Symptom, of Pladtxris.—These generally commence with a slight -cough, which at first exeitee no attention, but is regarded as a simple cold. The breathing is not seriously effected, nor is the appetite impaired. After a time the cough increases in and is accompanied by expectoration of a clear frothy saliva; the breathing and pulse become a little hurried after meals and towards evening; and at this time of the day there is frequently experienced a slight degree of chilliness, followed by heat, which continues during tho greater part of the night, and is succeeded towards inoneng by per splratien. The patient likewise become. somewhat paler, and is languid and easily fatigued. In sonde instances, the Bret symptoms are preceded by a more or less copious limmoptyeis. In the second stage of plithieis the cough become. more frequent., especially during the night; and if violent, it sornetiniee occasions vomiting. Hoarse ness, or loss of voice, is not unusual. The expectoration changes its characterit is less frothy and more opaque; containing small Particle. of a yellowish-curd-like substance ; or the sputa are streaked with dull-yollow lines, and bremoptyrris is pretty frequent, but in general not abundant. The breathing and pulse are more hurried ; the fever is greater; and the penspirations more regular and copious. Pains km the thorax, denoting pleuritic inflammation, often occur ; and the languor and emaciation still increase. In the last stage of consumption there is nearly always profuse diarrhma, and the sweats and expectoration are more copious; the latter becomes mere uniform in composition; and is separated into romintligh distinct masses, with flocouleut edges. The emaciation and debility keep pace with the other eymptomr, and the feet and ankles swell towards evening; the appetite generally decline* In the same pro portion, and the patient dies In the extreme degree of marasmile, not unfrequently flattering himself to the last with a speedy recovery. In females, the menstrual discharge almost always cease* when hectic fever Is established, and occasionally even before that is the case, which has led to a popular opinion that the disease In such caeca arises from the suppression. Such are the ordinary symptoms presented by phthisis in Its most usual form, but varieties exist in the order and duration of the morbid phenomena. Thus, tubercles many be developed in the lungs, and remain for a considerable period without exciting either cough or expectoration, or even any important general symptoms. In other cases they give rise to intense general symptoms, as fever, emaciation, anorexia, before they excite cough or expectoration, the latter appearing only a short time previous to death. To these cases the term latest pAtfiieit hes been applied : and what is remarkable in them la, the absence of appreciable organic alteration in orgena whose fuuctional derangement was most violent, while the only vinous really affected seems functionally healthy. The term eclat petkiais is applied to those cages in which the disease goes through all Its stages with unusual rapidity. It occurs most frequently In the young, and in those weakened by some previous disorder. In popular Language it is designated "galloping consumption.' (Ironic peteisis is the reverse of the last, and comprehends all those mace in which the progress of the disease is unusually slow end generally Intermittent.
Diagnosis of PAtAisis.—Auscultation and percussion are the chief means by which we arrive at the diagnosis of phthisis [At:acute TATION ; Pesersetoe]; but there are several collateral circumstances which must be taken into consideration in order to forum a correct opinion as to the nature of the disease. It is at time commencement of
plithiele that an accurate diagnosis is of most importance, and in which the stethoscopic signs are least evident. We shall be therefore more particular in enumerating the indications at this period, than In accurately describing the scours%) phenomena which are present at a more advanced stage of the disorder. As bronchitis is the Disease with which phthisie is most liable to be confounded, we shall place lit juxta position the principal points in which they differ. In the greater number of cases of phthisis the cough comes on without any evident cause, and many months may elapse without expectoration. This apparent absence of cause and dryness of cough are of themselves very remarkable, and differ from what occurs in simple bronchitis. Thomeic ;eine, when present in the latter affection, are generally fit in the middle of the sternum; while in plithieis they are situated in the sides of the cheat and between the shoulders. llitmoptysis, from the com mencement or during the progress of cough, Is frequent in phthisis, and is almost a certain sign of the presence of tubercles ; whereas this symptom never occurs in bronchitis. Out of twelve hundred patients affected with various diseases, not including cases of amenorrhces, or those arising from external violence, M. Louis found that not one, with the exception of phthisical cases, had experienced this symptom. Auscultation gives us little or no aid in the earliest stages of phthisis ; and when the stethoscopic signs first manifest themselves, they are esuch as result from an increased density in the structure of the lung, end not from the presence of fluid in the hrouchi, as is the case in bron chitis. Thus the expiration, which in health is scarcely audible, becomes more distinct; the voice more resonant; the sound elicited on percussion duller. These alterations in the respiration, and in tho signs produced by percussion, like the development of tubemles, take place from the summit to the base of the chest, arid at first are almost constantly confined to the upper lobe of one :tide. In bronchitis the sounds result from fluid in the bronchi, and originate in the lower part of the chest, and usually on both sides. In the more advanced stage of phthisis its diagnosis is less difficult, and is made from a consideration of the sputa, which wo have already described, and from the signs furnished by percussion and auscultation. These are now decisive : the upper parts of the chest are dull on percussion; the respiratory murmur is strong, coarse, or even cavernous under the clavicles; and the voice listened to in the mune situation gives rise to that peculiar phenomenon termed pectoriloquy. If there should be ninth fluid in the lungs, resulting from the patient's not 'wain lately expectorated, eve then have a mucous rattle in all those parts of the chest corresponding with the seat of tho disease ; and where cavities containing fluid exist, the sir passing through this produces that gurgling noise to which time term gargouilkment has been applied by the French. The space in which these different changes take place is at first limited; but it daily increases, and In some instances, where the entire upper lobe of the lung is converted into numerous exce 1 rations, the respiration Is coarse amid more or less tracheal throughout its whole extent. The diagnosis of latent phthisie is not difficult,. provided we make use of the proper means for aacertaining the could ditlon of the pulmonary organs ; the evil is, that the attention is directed exclusively to those functional derangements which we have 'spoken of when describing latent phthiais, while the real seat of till disease Is overlooked.