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.
The pulse will sometimes remain steady to a healthy standard up to the period of dissolution; and such cases are generally slow in their progress. Commonly, however, the pulse is above ninety, and often it is much higher.
Diarrnoea is a common and an ugly symptom in Phthisis. When it occurs early, as it sometimes does when a patient, having habitually costive bowels, becomes habitually relaxed,-and you suspect only, from other causes, that he may have incipient Phthisis,-this change often sets its seal upon the nature of the disorder. Usually, however, diarrhoea does not become urgent until the disease is far advanced, and has already declared itself by other and unequivocal symptoms. When it so occurs, it is apt to harrass the patient exceedingly; and rapidly to waste his strength and flesh. He appears to melt away under the influence of the purging; which is therefore said to be colliquative. It used to be supposed that the diarrhoea and the perspiration bore an inverse ratio to each other • that when one of them abated the other always increased. But the more exact observations of Louis and others have proved that this is not so. One reason, perhaps, for this error, may be found in the circumstance that acids, which have the effect often of checking the perspiration, tend also, in some persons, to produce diarrhoea. Louis found that this symptom began early in the disease, and continued through its whole course, in one out of every eight patients; and in one case only in every twenty-two was it wholly wanting. It depends most commonly, if not always, upon ulceration in the intestines.
In consequence of this diarrhoea, and the general wasting away of the system, the patient soon becomes emaciated, the ankles swell, and sometimes the hands and face; and ulceration frequently takes place in the throat and windpipe. The hair frequently falls off; in women the monthly discharges are suspended; and there is a clubbed state of the ends of the fingers.
Consumption is sometimes an acute; sometimes, and more often, a chronic disease. In the acute form the patient, who may or may not have seemed previously to be in good health, is suddenly attacked, perhaps, with copious spitting of blood; or he catches a severe cold; and almost immediately afterwards intense fever sets in, of a hectic character, the physical signs of pulmonary phthisis rapidly develop themselves, and death ensues within a few weeks. This is what is called galloping consumption.
In another variety, the patient becomes suddenly very ill, has frequent shiverings, difficulty of breathing, cough, a very rapid pulse, night-sweats, and high fever. Meanwhile there is none of the expectoration which is characteristic of Phthisis. The disease runs a short and distressful course, the countenance and lips of the patient become livid, often he cannot lie down, and within a few days, or at latest in a week or two, he is dead; and after death you find his lungs bestrewed from top to bottom with miliary tubercles.
Dr. Latham has described two interesting forms of Phthisis; in one of which the lungs are apparently tenanted by a multitude of tubercles, which remain crude and unaltered for a considerable length of time. In the other, successive crops of tubercles appear to form: or, at any rate the tubercles ripen and are expelled in successive crops: and there may be long intervals between each crop and the next.
In the first variety Dr. Latham says: "An individual loses the complexion of health, and becomes thin; he coughs a little; but perhaps he has no notable fever, and no constant acceleration of pulse." Upon examining his chest with the stethoscope it is ascertained that there are tubercles in the upper lobe of the lungs alone, and that the rest of the lungs is healthy. This state of things may endure for years, without variation; the patient remaining always a great valetudinarian. "To such a patient," says Dr. Latham, "it is a continual puzzle why he does not get well. He consults an infinite number of medical men, and it is remarkable that he gets no comfort or satisfaction from those who understand nothing about it. Those who know what it is, out of kindness do not tell him the truth, and they cannot asseverate a falsehood stoutly enough to carry any weight with it: whereas they who know nothing about it affirm boldly and unhesitatingly that it is all stomach; really believing that the whole and sole disorder is in the stomach, and that it is within the reach of an easy cure."
But at length, perhaps after a very long period, abscesses ore formed, and then the patient sinks rapidly.
"The other variety may be just as protracted as this: but it character and progress differ materially. In the former case the patient's condition was one of invariable ill health; in the other he has fits of ill health, and fits of comparative good health. He spits for a time considerable quantities of puriform matter, and then ceases from expectorating altogether. He has hectic fever, and then throws it off, and then suffers it again; wastes, and recovers his flesh, and again loses it. Such cases are common enough. The lung is destroyed bit by bit, and there being still a large portion of each lung to breathe with the patient regains more health and strength in the intervals of his attacks than the former patient possessed habitually.
"But a period at length arrives when the patient does not return to the former state of apparent health. The quantity of lung that has now been destroyed forbids it: the hectic continues, the emaciation increases, and the strength declines; and the fatal consummation arrives.
"Of these two varieties of genuine and unmixed Consumption, the first is the most hopeless. The tubercles are numerous; they probably go on increasing in number, though they do not soften; there is not, and there cannot be, any even temporary return to health, either real or apparent.