This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
As to the ordinary duration of Phthisis: of 314 cases noted by Bayle and Louis, 24 died within three months; 69 between three and six months; 69 also between six and nine months; 32 between nine and twelve months, 43 between twelve and eighteen months; 30 within from eighteen months to two years; 12 between two and three years; 11 between three and four years; 5 between four and five years; 1 between five and six years; 3 between six and seven years; 1 between seven and eight years; 3 between eight and ten years; and 11 between ten and forty years.
From statistics collected by Sir James Clarke, it would appear that the greatest number of deaths from Consumption take place betwen the ages of 20 and 30; the next greatest number between 30 and 40; the next between 40 and 50: and that after these, it is a doubtful matter whether more perish of Consumption between 50 and 60, or between 15 and 20. These calculations refer to human life after the age of puberty. Before that age tubercular disease is fearfully common, especially in infancy and childhood.
According to a report made by the Physicians to the Hospital for Consumption at Brompton, their tables, which comprehend the cases of 2679 males, and 1679 females, lead to the conclusion that, in both sexes, the liability to Consumption is greatest between 25 and 35 years of age.
From the same tables as well as from those of the Registrar-General, it appears that in London more men than women died of consumption. In the provinces according to the Registrar-General there are more deaths among women than among men.
Cough is one of the earliest symptoms of Consumption; and it is that which commonly first attracts the attention, and awakens the fears of the patient or the patient's friends. Generally at first it is slight, occasional, dry: it occurs upon the patient's getting out of bed in the morning; or if he makes any unusual exertion in the course of the day. It feels to him as if it were caused by irritation about his throat. Sometimes it will cease for a while, as in the warm weather in summer, and return in winter. By degrees it begins to be troublesome at night, and to be accompanied by more or less expectoration of mucus.
Great attention used to be paid to the expectoration in cases of suspected Phthisis. It was thought that if a patient spat pus, he was in a state of confirmed consumption; and whole volumes have been written, and prizes awarded to their authors, respecting the means of distinguishing pus from mucus. But we now know, that, so far as the diagnosis of Phthisis is concerned, this is a very-idle inquiry. The presence or absence of pus in the sputa affords no test at all of the presence or absence of Consumption, nor are there any trustworthy means, even when the microscope is appealed to, of distinguishing between pus and morbid mucus.
A portion of the matter expectorated comes from the surface of the bronchial tubes, and consists of altered mucus; and therefore the sputa brought up in Phthisis, and the sputa brought up in Bronchitis are, in a certain degree, the same. These are partly composed of a ropy, transparent fluid, in which opaque masses of a yellow or grenish colour are seen to float; and intermixed also. with which there may be a good deal of froth. The froth is a measure of the difficulty with which the mucus is brought up: and it is usually less abundant and conspicuous in. Phthisis than in Bronchitis.
Spitting of blood is a common symptom after the age of fifteen. If a person spits blood who has received no injury of the chest, in whom the uterine functions are healthy and right, and who has no disease of the heart or great blood-vessels, the risk of pulmonary consumption in that person is fearfully great. Excepting in cases of suppression of the menstrual fluid or of mechanical injury to the chest, Louis did not meet with a single example of Haemoptysis among twelve hundred patients, except in such as were phthisical.
Prior to the age of fifteen, Haemoptysis, even in phthisical children, is extremely uncommon.
Shortness of breath is not a very important symptom in Consumption. It is seldom extreme till towards the termination of the disease, and not always then. Patients who fear, and yet are unwilling to believe that they are consumptive, will fetch a deep breath, and bid you remark how thoroughly they can distend their lungs; and they expect you to say that there can be no disease in those organs. However, if phthisical persons do not in general suffer much from shortness of breath, their breathing, although they may not be aware of it, is generally, in some degree or other, short or hurried.
In many cases, pains, more or less severe, resembling those of rheumatism, are complained of; in the sides, or beneath the shoulder blades. In others, no pain at all is experienced. When sharp pain occurs, it may be supposed that the pleura is inflamed, and beginning to adhere at the painful part.
When, during the progress of Phthisis, violent pain in the side, and extreme shortness of breath, and anxiety, set in suddenly and together, they denote, with much certainty, perforation of the pleura and its serious consequences.
One serious symptom of Phthisis is hectic fever. It often creeps upon the patient insidiously. He feels chilly perhaps, towards evening; and in the night his hands and feet are dry and burning, and towards morning he perspires. The most marked symptoms of the hectic are to be found in the variation of bodily temperature, in the perspiration, and in the state of the pulse. The variations of temperature are great and striking. The heat will rise from 98 ° , that is, from the degree which is nearly natural, in the morning, to 102 ° or even higher in the afternoon or evening. The perspiration is usually out of all proportion to the previous chilliness and heat. It seems to have a close connection with the sleep of the patient: it seldom comes on while he continues to lie awake; but, after sleeping he wakes, and finds he is sweating. The perspiration is generally most profuse on the upper part of the body, the chest and head. Sometimes it is moderate; sometimes the patient is drenched and drowned in it. Generally speaking, it does not come on till the more advanced stages of Phthisis; but occasionally it commenced early. It will cease without any apparent cause, and return again without our knowing why. Sir Thomas Watson, speaks of a friend of his, who died of Consumption, who was much troubled with sweating, who fancied that posture had something to do with it, an/1 slept for several nights in succession, sitting in an easy chair: and during those nights he did not sweat, although he had been doing so profusely before. Louis found that one person in ten escaped this symptom.