The general symptoms of C are patent to every eye; the more accurate appreciation of them, however, and the use of the more strictly medical means for detecting the dis ease, and judging of its progress and probable issue, are among the more difficult of the duties of the physician. The disease often escapes attention in its early stages; yet not so much from the absolute difficulty of its detection, as from the insidiousness of its invasion, and the small alarm which its early symptoms excite in the mind of the sufferer, and even of his friends, when much occupied with the business of life, or when naturally not gifted with the faculty of refined observation. Whenever a young person appears to lose flesh and strength without known cause, when the color changes much from day to day, and from hour to hour; when shiverings are complained of, or even a sense of too great chilliness, alternated by flushings and an oppressive warmth, or too copious perspiration; when with these symptoms there is cough, however slight, or pains between the shoulders and about the shoulder-blades, or below the collar-bones; when there is an occasional tendency to spit up small quantities of blood from the chest, or when the patient is subject to repeated attacks of catarrh (q.v.), or when the bowels are habitually loose or very irregular, or when with any one of these symptoms in the female there is diminution or suppression of the usual periodic discharges, it i5 not too soon to apprehend the occurrence of C., and to place. the patient under medical advice. In some instances the alarm may appear groundlest, and health may rapidly return under appropriate treatment; but a far greater danger is that these symptoms, being overlooked or neglected, may prove only the precursors of a more apparently serious attack of disease, and that the first suspicion of C. may arise only after irrep arable mischief has taken place. In general terms, it may be said that during the period of adolescence—i.e., before the body has assumed its full development in regard.
to strength and weight—no considerable check to its advance in these respects ought to pass unnoticed, more especially if attended with habitual feverishness, cough, or other symptoms of impaired health.
Attempts have been made to show, that a peculiar habit of body or physical con formation, apart from disordered health, is to be regarded as predisposing to C.; and this has been called the phthisical diathesis (q.v.), but little or no dependence can be placed on any such indications, for this disease unquestionably occurs with nearly equal frequency in all the physiological varieties of the human race, when exposed to its exciting and predisposing causes. The experienced eye of the physician, however, will often discover the lurking germs of this insidious malady, even when active symp toms have been long absent, or have recurred after it long period of comparatively good health, by the effect of former disease upon the development of the frame in the period of childhood. For a similar reason, the use of the stethoscope (q.v.), and other means of minutely examining into the state of the chest, will sometimes detect a wholly unex pected attack of pulmonary C. in persons who suppose their lungs to be quite sound, or who have forgotten that they were ever subject to disease. As a rule, however, the symptoms mentioned above are pretty safe guides as to the commencement of C., if care be taken that their gradual progress does not cause them to be overlooked. In a few cases the disease begins otherwise, the form being that of an acute attack, such as fever or inflammation of the chest; but such cases are of course at once detected, as being serious enough to require medical advice.
The further medical history of C. is very complicated, and can hardly be treated of with advantage in a work like the present. Generally speaking, the progress of the disease is marked by the following symptoms: progressive emaciation, with habitual fever and frequent sweating at night; cough and pains in the chest, with expectoration of mucus, and, in the end, of purulent matter in large quantities; diarrhoea (q.v.), and sometimes obstinate vomiting, oftener failure of the appetite, with occasional sickness; gradually increasing weakness and indisposition for active exertion, often with more or less difficulty of breathing on exertion, but rarely with extreme distress or pain of any kind. This remarkable freedom from acute suffering is probably one reason of the
self-deception usually attributed to consumptive persons, by which they are led to believe in their curability up to a very advanced stage of the disorder.
The degree to which C. is curable has been a fruitful subject of discussion of late years. Properly speaking, there never has been any doubt that cases marked by all the symptoms of C. occasionally, and even pretty frequently in the early stages, get well; but it was argued that these were probably not genuine instances of what is now alone technically called C.—viz., tubercular disease. In France, where morbid anatomy was extensively cultivated in the beginning of the present century. the incurability of the tubercular form of C. was a general doctrine of the schools till the time of tnennec (q.v.), who, by multiplied instances, and careful observations on the dead body, showed beyond all question the occasional arrest even of advanced C., and the frequent cure of it in the early stages. The appearances in the lungs, and other organs of persons affected with C., will be discussed under TUBERCLE.
The treatment of C. is a very complicated subject, and one much misunderstood, partly owing to the misrepresentations of quacks, and partly from the great demand for palliative remedies on the part of patients and their friends, tending to obscure the 'true principles of treatment even to the mind of the physician. It is, however, now well ascertained that the greater part of the cure consists in hygienic measures—i.e., the 'regulation of the mode of living, the occupation, the diet, the clothing, the food, the hours of repose, etc., of the consumptive—and all treatment by drugs is usually regarded by well-informed physicians as subordinate to that just mentioned. A life in the open air to a considerable extent, and in a climate which admits of the enjoyment of such a life even in winter, is the best restorative in cases of incipient C.; yet too much may he sacrificed to the desire of obtaining these advantages, if a genial climate is sought at the expense of the comforts of an English home, or with the effect of producing anxiety of mind, or exhaustion of body by a long and fatiguing journey. Moreover, to many men a regular occupation is really a necessity in more senses than one; and to break up all the associations of habit in a person debilitated by disease, and not capa ble of seeking new sources of excitement, 1: to poison the springs of enjoyment, and render the remainder of life a burden. Many consumptives have been sent abroad only to die, and in all probability to die more miserably, and at an earlier period, than if they had remained at home. On the other hand, the favoring influences of climate are by no means to be rejected, when they can be obtained in accordance with the patient's previously formed habits, and with due regard to his means of occupation and pros pects of eventual cure. A varied and wholesome, but light and unstinulating diet, Including abundant dairy produce; flannel coverings next the skin, and clothing which is warm but not oppressive; a well-ventilated sleeping-apartment, with a moderate fire in cold weather; bathing in tepid water; the use of a' respirator or of a light woolen covering for the mouth and nose in excessively cold weather; avoidance of late hours, crowded rooms, and every kind of dissipation; avoidance also of draughts of cold air, and of sitting in damp clothes or with damp feet; these are the principal circumstances to be kept in view in the ordinary regulation of the life of a consumptive patient. The use of cod-liver oil has been very popular of late years in the treatment of C.; but it may be reasonably doubted whether the reputation of this remedy be due to its powers as a medicine or simply as a fattening food. Occasional small opiates, and other medi cines to arrest irritating cough and subdue feverishness, and in special cases the treat ment proper to the complications, such as diarrhoea (q.v.) and breathlessness, are gen erally admitted as useful adjuncts to the means above mentioned; but they can hardly be discussed in this place with advantage, and should be in general used only under medical advice. See Ancell on Tuberculosis—on Phthisis (translated for the Sydenham Society).