The following are criteria for the early diagnosis of tuberculosis:— Intermittent pretuberculous albumi nuria, often alternating with phospha turia_ Tuberculous pseudochlorosis, distin guished from the true by the fact that there is less lowering of the haemoglobin standard, slighter accentuation of the cardiovascular phenomena, and by the presence of leucocytosis.
Disturbances of the digestive appara tus: anorexia alternating with vora cious appetite; gastralgia.
Afebrile tachycardia, characterized by the greatest instability.
Lowering of the blood-pressure.
Marked and permanent rises of tem perature following active movement, and in women elevations of three- to four tenths each day before the oncoming of menstruation.
Tendency to sweats, not only noctur nal, but also following the slightest fatigue and emotion.
A sense of pain in the nuchal and supra-orbital region, the upper part of the trunk, etc.
Inequality of the pupils, and, accord ing to some, dilatation of both; this is rare.
Appearance of herpes zoster in the area of the distribution of the fifth pair in meningeal, and on the thorax in pulmo nary, tuberculosis.
The color of the gums: red in those suffering from acute forms, bluish in chronic cases, and white in scrofulous individuals.
Pretuberculous enlargement of the spleen.
Amyotrophy of the thorax.
Dyspncea, cough, etc.
Hremoptysis, when there is no other cause for it, but hysterical suggestion must be guarded against.
A sensation of resonance felt by the individual in talking.
Percussion; this is of little impor tance, owing to the possibility of asym metry, or insufficiency of air owing to marked atrophy.
Auscultation: the bases also must be auscultated; harsh breathing at one apex should not always be taken as an indication of tuberculosis.
Injections in guinea-pigs.
Serum diagnosis after the Arloing Courmont method.
Fluoroscopy and radiography, but dis count should be allowed for exaggeration.
Injection of small quantities of physio logical serum; this gives a febrile reac tion in all grave ancemins. even non tuberculous.
Injection of tuberculin; this is the best criterion of all, but, as it may make a chronic process acute, it should be used only when it is absolutely necessary. Bozzolo (Tuberculosis Congress; Brit. lied. Jour., May 19, 1900).
In many cases of pulmonary phthisis, but more particularly in those which fol low- the ordinary sequence of initial dep osition and consolidation within the up per lobes accompanied by dullness in the supraclavicular and supraspinal areas, a number of venous varicosities one-third to two-thirds of an inch in length may often be observed beneath the skin in the neighborhood of the spines of the seventh cervical and three upper dorsal vertebra=,. They appear early and may become very conspicuous. At times they become ap parent only after stretching the skin lat erally. Local pain is occasionally felt; also slight oedema may be found over these vertebral spines.
The sign appears useful. The atten tion of the practitioner is at once ar rested by it and the condition of the pos terior apices of the upper and lower lobes determined. The presence of ausculta tory signs within this dorsal area, com bined with wasting and myoidema. ren der the diagnosis of early phthisis, even in the absence of sputum and bacilli, practically conclusive. Walker Overend (Lancet, Aug. 31, 1901).
Arloing and Courmont say that by the employment of homogeneous glycerin bouillon cultures of the tubercle bacil lus an agglutinating action of the serum of tuberculous subjects can be obtained. The difficulty lies in preparing a suit able culture. The test requires a rich culture eight to twelve days old. In a recent paper (La Presse Modicale, Sept. 1, 1900) they reach the conclusion that an agglutination of the tubercle bacil lus by the serum of tuberculous patients is usually found very early in the course of the disease. It is commonly obtained in a dilution of from one to twenty to one to five. The maximum of intensity is found in those patients having di, crete lesions, those suffering front gen eralized tuberculosis not presenting the reaction in the same degree. This diag nostic method is devoid of any possible danger to the patient.
The serum-reaction for tuberculosis tried in 40 cases. Three absolutely healthy persons gave no agglutination in a dilution of 1 to 3 or 1 to 5. Thirty eight cases of tuberculosis were tested. and in only 2 eases was the reaction negative; and both of these were eases of advanced phthisis. The milder cases of phthisis gave the most reactions and reacted in the greatest dilutions, while severe cases gave the re action only in smaller dilutions. The serum-reaction is of great importance in the early diagnosis. Bendix (Deutsche med. Woch.. Apr. 5, 1900).
The scrum-reaction tried in early tuberculosis in 75 eases. In early tuber culosis the serum exhibited its aggluti nating properties in only a few cases, while a relatively large number of pa tients in advanced stages, and who, ac cording to Courmont. should in general not give the reaction, possessed a very high agglutinating index. It was also observed that the blood-serum of a large number of non-tuberculous individuals had the property of agglutinating the tubercle bacilli. Again, others in the earlier stages which responded unmistak ably to tuberculin gave an absolutely negative result. Beck and Rabinowitseh (Deutsche med. Woch., June 21, 1900).
As the process advances from infiltration to consolidation the physical sounds come more pronounced, fremitus and vocal resonance are much increased, and on inspection there is seen a failure of expansion over the affected area, with slight sinking in of chest-wall. The per cussion-note is dull, higher in pitch, shorter in duration, wooden in character, and the percussion resistance is much increased; deceptive cracked-pot reso nance may be obtained over the main bronchi, and on auscultation, as the ve sicular element becomes eliminated, the broncho-vesicular passes into bronchial breathing and bronchophony results.
The expiratory note is now very markedly prolonged and blowing or tubular in character. Not infrequently the heart-sounds are heard over these consolidated areas with as great or greater intensity as at the normal site of the apex-beat.
At the point where the process is most advanced scattered or isolated erepitant tiles are now heard at the end of inspira tion, and gradually become more closely massed and progressively pass into sub crepitant and mucous rides, which indi cate the beginning of softening, followed by breaking down of the tissue as the disease passes into the third stage.