Chronic Tuberculosis of the This is what is ordinarily understood by consumption, or tuberculosis of the lungs without qualifi cation. Its symptoms vary with the progress of the disease, and the susceptibility of the in dividual to the poison (toxin) excreted by the bacillus. The onset is usually insidious, and the disease frequently progresses for 5 to 20 years before the patient recognizes it. The symptoms are often brought out by a from which the patient seemingly does not re cover. Many, therefore, attribute their disease to such a The first noticeable symptom is sometimes a hemorrhage or a pleurisy; again, a progressive loss in weight or a slight dry cough, becoming gradually worse. The most important very early symptoms are usually slight fever, especially toward evening (which may or may not be accompanied by a chill), hectic flush, acceleration of the pulse-rate, cough, expectoration, loss in weight, progressive pallor of the skin, night-sweats, indigestion or loss of appetite, vague general pains, and sore ness localized in the chest. The one positive sign of tuberculosis at this stage is the finding of tubercle-bacilli in the sputum. If every lesion were open, that is, in communication with a bronchus, there would be tubercle-bacilli in the sputum from the earliest stages, and the diagnosis would be easy; but many lesions are closed, that is, completely encapsulated, and, therefore, show no bacilli in the sputum. Hence the physician must rely on other signs brought out by careful inspection, palpation, percussion and auscultation of the chest and X-ray ex amination.
As the disease advances, all the foregoing symptoms are intensified. The pulse-rate be comes more rapid, so that it is evident to the patient in palpitation or shortness of breath, the temperature rises to 102 or more, the loss of weight becomes excessive, frequently reaching one-fourth, sometimes one-third and rarely one half of the usual weight, the pallor becomes marked, the appetite is completely lost, cough may become almost continuous day and night and of a most racking character, expectoration increases, the feet usually swell and the picture presented is known to everybody. The patient is extremely emaciated, the chest is quite flat, the depressions above and below the clavicles are marked and the scapula: stand out prominently on the back. Hemorrhage may or may not occur. As a rule there is little or no pain. The lungs themselves possess no sensitive nerves, and it is only the associated pleurisy which occurs at intervals that produces this symptom. Examination by the physician now reveals the signs of extensive solidification. This may extend over one whole lung or over the greater part of both. It may or may not be associated with cavities.
Chronic tuberculosis of the lungs, when diag nosed sufficiently early, and when the personal resistance is good, is a very curable affection. This is proven by the number of cured lesions found at autopsy. It is very conservative to say that 50 per cent of all bodies coming to the autopsy table past the age of 35 (death having been the result of some other disease than tuberculosis of the lungs), show a healed lesion of tuberculosis of the lungs. The present post mortem and clinical records demonstrate that 75 per cent of cases recover. Moreover, these post-mortem records are absolute; there is no practical question of diagnostic error. In addi tion, many cases with a lessened resistance can be so improved under judicious treatment that their lives are prolonged in comfort for 10, 20, even 30 years. For the encouragement of those afflicted, it might be stated that according to Jacobson the following appear to have suffered from tuberculosis: Cicero, Milton, Samuel But ler, Pope, Shelley, Hood, Keats, Elizabeth Bar rett Browning, Francis Thompson, Goethe, Schiller, Moliere, Richelieu, Merimee, Thoreau, Calvin, Descartes, Locke, Kant, Spinoza, Mozart, Chopin, Paganini, Beaumont, Samuel Johnson, Sterne, DeQuincey, Scott, Jane Austen, Charlotte and Emily Bronte, Stevenson, Bal zac, Voltaire, Rousseau, Washington Irving, Hawthorne, Gibbon, Kingsley, Ruskin, Emer son, Cardinal Manning, Raphael, Watteau, Bastien LePage, Marie Bashkirtseff, Cecil Rhodes and Laennec, as well as a large num ber of present-day physicians, who after de veloping the disease became tuberculosis experts, like Edward L. Trudeau, Lawrence F. Flick, H. R. M. Landis, Lawrason Brown, A. M. Forster, James Price, Estes Nichols and E. S. Bullock.
Diagnosis.— Only rarely is the diagnosis difficult. The comparison of the autopsy find ings with the clinical diagnosis at the Henry Phipps Institute showed the physical signs of Laennec to be practically perfect. In addition, we have as aids the examination of the sputum, the X-ray and the tuberculin test. Of these the physical signs elicited by an expert are the most positive. The sputum may fail to show tubercle bacilli on account of the lesion being closed. The tuberculin test is practically absolute, though it does not tell us in what part of the body the tuberculosis is. It is very useful in the diagnosis of tuberculosis in cattle because we only wish to learn the fact of its existence and are not concerned about its location; but not so useful in human beings in whom we usually wish to learn the nature of a lesion in a particu lar place. The X-ray in advanced tuberculosis is about as accurate as physical signs, but in i early lesions it frequently fails. It is likely that time will make the X-ray more accurate.