Acta Morphologica 4. Supplementum (1954)
Proceedings of the annual meeting of Hungarian Pathologists and Anatomists. Budapest, 1954. The Pathology of the Tuberculosis
Haranghy, Kováts. The one adopted by the 5th Phthisiatric Congress of the Soviet Union, the proposition made by Rabukhin in 1953 as the plan of the Tuberculosis Institute of the Medical Academy of the Soviet Union, the plan of Khmelnitsky and M. G. Ivanova, Strukhov's motion at the congress held in Kuibishev, are discussed in detail. In this country, pathologists have paid little attention to this problem, wherefore our classification of tuberculosis is far from adequate, as a) it does not meet with the demands of clinicians. It is for this reason that at clinico-pathological meetings clinicians and pathologists employ two different languages ; b) various classifications are employed by the pathologists themselves, depending on the institute (universities, departments of pathology at hospitals) where they work. As a rule, they adopt the classification of Abrikossov and that of Aschoff and Nicol ; c) the classifications used in western countries and that of Abrikossov are of an anatomic character, taking into consideration merely the local tissue reactions. In this respect, classification is lagging behind the present clinical conceptions which regard tuberculosis as a pluriphasic process ; d) the classifications hitherto advanced consider mainly the grave forms, whilst the early processes which are of a decisive importance, especially in preventive work, have not been listed by them ; e) the classifications used, probably under the influence of virchowian pathology, do not emphasize the fact that tuberculosis is always a disease of the whole organism ; they do not reflect the dynamics of evolution, nor the reversible or irreversible character of the changes. An uniform classification is therefore needed. To this end, the Association should form a committee for the preparation of an uniform anatomo-pathological classification of tuberculosis. This committee should take into consideration the classification accepted by the 5th Phtisiatric Congress of the Soviet Union and Strukhov’’ s plan. After the pathologists have attained an agreement, they should discuss the problems with clinicians. Every classification is incorrect if it gives a mere scheme without reflecting the pathogenesis of the disease. It would, therefore, be incorrect to discuss classifications without being concerned with the problems of pathogenesis. This is why in this review we shall discuss the recent conceptions about the pathogenesis of tuberculosis, with special stress laid upon the work of Z. Lebedeva et al. According to this concept, the primary focus is not identical with the first localization of the pathogenic agent, from where the process may spread. The primary complex (focus) is merely the clinically and morphologically best observable manifestation of a general dissemination taking place in all cases.