The Symptoms of Consumption or Tuberculosis

Loss of appetite; emaciation; debility; malaise; frequent breathing; shortness of breath on slight exercise; pain in chest and shoulders; prickling, heat, and pain beneath the sternum; cough; hoarseness; expectoration of frothy mucus, rusty sputum, or mucus streaked with yellow; fever, highest in afternoon; chill or chilliness in morning or forenoon; night sweats; pointed nose, from emaciation, with motion of nostrils at each breath; incurved nails; narrow chest, sunken beneath the collar bones; usually dullness of affected portion of lung when percussed; irregular or jerky respiration; rales and other abnormal sounds heard by examination with the ear; hemorrhage.

This is one of the most formidable of all the maladies from which the human family suffers, being the direct cause of more than one fifth of the deaths from all diseases combined. Notwithstanding the great interest which has always been taken in the study of this disease, it has not until recently been well understood, and even now presents many difficult problems. The symptoms above mentioned do not all occur in the same patient, as individual cases are seldom quite alike, but all belong to the disease, and any of them may occur in any case during the course of the disease. The disease usually begins insidiously, and progresses steadily to its termination, though not infrequently the patient will, at times, seem to improve very much, the disease seeming to be held in check. The rapidity of the progress of the disease depends much upon the temperament of the individual, his hereditary or acquired tendencies, and the particular conditions under which he is placed. The two sexes suffer with about equal frequency. The periods of life most subject to the disease are infancy to seven years, and twenty to thirty years of age.

Owing to the extreme frequency of the disease, we ought, perhaps, to sketch the progress of the malady with somewhat greater definiteness. Its cause, as remarked, is different in different individuals; but there are three principal types of the disease which may be definitely described. One patient has an attack of pneumonia; it may be of the ordinary croupous form, or it may be of the catarrhal variety. Instead of recovering in a few days as is usually the case, he does not regain his usual strength, and continues to suffer with a slight cough and some shortness of breath. By degrees the cough increases, all the other symptoms become more aggravated, and the affected lung begins to break down, as shown by the character of the expectoration, which becomes yellowish, or streaked with yellow, and when cavities have formed, is coughed up in round, grayish masses which preserve their form. After the cough becomes severe, hemorrhages are also likely to occur, which, if very frequent, rapidly exhaust the patient's strength, although death seldom results directly from the loss of blood.

Another patient takes a severe cold in the fall, from which he does not entirely recover before spring. The next fall he takes a more severe cold, which lasts well into the summer. The following winter he con tracts a still more obstinate catarrh of the bronchial tubes, from which he does not become entirely rid during the summer, and which is augmented by a fresh cold the following winter. Thus the disease which was at first a simple acute catarrh, becomes chronic catarrh, and soon, by extension into the small bronchial tubes and air-cells, real consumption is occasioned. The cough continues, the fever rises, the expectoration becomes more abundant and purulent, the appetite fails, emaciation comes on, hemorrhage occurs, and the patient rapidly declines.

Still another patient has neither cough nor expectoration at the start, simply feeling weak and "good for nothing," gradually losing strength and flesh. Perhaps he is first startled about his condition by a hemorrhage from the lungs. Soon cough and frothy expectoration begin, and the patient fails rapidly. This is a case of primary tuberculosis. Less than an hour ago we examined two cases of pulmonary disease, one that of a man in the prime of life, the other that of a young lady, both of which gave essentially the above history.

The disease is sometimes divided into stages; but as it is impossible to discriminate closely between the three stages described, the classification is of no practical value. The disease begins with a consolidation of the lung tissue, a catarrh of the smallest bronchial tubes, or deposit of tubercles. After a time, there is a breaking down of the lung tissue from the destructive changes which occur in consequence of the morbid process, and cavities are formed. The matter expectorated, if examined under a microscope, shows the presence of portions of lung tissue. It is possible, by physical examination, to determine whether or not a cavity is present. The course and progress of these destructive changes are exactly indicated by the intensity of the fever. When it rises high, the disease progresses rapidly, and when it is checked the disease is controlled. In some cases the destructive process is prolonged through years. In others, it is completed in a few weeks or months.