr eet at, ardtfer aera (are) wre: ara tar are at Frere aren anfer fie ag ori corenrred et vat 21 ale zo aren,TUBERCULOSIS By Late Dr. D. N, Banerjee, 1, B,(CAL.)M. D.(BERLIN) Fo Mo To Tro ww mt ag ter Saw rer fears gee “aeratish! ew wit Et EA geez fe sivet erga wa ge wht & ate agi; faa Reade mee aera AT TAT be Ot frea-gel & eet fata eq 8 ga fara a afd wear at site ga fers oe TET res wife gta & wren canes ea Age ae Seat area Fai’ ares Gere FR finer dee rar ferafier feedi wr seit gt awa g; ewer Fea smart eg Rare Cat et aT eT aT omega Ae ele frdqare faa & era dare wee, Saat fede Hameed wanfirs feat wT eer el aEHTE, weet mga aie rarer eT re der a ferme BF ata ot feat wa fanet mr ara nest at ater, fee tat oar weer F fe cel % feed ag ae ager gt att ao aENee Tuberculosis is a specific infectious dese- domestic animals to he infected. Monkeys ase causcd by the Mycobacterium tubercu- usually suffer when confined, It is present losis and its toxin, and characterised by the in all races and all climates. ‘The mortality formation of nodules called tubercles, A from Tuberculosis is rising in India, In Tubercle is an inflammatory, more or less circumscribed nodule, which undergoes degeneration in the form of caseation, necrosis and ulceration -or heals with the formation of fibrous tissue and subsequent calcification. human beings one-seventh of all deaths are due to ‘Tuberculosis. More than 90 percent of all individuals have a primary infec- tion, of whom about two-thirds develop a re-infection. OF these reinfected individuals, half get absolutely well. The course and progress of tuberculosis can be divided both pathologically and linically into different periods, each having quite distinet and peculiar mani- festations, of which the tubercle Mortality is high along the first formation is a particular phase. five years of life, followed by We may employ the name phthisis for this a fall of death rate during adolescence disease-entity, Tuberculosis is only a special with a rise of mortality, being very high reaction form in the course of phthisis, between twenty and thirty years, especially Tuberculosis is a widespread disease in in women. ‘The children generally. sufter the animal kingdom. Man, domestic ani- from tuberculous affection of the lymph mals, even wild animals are subject to the nodes, bones and joints, the so-called surgical disease, Cattle are commonest among the tuberculosis, In the adult, the lung is the Age incidence :—It is rare under one year; afier the fifth year it is more frequent, and most frequent between twenty to thirty. Dr. D. (. Banerjee. are, 2 u stBAO SRM Tuberculous Tumour of the cerebellum. commonest seat. Bad hygienic condition, poor food, lowered vitality predispose to the infection, Sites :—(1) Lungs—This is the common- est situation, being affected in about 95. per- cent of the cases, either primarily or secondarily ») Serous_membra- from some other focus, nes, ¢. gy Pleura, Peritoneum, pericardium, meninges etc. (3) Lymphatic glands. (4) Organs——Intestines, liver, kidney, spleen, brain etc. (5) Bones and joints. (6) fibrous tissue and muscles. (7) General — This is generally known as acute miliary tuberculosis. In this condition the organism circulates in the blood and is carried to dis- localised meningitis or arthritis or tuberculosis. In adults, the are the commonest situations of the ¢, whereas, in children, glands, bones joints are usually affected. larynx, tant parts, causing either €. g4 tuberculous general miliary lungs lesions, Sources of infection :—-(1) Sputum— ‘The patients suffering from pulmonary Tuber- culosis expectorating large quantity of tubercle bacilli form the main (2) Milk obtained from cows, suffering from advanced tuberculosis, is the souree of infec~ tion. Cow’s milk may also be contaminated by puman type of bacilli when handled by per- suffering from tuberculosis of lung, contaminating it by coughing. (3) Urine and source of infectis sons, BR AER ON, EUR Lo Sc faeces from patients suffering from tuberculo- sis of urogenital and intestinal tract may also act as the source of infection. (4) Dis- charges from tuberculous sinuses or milk from tuberculosis of breast are also infective, (5) Blood of the mother containing tubercle bacilli may be source of infection to the pla- centa and subsequently to the foetus. Mode of infection :—(1) By inhalation- This is the commonest mode of infection. ‘The dried sputum of a tuberculous patient containing a large number of M. Tuberculo- sis, c.g, from the dust, from sweeping of the floor, wall, handkerchic& etc, or the organisms in droplets of mucus expelled from coughing, kissing, sneczing or even ordinary conversation, when inhaled by a healthy individual may reproduce the disease in him. ‘The infection takes place through inhalation, is proved by the facts that the lungs are com- monly affected and persons in close contact with tuberculous paticmts are affected more than others. (2) By Ingestion—The tuberculous mat ial is taken up with the infected food material, commonly through milk, The organisms are Disseminated acinous tuberculosis. eng,either taken up by the tonsillar mucous mem- brane or are allowed to pass into the intes- tines. The organisms can enter the body through cither intact or abraided mucous mem- brances. M. Tuberculosis coming in direct contact with any mucous surface gets absorbed into the system without leaving behind any area of destruction which may indicate their path of entry. the they carried by means of the lymphatics to the cervical lymph glands causing cervical aden- itis. ‘These glands become infected one after another and either burst externally or may From tonsils are Tuberculosis of the spine. were, XY LORS Tuberculous ulcerations of the small intestines infect and From the tracheo -bronchial glands ultimately even the lungs. themselves. the intestinal mucous membrane the orga- nisms enter into the mesenteric glands causing tabes_ mesenter ‘Thus the sequence of events are ‘Tuber- culous ulcer of the intestines—tabes Mesen- tericaTuberculous peritonitis. When the organisms enter through intestinal mucous membrane they may cause primary Yes mesenterica. without — producing intestinal Again the organisms pass unopposed through the intact mucous mem- brane as well as through the glands, produce ing primary peritonitis, From the peritoneum the organisms may pays up- wards through the lymphatics and may in- fect the bronchial glands or the lungs. a and. subsequently periton- itis, intact any lesion. tuberculousSO 4% LGN M. yr OSes Tuberculosis have been obtained in pure culture from hundreds of _ tuberculous patients all over the world, The bovine type of bacilli could be found in only an of such cases. astoundingly small number The organisms causing pulmonary tuber- culosis are usually of the human type, whereas those causing intestinal lesions are commonly of the bovine type. Bovine Tuber- are more virulent for the cattle than the human type of bacilli and the for- mer are commonly found in affections of glands, bones and joints. Bovine type of infection has been experimentally produced by feeding monkeys with milk from infected cattle and also with meat of infected animals. Natural infection of cattle is commoner in Europe than in India. Pigs are also found to be infected, In some cases the sputum of tuberculous patient is swallowed by him- self, giving rise to intestinal lesions of the human type. In the intestines the areas cle bacilli Tuberculosis of the kidney. The kidney has been divided into two to show the interior. In one half the caseous matter is present, while in the other, it is removed by washing showing only the cavity. 5¥ Showing miliary tuberculosis of the lung from rupture of the cascous hilar lymph gland into the pulmonary artery. richly supplied by lymphatics are commonly alfected. ‘The infection of the stomach is rare. Of the intestines, the lower part is readily affected. Tuberculous lesions of the large intestines are not so common, (3) Through Blood :~In case when the bronchial glands are affected, caseation take place with adhesions of the neighbouring structures including the blood vessels. If the wall of one of these vessels is eroded, the caseous material is poured into and carried through the circulation into distant parts of the body. If one of the bronchial arteries is affected the organisms are carried to a part or whole of the lungs causing acute pulmonary miliary tuberculosis. In case the caseous matter is evacuated in the pulmonary vein, it is carried through the body, particularly in the bones, joints, urogenital organs etc., causing acute general miliary tuberculosis with or without localisation, Unlike Typh- oid or other organisms, the M. Tuberculosis dose not grow while circulating in the blood. But it ix transported from place to place by means of the blood current giving rise to local or general lesions. ‘Thus the lung acts both as the receiving and broadcasting station for the organisms. M, Tuberculosis may aed,A portion of the tubercle in a lymphatic gland. reach the blood from the lymph channels via the thoracic duct or in some instances the thoracic duet may itself be tuberculous. Tuberculous infection of the intima of the blood vessels may also be the source of tuber- cle bacillus being directly passed into the circulation, (4 Through continuity and contiguity of tissues :—The pleura and the peritoneum are very frequently involved on account of their proximity to, the pulmonary and intestinal lesions respectively. As contents of the bron- chus the Tuberculous material may be carried during coughing to another bronchus and finally to healthy lung. (5) By hereditary transmission : This may be through spermatozoa, “ovum and placenta. Generally speaking ; tuberculosis is not transmitted through actual inheritance. The children of tuberculous parents are more pre-disposed to infection due to increased chance of exposure, diminished resistance and in- creased susceptibility. (6) By Inoculation :—In this condition the disease is always local and is commonly found in butchers, taxidermists, veterinary ‘wore, "A surgeons and those who perform post-mortem, examinations. The infection takes place by the inoculation of tuberculous material of the dead animal through some abrasions present on the skin of the person infected. In case of butchers a localised wart like growth, tending to be very chronic is produced which is known as butcher's wart, Such infections are self-limited and rarely lead to pulmonary or other widespread infections. Mode of Spread :—The spread of the lesion within the lung may take place in one ot more of these ways—(1) by the lympha- (2) through aspiration of tuberculous material from a recoverd area into healthy portions forming tuberculous broncho~pne- umonia and (3) through involvement of the lumen of the pulmonary artery by the and transmitting into other parts, producing the miliary ‘The organisms leave the body when the lesion is situated in direct or indirect. communication with the exterior of the body e. g., in the Iungs, ali- mentary tract or the urogenital tract. Acute Miliary Tuberculosis :—T condition is characterised by the presence of a large number of small grey tuberculous nodules, all being more or less of the same tics tuberculosis. Tuberculosis of the thoracic duct. ByTuberculosis of the heart age and same character due to sudden extens sive dissemination of the organisms through- out the lungs or throughout the whole box The occurence of acute generalised tuber- at least 6 factors. (1) Exis- tence of previous focus, (2) involvement of blood vessel, (3) Liberation of large number of virulent organisms in the blood stream, (4) an allergic condition of the individual and (5) the lesions are generally discrete as, culosis requires ficient time is not available to coalesce together to form large masses. Miliary tuberculosis indicates that the tissue finds sufficient time to produce local reaction in spite of apparently very heavy blood invasion. This shows that the tissue must have attained a certain amount of, immunity beforehand due to some primary focus, otherwise the heavy invasion would have caused death, The presence of tuber- culous lesions in remote organs at once sug- gest that the tuberculous infection must have reached the organs through the blood stream. ‘As the number of the organisms are much, small, the lesions naturally localised. But on the other hand, if the discharge is heavy, the lungs will show a large number Bq Miers con NOES of miliary nodules, all of same size and app- earance, This constitutes acute pulmonary miliary tuberculosis. If the material is dis- charged into the pulmonary vein, the bacilli will pass through the left heart and aorta and will be distributed throughout the whole body, forming acute general miliary tuber- culosis, Acute miliary tuberculosis is bacteriamia manifested toxaemia like and is acute general clinically as that of typhoid fever. Tuberculosis of the liver, The symptoms closely resemble those of Typ hoid fever with meningeal complications, The Common seat of miliary tuber- culosis :—The lungs are affected very fre- quently and most extensively. Then come liver, kidneys, spleen, testes and meninges. Ovaries, breast and voluntary muscles are rarely affected. Pathogenicity :—Tuberculosis is the re- sult of the fight between virulence of the or- ganisms vs, resistance of individual, Pathogenicity depends upon (1) Virulence of the organisms, (2) the dose of the organism, (3) resistance or immunity of the tissues of the individual and (4) the degree of allergy to the toxin of the tubercle bacillus, All cultures of tubercle bacillus are not patho- genic to man nor to all animals. The bovine are, thestrain plays a very minor role in the produ tion of the human pulmonary tuberculosis. All human tuberculous lesions of the lungs are due to the human type. The affections of the bones and joints, lymph nodes, the snrgical types of human tuberculosis and also many cases of tuberculous meningitis and general miliary tuberculosis of children are caused by the bovine type. It is a common fact that both types are rarely found together ; thus the occurance of pulmonary tuberculo- Lobular and acinous Tuberculosis. sis and surgical tuberculosis at the same time is rare. The produced by one type protects. the individual from infection with the other. Bacilli of human type may not infect the cattle and vice versa. Again, the question of tissue resistance plays a very important part in the role of infection, some tissues being more vulnerable to infection, than others, immunity urea, 4 Tuberculosis is mainly a disease of civili- sed people, who live in populous aggregated towns. Long continude tuberculous diseases in civilised people often confer increasing degree of resistance to infection while people living isolated but coming in contact with civilised races show absence of immunity and. so the disease takes a virulent form. The pathological condition produced in the human body by tubereulosis are (1) for- mation of a tubercle, forming daughter and grand-daughter tubercles which may ultim tely agglomerate to form a tuberculoma. Caseation, sclerosis, calcification take place according to the progress of the disease. (2) No organ or tissue is exempted from lesion of tuberculosis. ‘The organs commonly affec~ ted are (a) lungs and pleura, (b) _alimen- lary tract, (c) lymph nodes, (4) bones and joints, (e) kidneys, (f) liver, (g) peritoneum, (h) meningitis, (i) pericardium, (j) miliary tuberculosis affecting the whole body. Morbid Anatomy :—The carliest cumscribed tuberculous lesion is a tubercle, cir Fibro—caseous Tuberculosis. BeCaseous Tuberculusis. ‘This is a very small, round or ovoid, raised nodule, generally colourless or transparent, often white in colour on account of central caseation. The size varies from pin-point to a pea. As the stage advances, secondary tubercles form surrounding the original one with involvement of the vascular supply of the central part resulting in necrosis. ‘The central necrosis is not only due to the want of blood supply, but mainly due to the direct action of the toxin of the tubercle bacillus on the tissue elements. This toxin may also Jead to thrombosis and necrosis of the cap- illary wall thus providing further avascula- rity. The nodules may be single and isola- ted or may appear in large number dissemi- nated over a great area of the same organ or distributed on several or even all the organs at the same time, Fresh tubercles appear surrounding the necrosed zone until all the tubercles coalesce forming one single mass with caseation at the centre, called tuberculous. In the case of an acute process the extension is rapid and encapsulation rare ; whereas in chronic con- 5G SOOM WOR ditionsa large amount of fibrous tissue sur- rounds” the focus and may often check the further progress. In very chronic conditions the encapsulation may be complete and no further tubercles form outside the capsule. ‘Three stages of pulmonary tuberculosis are usually met with, viz (1) Congestion, (2) Consolidation, (3) Cavity formation. The above process is true for all tuberculous con- ditions whether of glands, organs, bones or joints, Nutritional disturbance is the rule in all tuberculous Iesions, hence, sooner or later caseation takes place. The cellular elements undergo cloudy swelling and fatty changes and form a cheesy mass. In case of chronic conditions it is encapsulated and in some instances may be calcified. Calcification does not mean that the organisms are dead. They remain dormant and may set up an inflam- matory process at a later date if the soil become favourable, Complete healing may — take place by fibrosis. Tuberculosis of the animals -—Ani- mals are also liable to be infected by M. Tuberculosis, Guinea-pigs and rabbits very susceptible to the infection. animals particularly the catlle are often natu- rally infected. The infected cattle show no symptoms of the disease unless in an advanced condition. ‘This is the why tuber culous disease of the glands, bones and joints are so common especially amongst children, Pigs, monkeys, goats, cats, horses and birds are also found to be infected naturally. Bovine T. bacillus is more virulent to cattle than the bacillus of the human type. Immunity and susceptibility :—A man or an animal already infected with M. Tuber- culosis reacts differently, from one not so inoculated, to subsequent infection of the organism or its products. This allergic res- ponce in tuberculosis may be indicated by no symptoms at all, or by symptoms of high fever, cough, anorexia etc. are Domestic reason ent,Primary infection and re-infection :— The active tuberculosis of the adult is the result of re-infection from outside. The pri- mary infection generally takes place in the Jungs and may occur in various parts, but the sites of predilection are the upper lobes, especially of the right lung. The primary focus of infection of the lungs is, as a rule, subpleural. This explains the so common attacks of pleurisy, which precede an attack of tuberculosis of the lungs. The primary lesion undergoes caseation but cavity forma- tion does not take place. In a majority of instances the primary infection heals com- pletely leaving only a scar which may be calcified or even ossified. The primary effect of M, Tuberculosis with respect to the lung is usually mild and less destructive than that found in later stages. This destructive behaviour in the later stages is entirely not due to the causative organism itself, but to the allergic changes in the tissues, produced as a result of the primary lesion, The lesions of re-infection are usually multiple and generally affect the apex of the lungs, about one inch below the extreme tip, less frequently other portions and are situated more within the substance than subpleurally, ‘The right lung is affected more frequently than the left one. Healing takes place by the production of fibrosis, The lymphatics are blocked early so that the tuberculous material rarely reaches the regional lymph nodes, rendering the tuberculous focus more pig- mented. Calcification of the caseous material may also take place. Endogencous re-infec- tion is that due to metastasis in the lungs alone or other parts of the body from tuber- culous material derived from a primary focus already present in the same individual, Exo- gencous re-infection is that due to infection of the lung, already the seat of tuberculosis, with tuberculous material from further exter- nal source, The primary infection generally takes place in the childhood which leads to arret, "a Fibrocaseous Tuberculosis of the lung with cavities. immunization of the individual so that the re-infection in the adult, as a result of fresh sufficiently massivs infection, breaking down the immunity, leads to the formation of fibro- caseous type cavity the lesion of the primary infection is more caseous, with formation ; while Tuberculosis of lymph glands :—Tuber- cle Bacilli, gaining entrance into the lympha- tics from the mucous surfaces of respiratory tract enter into the lymph glands through blood. Caseative form is the commonest form of the disease. Tuberculosis of bones and joints occurs commonly in children in the first 6 years of life. In children the pro- cess is slow. Adults are however not immune to it. Tuberculous arthritis happens in the majority of cases but the infection of the joints may occur primarily. In long bones, the epiphysis is the site, In short bones, the disease begins in the diaphy- sis on account of their arborescent blood supply. Tuberculosis of the vertebrae :-~The spine is the commonest site of bone tuberculo- 12 commonest Besis, because the spinal column is subject to many strains through weight bearing. Fur- ther the spine is so deeply placed that earliest manifestations are obscure and complete immo- bilisation is difficult. Commonly the centre of the body of the vertebra is affected but in adults it begins under the periosteum on Tuberculosis of the chest wall This is generally found under the following conditions :—(1) _Pleurocutaneous as complication in some cases undergoing artificial pneumothorax treatment. (2) Infec- sinuses Pyopneumothorax. Note the great downward displace- iment of the left dome of the diaphragm. tion after thoracoplasty or extrapleural pneumo- thorax, (3) Tuberculosis of the rib, sternum, perio steum and cartilage. (4) Extension along the endothoracic fascia which lies between the ribs on the outside and the pleura on the inside and containing channels and lymph may form, which may burrow between the ribs and present itself under the sl numerous lymphatic nodes. A cold abscess Intestinal Tuberculosis :—Sources of infection—(1) by drinking tuberculous milk ge and (2) by swallowing tuberculous sputum, It is of five types—(1) Ulcerative, (2) Hyper- trophic, (3) Mixed, (4) Tubercular and (5) Polypoid. Ulcerative type in children and adults :— This is both primary and secondary to lung infection. The small intestines is involved in largest number than the large intestine. Hypertrophic Tuberculosis :—The _forma- tive process isin preponderance to the des- tructive process. Common in young adults, Mixed type :—Main changes are of pro- Pyopneumothorax opening into the abdominal cavity through the diaphragm. The opening is seen at the base of the left chest. Note displacement of the heart and the mediastinum. A band of adhesion at the apex prevents complete collapse of the lung. ductive type in which there is a marked local- ised thickening resembling a tumour mass. ‘Tubercular type :—There is hyperplasi of lymph nodes and lymph follicles only. Polypoid type :—There is noduler or finger like process of different dimension projecting from the surface of the intestinal mucosa. Tuberculosis of the Kidney :—kidney is the commonest site of tuberculosis next to ou,the lung. The course of the disease varies from a few weeks to years. Tuberculosis of the kidney may appear in any one of these form :—(1) It may occur primarily due to Showing giant cells with round and endothelial cells above and caseation below. acute general tuberculosis, when both the jdneys are affected by miliary uxberculosis without marked symptoms. This form is more frequent in children. (2) It may be secon- dary from tuberculosis affection of the bladder. ‘The infection spreads upwards and attacks both kidneys. This form of tuberculosis gen- erally affects the young adult males, (3) The kidneys may be affected from primary Iesion of tuberculosis which generally involves one kidney, ‘The infection spreads from the ureter to the bladder and also gives rise to a tuberculous Young adult males are frequently affected. pyonephrosis. Chronic Tuberculosis of the Kidney :— Ghronic renal tuberculosis may be divided into four groups, e. g. (1) tuberculous ulcera- tion of the apices of the pyramids, (2) chronic disseminated, (3) cheesy cavernous and (4) mixed forms. Chemical pathology :—The urine gen- erally remains acid so long there appears no secondary infection, When caseous ma- terial from the kidney appears in urine it becomes thick and turbid often with presence of blood. Urine shows the presence of M. Tuberculosis by examination of the centri- fugated depos Tuberculous bacilluria :—Urine may contain bacilli, even when the tuberculous process is in any part of the urinary tract other than the kidney. If the kidney is in- volved, urine will contain the bacilli. Hence the presence of bacilli in the urine is quite consistent with the absence of any gross lesion in the kidney. Bladder may he infected from the kidney and the ureter. Tuberculosis of the genital tract may be due to infection of the epididymis or the seminal vesicle of one or both sides. Tuberculosis of the genital organs may be primary and may produce a renal infection invariably and conversely the renal infection involves the genital tract as a complication. So the infection, when primary is always blood borne to the epididymis. When secondary it follows the primary focus elsewhere, In the female, the fallopian tubes are the first to be involved. The infection may extend to ovaries producing adhesions and matting up of all neighbouring structures. The in- fection may spread from the tubes to the uterus producing tuberculous endometritis, AIS aeqeaea efe & fata aat at far BPRIR oe Ue Te, We To THe Ceo FaTTRT veferera aera ag, OR. &. GH Ge. freq Feed erfecMEaE mea Feat, UR. CR. Afera eras, wate et fara 8 orgies gol fetes & 1 mraa'e wie ete oe sa eT aarafinere & 1 ore etngel Ser afern orga a’ A arene refer GA ER Et TMT & eae a man dente A gt aww mate at &, weg Sera ag areieit a ssfrera ot aga afore B eva gee fem geet at ghee fee ee Se aR ate iett a erat wed et der fe rege BT AR gee fie carrera & reo ga Ser A sie A ea arf we aH se via mut sist gfeargare wef fat are 1 erearen afte & erat ar ee rere fait ait sat H eartht F ater] Mycobacterium Tub- erculosis (Commonly known as Tubercle Ba- cillus, formerly known as Bacillus tuberculosis) ie erm seve gE fret, Foerster maar eq sit at serfe ert aa wait a ATT Hoga sera ae, wea, wrt Te oT, waar qaranitr gad ¥ ofeafaa a ore vent oftaia ait gu rae 5 fafaa sare % earfae car aaifre seit #1 seafa eit Qt ores aanfast at at a fe rde arate wt dao are Fare a refer cer rea rat aT TAT | aT aie Rach weit aati at aaa 21 aq otss? Ho srH (Koch) 4 er Hem Famine gat a aren aaraT a, ferb ararpare za Fiery aT Koch's Bacillus WY Fer ae) artes ardifer frefaqrs wait 9 gr tempt at oofeefe awe don ar faera Gor ora eae ae aR ae ere Ha wre we welt ow Pret car afer aA EI are & Teh eRe ot reba reat 2, oat AT a ret wer a frat Zeer ea a ge Stems ede agi ee aa) yo Tee Hit ag Stary Sh fer ow Sif waTte1 Teg TH feco ca atery & fat dtr arn @—Priiva: gare er a ae qiefien tT we aft caer aret Hg eae et ort etx sfaere actif afas at ata a Ostrany & fae wae ar orate fea apa Ht A, TTT wer sft Fost atarter erat a; veg det ont ae Hans F Fa were wae eT frat 21 saa aatnasttampit wT H, faa: feet & Ser sere aT BAT ra 8 Tere vara & errctestaropsit Bape a Fate aif aa gat 1 avatar oat arafae Sit ware & ardastamy age & fer wert afrarer war aren art ort é1 see Wa eerstany ae aaa aT and,age and Boe a ere & oe h, ot fe gerne arrvent & area at atrar & ate wae & ear aTt ara ata erat @ oie gaat aT raat aa ge 8, fe Aor sr era-afraT ye are wae eee ea ga yaar a paar aaa & Praga tetamy mee A war ae aeT Zh erated TT H were a aft aE Det ACT ae & data at ara 31 ced waiter erat aren & wart art ort Bi rater aT ery afie Ut wett Gretn sfaa adi dit; elif we were Hoar aaa 21 eg aera Sarena sera oretfew area Bt Mer wamat & ara t erG amie vd 21 aa satire Oral F aeaes 8 ag a Soret safe ATT ‘omar & far rafaent # arar & Creat HITT A OTT & car # drcttary date dee A Oe sera dar reg BR Ofiai at er aga a AE aratfrar & water F aren ware W thar-wfa- Sfrsr-afaa & gra ar ara wt at ee Taya Aargnfiret meat arifer Samrat at tm aaTOTTAMAT HE TTT TI erat serysit meray arden ge, arate gfe, afta, weareenee ara-aaa, va, wha, oH ae, StF Reread deat, Fafice sae, Ferd % arcane wire, a4 fer ort ST, Mea SaTAT TE var fearTATT eae ot enrdier & serfer & fay ov de aad aT ser FET aT a Tee eH rae Fe Straropsit 3 etamror erat tear AF et Meteafer aét at 210 ter ennfee deafeafiret afer & are dare Bare A faeht Se- trary Or sera wea HF a AA 1. see Ht Aa-srer- pai att ger, sateen aan ager at Oer-afertfire caer B areerea B seqere ft Sera wT fader Fina or awat 21 aftand de-stary avai ey 7 weartey gree aa HE Tae, WHE wT AY a rare, 2 Seta & agar & gear eres eavafen tesfrdfrerafea er gra a at ae Chita aed 10 ata os ena & eafna a stare agt arg aeron a we He HTTPAT A gat ara afera Shere eran aE TAT EAT tar at ter aren 2 fe aater-strarsal & Pro gear at Coit arrreer eareemara Te Re aT aT feat €1 0 a aad ate atte & faferce ser fearg vst &, ate tote sat afer oe a a aye wat ert and Z) rearet afte & ga tr % facia ar Prema ‘sre 8——aatrr H Kary et Tener ze TAT Haat F ait wag wae wT gr Wt aaa amar & Hempat sr gear adh dar, aa ae reserves a-freta at Peare re aaa Bree aires & aa & rai Fy aaeararse Hear ora 2, dafaotas adh war ar RAT) att Tate Pepsi wr wera fed fae atte & eae farwareas arate adt tat afer qa a, wa a, aa a, orarag & sora rat a, wfeton- aqeama %, geqsacimar ara aan afens ara wetset ada ar az a, aatt ateita carat at aettathe ota ae eatin & serra ar genet aa Fe are a faeaaeme ce-fasia at anar dower teefinia wegenn A ow oat at gat aarar te-facia fag ate sent sort qresreaanes Ht gfe % aad wa 3-4 fr “cuaregtia 20", quired seen, aatemercre reer, wana Taher, waa Teen, gone | ETAT frag aia agt earn & Bar qewa adi 21 crear weiter genet fara dt arar 21 ore gfe vate a far ate vt sir ara aét te oat 2, wet Pe rad adi a aman vee Baa dt areal Hard sarees at, ag waist, we owaTT, wor, qa fava, adterafeat, arétatert fret azLN KO arafaa a—amtr at aman at aeaT B ceara areat # faeafafiaa eat car sreat & aati er area afer 8, faak ag wate tar fe vere amr are arr arate Feat at a1 sah aaa a aaa A awa 2; TT area a a & afna vat 2 1 oath a meat a (2) anfitet (Nose), (3) erat (Larynx), (3) witiafre (Trachea), (¥) Age (Lungs), (4%) forgt, (Tongue), (&) afar (Pharynx), (©) ‘rarera (Stomach), (=) ara (Small Intestines), (&) yaaa (Large Intestines), (te) 30EF (Caecum), (%2) See Jey (Vermiform Appendix), (%%) qaafret (Rectum), (2) cater (Spleen), (2%) gerrawar (Pericardium), (24) gaatrar (Peritoneum), (2%) geatearafer (Mesenteric glands), (Qe) gafafget (‘Ton- sil), (5) 4a% (Kidneys), (¢&) afer (Bladder), (2°) dterafer (Prostate glands), (22) qrmafea (Testis), (22) afagaforer (Epididymis),(2%) araarfedt (Vas deferens), (3%) sPREfrAT (vesiculae Seminalis), (2%) arated Tubes), (2%) 27 (Breasts), (39) afer ayearazrarar (Cerebro- Spinal meninges), (35) Afetor (Brain), (¥&) atiaateaat glands), (38) arftararét att (Lymphatic Vessels), (2%) aia Gfaat (Muscles), (2%) 44 (Skin), (23) sfeq (Bones), (3%) aftaat (Joints), (2%) afeafeaa eterrzrrant (Synovial Membranes), afer 4 4 (¢) sferezrrar (Periosteum), (2) swarfea (Epiphysis), (3) ar (Bursa), (¢) aveafer (Palate), (x) aritarafer (Jaw), (&) Feryafive (Mastoid), () Fate (Cranium),(5) 4graaat (Atlas), (@) aqst (Axis), (@e) ge@¥a (Spine), (22) eter a Sey Si (Fallopian (Lumphatie BORN BARU (Ribs), (22) sew (Sternum), (23) siyatwae —(Phalanges), (¢¥) feet (Os Caleis), (2x) sagdfet (Tarsus) ; abadt # # (2) Baz afte (Elbow Joint), (3) dara afer (Hip joint), (3) Parsaa dart (Sacro-Iliac joint) (¥) aferara (Wrist joint), (4) Far wart (Shoulder joint), (&) aaeafer dart (Temporo-Maxillary joint) vat wafadt oar Sas rere Baer HF qrearepaTeat F Bw ara mer Qa 8) veg ae race a oadaa vit errant aattt er ata aera wal 31 ae at cn qeaere gere Hera A aafaa AF ® ava fava 210 ea area A ea aTtaT Sat wa arevart faa ge wart srt at wife ett meara fasat qe Fae eaeT fearon dt qeat & aaa safeaa fear ara faa faacn % fa qreara aedat gerst sates ficar onar arfee ) wart tt arr 4 mepttre Pater at A watt | actif fazer & fama & ag fara wT A Arai zat 1 HAT qreara fafa % faaoer ar acta far are 1 aati % vtec segfra-aatir aa a saver Raragt 2, aa: set wr atta He fans eT a TET fara ar zer zt tag fire eadtt (Pulmonary Tuberculosis) Raz (2) Acute wy Tuberculosis #aat ae (2) Chronic Miliary Tuberculosis waar eaztT (2) Acute Caseous Tuberculosis @4ar THa=RT, (*) Fibro-Caseous saat aan, (4) Fibroid Tuberculosis sat apa eatin, (&) Hilum ‘Tuberculosis #aat MAT, (6) Epituberculosis waar garg aatrT we (5) Hilar Flare qzat garen aati | (%) Acute Miliary Tuberculosis W471 umme——et orf AX fat A gage and,ARCA y att wr # onaat careafamfert whadi # waa wiitieaa aq feet ft in a oR Raat cafes safes agree aqtie-tez faa 2, oat & frdt for Faraz tar Mae get art ae ag tan Saar & 1 page & were sist Tete afadt & at gq faa ant G1 wilt qe anfa gaat ata ST aren Re aa & fe earrarat at ta wafer weer see ATR alee a eta eq a arta mere aati a wfraaea Hag ae sera dae HET wT TOT aa oar 31 (3) Chronic Miliary Tuberculosis #221 matinee anf gaps aftae fafier sare & aer iz-attet afaat we ge fearg sect Z, faaar tr qat aaat aad ar garg HIRT ar gg set vega it at awa eared wae & wen aa a, wa fie aay, TH, after aris a oatedt rae at afaat ag ade (Miliary wea ar ad art at Baars 1) (3) Acute Caseous Tuberculosis waat ea O——aa aarfa EIHAaT H qesrere seit wT ara dt oat, aeitartt sad ga ea dar at TAT wats wr cart ofeadta war aT AHA oI TAT gape frat & frewa aed ree afeataa eT a agtaet fearé cet GF 1 area er arg aan are at oar &, oft fr ort a aa ore 21 oferta da 4 sa ata amet a agar ar ordt & frat wereret az ar qeq ate aa or Gar wamet fear agar 21 (¥) Fibro-Caseous Tuberculosis #7at eatin—afesia era-Ofrat ¥ Aart ca ort erage wen ae etter itt & fee area wt FE A oferta me ot ea Ge F seat aet & faire ere Te F poe gy ee free aah Gees avy ate? ate At fearg tet fo gear area wei F feat apeaaT ot werent, "A Ne # LEO frat 210 ea anf a srafies aren ararera: pega & ahh & frost sear Ft aa oA aft acer art Hooft feerf cert tet F sara: aati ope Frere Ho wafea ae & we gat gga & att arr Hoefer dae AT oat at Gat ome 21 (%) Fibroid Tuberculosis staat area aq- ‘Chea orf i fart ait eration arsicier Fart ew TAT area AY CT eee Cre HT aT we Wrterse ates wien gyre wr ass Hern ap pee Heth were Hara vat % aren goga sgfaa var ge a} are 2, frat gurr (Calcified) wat, da ae waar arate ata ome fearé ve aad Si Hoge Ft aequaan var ggat & are ware afer a aeraren sar ETE HEPAT sar fayart fearé cea 81 mer go wen seme pg & create F ofew ah ware Hare HoHaatG A aerare fears Tear 21 artes eit enteral # carrafermfeat (Trac- heo-Bronchial Glands) aferat arated 21% STAT arate ag arate sae tr H ofa et TeAT 21 faeft afar a rvaarcem, feet aH agaraeaT, feet Ho aeqreret amar Peet qareaa spat fafen oforia afezitac a 21 ta a sa anf a geyrrcea aT Aan Rt are: gga aoe ware gt stay gtat 2 ate are A gat yaa, Faapra aife ar art &—faak gega a ae faegeT faan it arardt a | Odi eae & GFR wromar Hyon erthenfea ae one fate a FAT er acinar & ear sera ELTA E (&) Hilum Tuberculosis Raat a7it— faeft-faeit arate toe fafirce ware eater ser apie Prat, fae gpa a a a oer atet caopit & orate & safer ata gy atest ayTANK ae Ga oat @ 1 torrefer at agra & xe Or aT eta aca F et arate ea MT aT faforeat & araer H aenfret omit aw ater weet (9) Epituberculosis waat gareq waztt—— fey ger aarti & orgaia et ait ee: ay 2eRo HD aanfrat & Prat on, fae gega aT oH fave quicrar ate at ona or aie fara BT a mies ofearia ett gu oi, wart at never aa agererar ea Orr Paiva & (5) Hilar Flare saat gareq a7an—— Ferqatt & eferor gop eats era fart at pga & macfres Hoge orf aT ar gta 31 orxfey tt meme & ot far frat &, sat PRATT ST TAT EHAAT a yf TAKS um Pratorgfe gor wepfea ater & 1 ee fata & aren ener Fe aenftat A wT 2; TST aren & arava a soit om freraern aout Tet org ort 21 ae enfiz aft Hilum Tuberculosis a afer qarea wat we Bot ai arf 7 wrreferfar a at teat gee ter foie art arat @——arafrs gett at eretat ett dare a Stefi err Mer ee — area Ter a ‘afte & cere at ta afinat & faraa feat rat & 1 (®) gega eaaitia cer; fa—adi, sary, ate & ara ae firear, aot & are qa mT ATT, ar saan afer aa PeeraeT, GRTTAT aT sare ater ger) (mt) eqafins ar sifereferer warm; $328 iar, aie am, erat ge gues arge Tear gers 1 (4) rere a fafa aero | tarde reat at coe, saz, fer at wena, erst, art ay a oer genie) se earth ar sree aT ETE ate & (2) fiw: a A mata, ert ae Farr Fo ara aeraga gare ag or, ae ERD MEU wee: ToT Tea TAT, TOY eA aT HS ATT Beye & oferta & are tet oer Fs fre areea grat & 1 (3) sahagerr dae —atigart a gare saree ag Ot area a HT 2 (3) ate are ga eR are EECA eater atom tor aren ge tare ar aTeeT aT ara 81 qa ar afer argh & anc rst carer ae et awa Et ege-T aT A artani art ate aitanh safes aren a err frat 81 (¥) ero et fagis Qo rT araete grt ga tir ar arera feerg oat g 1 eqcaea Br ra tht ararena: ptepfrs ere Ot ara & dtr 8; Tea ter ah dia & fe steph arm aero he THC Tae eT OT TAT arate eT A wee ga 21 ae A HT At eran Ham tire oer frat 1 (4) mifae Rat—aree Fo oaefe sar mond frag 1g waa e1 TY Te eT TT Qa ara wer eet oer 2 ate a Tae sagt arrar @, aot era he aT RE Ata (8) QoyMNTHarM—Te NTE aT are: oH Hah aT eT & | ATLA GHA sree at ware at & erry aT wae dat 21 arrayae ware a aco ae are At rear F ert Or at fro at arat @ 1 aeiianit gepe-fearor ait arth & arefera ara } es F fare TeaT 3 1 (9) sree afar & eq a—afireta ca 4 cvtent (Galloping Phthisis) ser aTeET ETAT afaara % et # glar @, fret cree afer a water & sovat feat aa oer viet 9 ga at ate, at a trefiria ater 21 (5) Se: ara ere aere——gege FF ot ware & ara; FR fe wads H “aay fae” Bert can watt mat a ta aor,AO arpa dar ere Frere qear 8 | eardta fasifaar aaa TT HITT 21 (&) stafew Cee eae amfrn faeasor earanfer 85 ea Fafa arafirn fretaar ® fart etter wet aaa amet % warm wwe ATE (te) mafeat arta faarsse & aa — wafomratatina eartist arareort: ag 9m sera eat 8, oat afar aos Rae gare maT ate char Sar gat aa 21 ga wafer aaaae Mer FT fafrom at ond 2; reg area at & sere révard A at art &, fate racer ar facia at aret & 1 (22) weatea Sait ara afeafarr ea F- aad, tonfast, cine sae aa gEahhh & ara, Prdaae en ehif Fo saad er H caTaT afaara a ot 1t vera at aear 2, WaT Tet AT aeonraear ait aarti a are eae ene eta Fars eat &1 (22) qaraeat Herat ar ae aR oe dev 8 1 anoph aac ear ar aE wT ear 8 aie car anya eararce & gana aa teat EI arta & fafas war (4) ema feet ta a ag rere are sar feat da a sepa aed eT Ho wee erat 21 ait ace site anit ach wra—faa edt we fama ana a—feer§ rare air ary att Ho at at dt award (2) 8% at aanA—fafna SHH Te # gaa shear wa-sarar erat 2-—AA fe Fibroid Tuberculosis (aqrareas aa tt) H HH Farge wat faraar @ ; Acute Caseous Tuberculosis (asaeia came) Hart ae farsa Si omient fet gece a ofe arr aca dame ae a aware aati ar ah aati at fega ar, wit crore, wit gaat were, "4 13 ee Hea waar qa wort wea Bi alta ae 7H wat & arfine feafsearan waar fasat gat gat tiara: aaa wae ae Ges ae eA, qeg faaaaacin & me ow fafiree ware aT ae adit 2, it fe eatin & mH aT friar FET arama t) qa wn i aed at giana att 21 attra Heer FA TT ait aati & sere fee wea eae Pest are fear aad, dtga: dated weit autem mad ft aaa a fied, at Qe Tt a fae ee aaa dat ateaett afer jared waar wat cershay & genet Tar dea-afa st afr sree eat & Hepat at scfeafa seria ar or aedt 810 ae F arat ware Fa aay feats earn avgsit a gafeatar tr-frvia a Prd aerae att orf #1 (3) saawee—ag aa Taser arate weit deat # ame: gafeaa eae Giga & weax fag arcaey Smaart gaat Berate wr sar sacafa aren Al earace SUPTTTEAT FT AE, TAL at 21 varat at ara Zt ara Ht araaiaa, gupfacren meat Zeb Hf earaare waen & ag wet 1 aveifew Scar a aft sara a ara 2 (4) Grand ——aarte weave draft a of ag wean fear ogar 8; weg eatin # fade eT aane a ® wren gaat gees fear oar a1 sara: ath att per ar veer ag aern ee Zrat 8 | (4) ast ge aerate refer ae TA ATT aT RAT a) AEREOT aT FraaT, tit a teesfatfart afer arise sre saat friz B1 (&) sae art aries aregig—saz at ameata & tet & arére ¥ teawpit a Pe ara a tit at af wt gat TaAT ZL ve a vet a ade at terafar rere tr were &emeat % vat aT ar favia wt a awat) amt fafa Frafira ea & fea & ag are cat afer Woe orate H sae ATT Beat fret Tea safer) aad F arena: sree sat amt aa Xam ear 2) aT aT a a ae vitae ate anitanit ont at se % vftae sae amy wa carer cere | ered Ble aT A sar amy dat afar 1 aa % ea sacara eo Pet (4g a0) & Sac aa F afew ce 8 tov fet oF @t wwat 21 Acute Miliary Tuberculosis # 94% ATA: EL AH AAT TENT a, Peg ef eet wen &10 aitanit at at sax ar ae ae afer a oe 2&1 tar aa arr ara arat #1 Acute Caseous Tuberculosis # sacar fire Rei ae aire mfr eo Tey EAT é. gasfenfa qe ae ot area sacar ey fad ar wat dara Bae Fert Sfravepsit at Farafavat & are a ag gat & (Chronic Fibro-Caseous Tuberculosis # gag ate art rea H ree sree Peers gar 2 1 anita sae wet oft teat ste anita aferr erat arcifan- frat % rer wae sataT ag oat 2, St fe fara & aH TE AAT SI Fibroid Tuberculosis BH ararena: art Ht ofa aat Tre orret S—eara am dear 2) cog dr ast A aed eT mrenfan Prat prey FaT-ATT aS HAT BI (0) erafindtan—artaart yo afer erred at att & ara fine ae ane ate fat aera afire war a qa mare) ae ona a qa & Re fet wea 81 wawae afer F era dee tre aa ee fread OTR sftoh ra oe areca: cea SaTeT aPC H PrvTET infer cet ae fit gayi ett a amen aereren aaa fearon F wre stat 21 Sry st afaaraen Ht cafeedtar gaveat 21 wa: orator artifice tear H are st cafes as Sitar HTT RONAN AEE aa dia 8, tar adt ser oraaa crafts Soe wh wd dee ante ere aa ae at re at qe wee) Ag a Tt a fewadt wedt & we are Ho cafe sree Borer Bt wer cae ar Or free ree aT Saas tea e1 ga oT ge waa H ewe ETT #0 ae A oop am a 8 frargar aq det G1 oe arc ates crafter a Fora Be feet are anette Rear wea Baader wag tht are, arpa, farang sa i corte &t aera Baga at afer ag Tet BA erattr H gaa at aft ag onedt 8 1 waar aif ae at a, a Mer} AHF age Trae ete @io waar ea a war 21 fafeearara # frafer et & carart at afe aa eT aKa ae war ovat 81 terete fete ate artes ag ara ait cera, it aero aforerit at afa—eet ware er wae Fart aaa &10 qa ernfee watt 8) arcane afe dt ve quia at dat rar era, ator are ofa warm fret @ 1 atta Terra, refs, ooitet orfe wean arafar feof & are aaa e1 weit a aa ae & aren afsare aero carafe fi aafas aah & sitae grasa aries aaare car area TET &l ere waar sat at freee & aren feat 7 aqrert et weet 21 Oa at safe waeaT H raat threes F sree He Aqiset saad aat ea der nt fafiree gam 2) oey Oe at aTt safe at we aeroar feat we gt ot eI ferit a wirtte a ava @; veg te at ast srrfer att re Ht mt aren drat WaT a1 art & afaia weg wien ohit at ted a fate at oferta wera vet Peat ot awat 81 ater wma: tet ar Meer fer ware free gear ang,mae cara, Yor, TaN, aah sar Tae a_afgat fred gf, Fe aR, eae atthe retary afc 1 feral a erat ar frgear ere wae drt 21 ering oe ga waa A aT set # Qegs varey eH arg gar 21 tht Bacar om ff wee agard Bat ena gre HH aera pHa Alar @, ae eannfaes & saree HIGH ee Bowe eT A caer ale fe err fara: amaet & eft & grpetnee F ag oer sarer aya att 21 sa eat oe & sige at cate are ee arareralt eaeuar BT sea dit Bt aeattaraer et wermar fafae saeat H fafna sare ® cee gare get &1 wisi areca dt, ait qa ar ate aiftanit carseat at aft arate car eqa, sere ata, fsara dha goat ara wae at cafe qaré cgdt & 1 tend meqrarfas aez wa arg cet mitt dh adie art aa, what Fah Boers Fee Bere & aa ger waa we ae aT anit fare ate 8 ated F are Gt are wea €1 wae ame aH eae Gare wet, er safe writ, ge @ Gar are afer geyd To weangatea wiser & a rarer wait Ho taret afagrrar vat earfere avert frag vem @ 10 ert are afadtaat aor aegats at af mae att 1 sige aa aI Te capris Tera facie oie ett &1 wearnfis exe adh gant gear maar Aer ITAL AT GATE TS THAT BATT TT eat & ara att & aren sat eat Ff Tee Se Oar, aa gest ext Ga ME oor Faas weft at Zt qgrgs Howie sen AAS. TEMA: rete ar aaa et oat tar ate F ear Fafa aren, dren frtceto ofeafirr adh 21 are az ate pepeqer # tar gar a, dt ga ace A sia ae ree Ga A geet ae 8, aa sia afa at eiviar ereat sme aft 21 erie are afsdtrat sar sezatet #1 fe ayaa att @1 veg waz ate ara & wer gar a, at AIHA Sema aT eqTaT sera ge a, a eT aT qfa % aed F apne ard mea ater 81 wae aig ara Xow gar at owaar aft qe a, A set at cere A ever wee att 2; ToT aig are aedie a at, at ge ge feet F at wre Beet a care a Ser rare att 2, at A sara gare get 81 aS att sieht a cate art ara See ar hy rene ae af | ga wad & mare @ qaea & wae we TAT EI aati aah ae at opis R areaere srqare Patina wre Bane GATE TET gL AeA gen afar & vax & Prwadt gf arava % vara, at ag ware fret sate waar afre ate wee & frat gf wear & aa ae pit aT farrat-aeray raat gar ect 2 ee wer gat Tet a mere aft ag, iant Frage gare ae ai ge ait £1 ger aie # avarena: ate wea anfew ave agt gang geet 2) aefiamth were wer eq went ee ape BAL ate wT a & dat waar We wes a fanart gf ara gare ga @t 81 Gaaefer at aera @ ate er car mranat A aT THAT eI grea St aeguaat a waar F al creat a waar wT ATA TAT BL aA wa aoe A aaa ear aferstrar ate eremter afagen GR wrt vat aReafg, at er are fag wear Bae ed fer (safaet & stax er art) egfea & avar aat warfea frei er xe dat fear€ agar 21 ania & aqaa ena at afadtnan ere att 21 &oe Se wez at VaTaT aH aT aaa 2 eee TOT ara: giga at wifoer va grgsaerear at eqae wren oat 2 ae AY steph a eae ager sit} ore eseaat AY oar fray 71 wig sora at ve gah favdta gar 21 Te grpe a sieht at eae A aera wa mere ere wrqn att 8) ares ® ae ay war gama & ares 1 wearnfien sez ararenm: aét a wef) with ger waar worm eae aap gare ea ga aft iit ora freett cafe sere arate aATE wet 2) anit at tar & aan Pafrere a ag arc weet aifer fe ter at Pref ot aaa F GIT a op at ware a oferta aa fier wee 1 A ana oe grga & fafa sia F fate are at fagft-afra area oat at aadt 2, frat arm fatwa ware % afafiar ser fat 21 at Pe ow drama ve Grp fret ier TH vay, fret of areata, fret i mnfoer ar aga, area, alte gored at agate ara 2h ara st eA @, faa aren aero a fafraar va weTe aT apa 21 deft ofeferfa # fafreret at weit a ara ath at waco F wee aH frare HEAT mate e1 amt Ft SAofazer Feit e ret wo afe ada afeafat det a 21 atarema: ae ae gree ate ataia Bama fee vet BB, aah aan wert ag eam ofan vee ata Bs pret a agra a ae avast aad Fh aed aaa a at zt aaefin @ GEER A eee ANT TT Hag cea won wit wary ge) ear wamrirt (Diaphragm) aT rarereart ara dt ara gearaqaa, ave get ara et ara Bre FT areifaraear war gee aT goo cafe % aera A ara ores stat & 1 ea wera pipe F opifsa, asa, dieser, grpa-rT- ar a eqaa, sant 7 araaiaa, Gop ferareor conf er fate gat aT aeaT 81 ta fer at aera & ada faa a Oe at srafiee waco oft defavia # aervar fart aed 2 waft wa sare & fea 1a fra a ofadarer wen wat war a ama terfinhe at aera vara set tafe & fare pega aT ae aaa aifern faftarat et sataa ada diat 2, aat qrga-fraree aft wPrar ¥ sfarer a et pepe A afefeater & Grote farry toerefer at werrat & adta fat safes 21 qreares afte erate & frrotar & fore fafarr gordi wr aia frat 21 reg aritfen froat wa caval Herder strane at safeah ada aT art ¢1 arate tefia a sit ara, gap aT aemarea, careafaee wT ARATE, FATT, seeda, gga vids, afer mem 2a ore cent feat aad at aadt 21 Teg AT an efter, gupta ae, qa at ata, tafe a eater a oder gate are Cease ay wea ee ee teh at ae fea ow Peter A cat A trey aa et ara 21 qreaeraet Fre Hater HY safest fre aca far weer A cant saree arg 8, & a frat were Be (2) Sedimentation Test—— oral (cat arét) safaai-wafrend oa Sfrent qeufager er & mraaq warfare wat &, wet are area BT ATH FATT TT HRT TAT HT TERT aT facetica azar tite tfc: aferarsil ar free BIRT ae MTA SAK TTT EMT HT fra aT a TT aed Wf ardfen seat & ofemr-ereq (weet oR SORES, & « wauE es fesifed arg arg at ® aa cat Ff grgat (Body Metabolism) ¥ qgare were are ree & are ater teat Bh wa OTH ger S aa Hee vt ta cart tt F aren, adt oa caret ata are H ph at arte sera dar 8, wit qeerfirgen art a alaq (Capillaries) wor a ora s ste ert ar aT aM Te Ret ETT TTA FT TA (Blood) ange rat & 1 Hage a aww aT eT AT ET TAT 2. ga ait ae at gfe att @, at see HT Sag we maT teat a1 afore ae eat & fe sare-afaer tar saat sere qearfaget are wararsit (Bronchiols) #1 arardfer aor war # WerH (Congestion) sera arate we crear ata & ae gra Aa E froma: ara wart % eter wafer get oH wat AT WMT cada Pra arer mer aver arex im fear ore 81 Fe ae camera aT Fear sitet at ont 2, wa ear args # deen ud gear sera att Foca ee stor % are arqardy ar wate dar &, waar fear Fo faet dar dat @, ate ee FATT ATEN faferat att caanfatiat cz arch &, feat cat er a gam arate Hate fine areata art feta drat #1 aemteafer & fare arate “aferearree ere: arar, dora ee” & arr sh fea at (Chronic Nasal Catarrah) famgee @ ©T & arn 2, wal afsarr soraaar A earit eer aT te Tee BHT AAT HNL F ST aT a gepel ae aod Fagan dar 21 adh aro & fe sfereara & are are six ate oa AT oe a wae at ae at serra ah ot aor firgrea & mqare aecteafar ¥ fae oF fafee at % sary (Bacillus Tuberculosis) art saat gar grees, aT aa ej af eT ngHie aed Rak ©, WORE Fray wt wae site aah it at et awa &, wae sam ears & far aa afet 8 dare at waiq ardéfign career at fire armar eq ® oer eae tearera sR at erat & gaara eet ere ga Or at area at & fare araere ata Bowe are wa otra Pare at fate & (Droplet Infection) gupat # Wa at 2, aa agit @ acragde came Fo ogare ches af & gfe wea & (ceranfefrcrears aerated FAM: WTA: TAT Mer, HAreeTAT:) aie flex Sa are GUaa at enfiee fing sera QF art 210ow staid ate an ae sara ata ara, at ot are ale dt ait 5 aif az op Gar samy 8, freer aren Peary at wat wer 8, at ee faarer & qatar 8, aT ee ant ardifer angst oe oft frat det 2, gam afer eaet at orga at erat feet ae Fé ara Boma: wpe ee OAR ere sah avr wrardt atat at wre ata avila dat 2 ag wert err 8? eit ar farce ant wei seiner Setter at firee-firw vit aver meatier ee oe sen eat dam Gea R gre stot az (Apex) fa Assmann's Focus wg % at sat qe seat at waanfefrat sa ach @, va eat (Hilum) ot a ora: Aart 1 erat aren ag 8 fie war city afd & aia (Calcification) & aren gt ow HF ear sata % oforereg afr vat att aan srry 8 afe frat det Bi ee cere wt fret oe aren 2, SF arena wet G1 aE OH TATE aT sfor gare dat & at dt ware & ai & aT tat 8, fae sit F Gel System ( Giant cells, Epithelial cells, Lymphocytes ) ® rat Gare wet tet agar FT wie Samy at weet di eaat seaft aa waft (Infiltration) at & ere ata: acter art ait ‘eren, ’xx & fra ere arte seam aro at AR eevee 8 Ofna a, teeter ceri a ag tar on ana t fe ger careafaeni 4 aa sa% a aH (Fine Bronchioles of the 3rd to the Sth degree ) srefere sfrarepsit arava advem dar 81 eat ty ate sare ay zor sera anit @, frat ofc ag dar & fe et gen afaerit & aferder aaah a ware Ted H Bre SAT Tar BA aeaaT ear afverat et date tar & ( Collapse) wit Ta rar eaeahrer aay efor a oH EAT a (Brancho pneumonic Area) gygat # aa arat 21 aoe dt are careaferenat & aoe anit & aft ata sera a4 ara ( Peribronchial Inflammation ) 1 fat frit # aréfor aaat & ara tar oe faxa at aed a, aat at ea ax Hatfan aa at fruit gare ( Fibrosis ) a yt % aa ge gate ( Calcification) alec creer de dara d | afer oa seat a Arar var ardtfes wfatta at at att 2, aa ae aa area war a we zat ate oferta ert are at art 1 aa aitaet (Caseation) wilfn zqaena casas vat ater, er ere A sey Hap fader & art naPReT Ft (Coagulation Necrosis) #f aan seta ait & var amer args et amr earae At ora 21 ea aaa frat at zdrwat ( Caseation) Prat ret fia wat oferta oe career fates fave stat aa oat At gah are ar ait ag fies fimaat & aur attafaaft & er Fate aera at orrar @, fare ert gar rer caer 2, aT a aan wafers at Barn sat aaa aeafeat at art # ( Pneumolith) 1 aatrat (Cavitation) gfat art aa ata % erates gare, wag aT HeTaT towSCORN, Sh OST ASO WY, COMI Rare Hera Gefen wears) wa vat ag ear Ta mae ve Haar fee A HTT | ae ant re ee ard orare & dee ET FIST Ba mare ow ar at ava 2 adr wd front afrafia, qzat oar 3d gx att 2 od wae ard aa waar-afrart fearé at G1 anit anit wd wey R de wees anf war cearfefaat at ot ge gitadtac gt F 1 wa a Bact geet at ore 2, ca eae art TH afaa ag va ort 21 witht crarfeftai # faeere (Preurism ) vat ara 8, At eae rea 7 Fe OTe J ae aa Hae ToT ama ey ‘ation qigrac ( Fibrosis) grgdta argsit & sfafaur % oferrm-eret alae ag at frator ater 21 ag srefern rem Fo ar edrarr % aT, wt ataaa @1 er oferta Cedar a art & (Productiue) aan aaraaa rita mite oferta Exudative ¥eart #1 ag & op arr fa a er ar art a fret aifa a aeat a (2) aa wea ara (Direct Infiltration) 1 (3) eareafaat & aaa dat gf wr anfafaal car carafefaai # art (Peribronchial Lymphates and Capillaries) 1 (3) wRISat Fare GT FT FBT eare- afer arr Gry } we ani # ager Tae arnt wear 21 (6) zaanfefrad Harr gopd # dard oferti & are eA gingfae gent % fret Hz fey a Z— Acute Miliary Tuberculosis——cq ware H gat act F cqacaa ae prEeT A at wea @, fara rere at dt tae a at aifgaa feat & ar arete & fet geait sea arr Baa it earfee fererit F oa ao at one 2, aa ae tor sag ROM ae amar arar & fe Cer aT waTe CHT arer a ta @1 fedta Sot ® ofeada at a ge a Ot ferga a ota 210 anftantt ag feafr great afaaa ereg Fo ge A afar maa A aT at ®1 3. Chronic Miliary Tuberculosis—at sare FA gare ar eaeraet & ara & andi wet aurora at gap ae GF ea Zwaan a tte, ger ate age Ht me ong, are et ara a ware & Regal FH aga Grea ANH TG, ar oat fh at ora 21 2. Acute Caseous Tuberculosis—ct ware % anfser (Consolidation) & ada aia divs & gugdit sera at one & var are areal Hoot ate & ofer-eged aca cefaa aar @, saat crefat ator 21 fugit ate afer arr awe rp ba ge Te Te %. Fibrocaseous T. B.--7@ ¢t #T 74- ararey ey 2, wat wa at F ger a at cifer oot sraer att &, gegat a orefa-sfe ada, atfea erg & raion ate edna at ater fra faeare 9 Parke wear Bt arefewre aaeaT gem ah var eareeart oe afer sera sat 2) aeert frafirr eat omit at fafa sacant aa Fe 8 soar at (Caseation, Cavitation) 1 ot amerat get at ana @, vat difan ng ft art antes ae wan oad ala Ty Ts Ft ae ATATAT eT , fax fart a ar org warfaat gar 2, fac art Atal weradf aren FH Mat eT ware eat Baar are: gat Gage Haft eet a A ST Soe a ara @1 y. Fibroid T. B.—afay arg a frat warts sent at Gea F ferq ar at Gaga at feat at fafa oaend at gat att 2, dare wanda aan aT FET arg,ONT ANSE Fagg aren var afer a otra & 1 ge afar arg ora career ox fafeoer ang, wet cat afer a att oétater wenfat afentar att &1 fest gem & are ar oqT ot afee ee war grge F aaat tat 81 ga gaa Fea wi grpa Fo eer aa a aga a ge faeer< ( Compensatory Emphysema) #1 aTaT a att sare & pheptice ae caerafeerrt afant onfaa atta a ag ait 3, ita wrt wom ao sera at ant gz, ae sae TT wi eqaena, Bfirra, mead SR ae afer ere arn ofeadat at mt £14 ofeada wat waver ree ter ar ware dia 2, at wet Aer sera att & are ahaat Foret & ofoered a ofa ae! grpract ott tear fafera cara teat @1 warm arret a dia ata Hae sort aint | (¢) wa an fade ae aaa aeaarer a att wt aretee agit Bema a, af ae ett a ga aan & fafa att, dt ee fates aft a ora art wet A afer aeafer art aad. at, te strorra wet drt aft 1 ate deft ga feat ar 2 fr sat fad sttaw-fraig at meen areit ar ait aeret 72), at ga feat # Ot at ofa Pafror areeT @ te ofr a Patron savadt F at at aadt 8, ac ot aa ga a far afenier anaes areata ait ar sar diet 2, sam are farafafad &:— (®) vasita—aaqais, erp, PTH, , aafeern, eared, werTt sig, arte ad, warqa ad, yaar FaNyA, FISTS, serena, Sar | waren, ‘x aaa St aaa fafa aH Ws HR ae @ aie Rex teat: ae ere ee ait eat ara & daar tt at omt Sere afafert qe Hes cyt F aor At sera zt art & 1 gay & fats wey gt oe Toe & orem & oforeeet syarcnat A sehr eet & var wer wa sera eae 1 er mare fren ghee aed B orev afe ade oodaa frre Bear ara, at at oot ard art 8. a gare ara arat Fo afarTfst a a——aatg “agaerr det & arr wa cael wimede gare @, wt ange er am aren ait ti" aga sésan cafes (stegfre) agit Tt (Caseation, Fatty degeneration of the lung stroma) gat @, agrart araafew carga atl eT ware men aT gether att 21 amprara ait & afe saree etre an fafa Sirary ar we FT A, Tae aft eT AT ort 21 (re ey aT (a) aa—aqaorerys, zene, aftaraits 97, geronfec ga, wari a, Proven a (a) a —arenfe da, aeonfc dar (a) qi—areftens api, faieenhe ap, wate qa, wart ema ai, ariel ath, orate aa (5) wade-—senrite, afin 1 (4) afee——sagafee, conf, mara 1 fra feat at fea att at sar oma 2, 7 am a maer oe frie 21 aaa, ei, rH, frei, freta, avat att feang sa oTinT waren 3 ea om Pret at reat Har at a a, waer eee wear aaa arafe, sraasra,UHI ST arreabers are Bet Set casts angle fae aero srafte qreaer wear & yar area waaest agerifa ame eat ey ® aaa at on cat 3 Trearer wer-aas, arate forat sit omrefer ofrat & ara & ea wer outa mba meet femreactat war

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