When newly formed, tubercles appear to the naked eye as grayish-white or yellowish-white specks about the size of a millet seed, hence the name miliary tubercle. When two or more of these fuse, it is called a conglomerate tubercle. Usually the disease, especially in the lungs, pro gresses by a small number of tubercles localized in one area running together to form con glomerate tubercles and these again to form a larger mass which we call tuberculous infiltra tion. Sometimes in non-resisting cases miliary tubercles develop rapidly all through the lung and rarely in many other organs and the indi vidual dies before they become conglomerate. This condition is described as miliary tuber culosis. In growth tubercles destroy the tissue which they replace and even when cure results, they only change to masses of scar tissue; the original tissue never returns.
Children are most frequently the victims, and the bronchial, cervical and mesenteric are the glands of predi lection. Tuberculosis of the cervical lymph glands is popularly called scrofula. It is treated in a similar way to chronic tuberculosis of the lungs by rest, fresh air and nourishment, or by the X-ray, which appears to be frequently successful. When•the glands break down, surgical interference is usually necessary.
Bone This is likewise most common in children. It may be limited to the medulla or periosteum, and spread from either to the cortical portion, producing necrosis (tuberculous caries). It is most frequent at the joints, especially the hip and the intervertebral. Tuberculosis of the vertebral column is popu larly called Pott's disease, or hunchback. It is usually associated with lumbar or psoas abscess. When localized to the vertebra, cures are frequent. The treatment of Pott's disease and other joint, tuberculous disease, like hip joint disease, is similar to that of chronic tuber culosis of the lungs.
Intestinal The intestines show either a miliary variety (the tubercle lying either beneath the mucous membrane or the peritoneum) or a chronic ulceration. Both forms are usually secondary to tuberculosis elsewhere. Miliary tuberculosis and tubercu lous ulcers of the appendix are not uncommon, particularly in advanced tuberculosis of the lungs.
Laryngeal is mani fested commonly by adults as a complication of advanced tuberculosis of the lungs. Its bad reputation, as far as cure is concerned, comes from the fact that it usually occurs only when the tuberculosis of the lungs is so advanced that the individual is incurable on account of the lung condition. When it occurs early in the case or as a primary affection, it is just as curable as tuberculosis elsewhere. The amount
of hoarseness or pain does not indicate the seriousness of the condition. A small insignificant closed tubercle between the vocal cords may produce marked hoarseness; a small ulcer on the epiglottis may produce great pain; a large, much more serious ulcer when situated elsewhere may produce neither hoarseness nor pain.
The organs most commonly affected in adults are the lungs; in children, the lymph glands, bones and joints. The other organs are affected much less frequently, and in about the following order: Intestines, peritoneum, kid neys, meninges, brain, spleen, liver, generative organs, pericardium, heart. Tuberculosis of the skin comes under the head of lupus (q.v.).
Symptoms and Prognosis of Tuberculosis of the It is necessary to differentiate three varieties, acute miliary tuberculosis, acute tuberculous pneumonia and chronic tubercu losis.
Acute Miliary Tuberculosis of the Lungs. —This may begin as a primary or be secondary to an acute or chronic affection elsewhere. It is most common as a termination of a chronic affection of the lungs. It comes on rather rapidly, like the ordinary acute infectious dis eases, and is sometimes distinguished from them (especially typhoid fever) with difficulty. There is a loss of appetite, loss of flesh and strength, fever to 104° F.), accelerated pulse, hurried respirations, a brown fissured tongue, delirium, then stupor and death. The duration is from two to four weeks. The prog nosis is always grave, though no case of tuber culosis is ever so grave that treatment is surely in vain.
Acute Tuberculous This is practically always secondary to a chronic tuber culosis of the lungs. It begins, like lobar (ordinary) pneumonia, with a chill, high fever, rapid pulse, shortness of breath, hemorrhagic sputum, flushed face, and the physical signs of consolidation of parts of the lung. Instead of ending by crisis about the ninth day, like lobar pneumonia, it continues to a fatal termination; or the acute symptoms gradually subside, the diseased area becomes fibrous, and the patient gradually gets well, or approximately so, with a loss of lung-tissue equal to the involvement, which is sometimes an entire lung. The diagnosis is made by the ordinary signs of pneumonia and the tubercle-bacilli in the sputum. The prognosis is very unfavorable; rarely, however, a case recovers sufficiently to lead a useful life for a number of years. The treatment is that of chronic tuberculosis.