We may now go on to consider a few of the leading types of tubercular disease of the lung, bearing in mind that these types are not de pendent upon any essential differences in the real character of the affection, but are caused by the varying manifestations of the disease, dependent upon entirely secondary and sub ordinate circumstances such as have been dis cussed.
Acute Tuberculosis of the Lung may occur as part of a general infection of the body by tubercle, or the disease may be limited to the lung. In its typical form it bears no re semblance to an ordinary case of consumption, but affects the patient in a way strongly sug gestive of a specific infectious disease. Thus for a time it may be considered an attack of typhoid fever. This is probably due to the fact that the symptoms are not so much due to the changes going on iu the lungs as to the poison ing of the patient by the toxins produced by the organism (p. 376), the organism being a virulent one, or attacking in great numbers or spreading with great rapidity. In such cases the lungs (probably both are affected) are found sown everywhere with the gray miliary tu bercle, and the patient may die, overwhelmed by the attack, before any of the ordinary changes in the lungs have time to be evolved, and before the symptoms recognizably con sumptive have appeared.
The symptoms of such a type are fever, which runs high, and which probably oscillates daily, being highest about 6 afternoon, and lowest about 2 or 3 in the morning, the maximum being 103° or 104°. The pulse is rapid and weak, the breathing is quickened, and may be so embarrassed that a tinge of blueness is visible on the skin. There may be no cough, and little or no expectoration. On the other hand, the cough may be distressing, and of a dry irritable character. Loss of flesh and strength is rapid and marked. There is loss of appetite, per haps with a feeling of sickness, and maybe vomiting. The tongue is coated, and becomes quickly dry and brown. The bowels may be undisturbed. Delirium and stupor set in, and death may occur in a few days or weeks. All this time, while the lung may be the only part attacked, it may be very difficult to detect any marked change in the character of the breath sounds, &c., when the chest is examined. It
may be noted that this form of attack may occur in a person who has been long tubercular or consumptive, due to a sudden wakening to activity, so to speak, of the tubercular organism, which has been lying latent in the patient's body.
Other cases may follow a less acute course than the above. In some the fever may be less noticeable and occur only in the afternoon, the exhaustion and emaciation being the chief features. Indeed in some cases there is nothing to be noted except profound weakness and loss of flesh. It is, however, often in such cases that there is bleeding from the lung, the scanty spit being stained with blood, or frequent haemorrhages taking place.
In chronic forms of the same type emacia tion is the leading symptom, and the patient may be subject to recurring attacks, at one time of what seems pneumonia, at another pleurisy, at another a spitting of blood.
The detection of the true nature of the dis ease in this type of consumption is often ex tremely difficult. A correct opinion is likely to be formed only when the temperature is regularly taken and recorded, when the chest is repeatedly and carefully examined, when any spit that can be got is stained and examined for the tubercular organism, and in the very acute cases the blood should be tested for the reaction of typhoid fever.
Galloping Consumption (Acute Phthisis Phthisis Pulmonalis acutu).—It is in this type of consumption specially that the air-cells of the lungs become filled with inflammatory products and the tubercular nodules undergo the cheesy conversion, and ultimately both break down and liquefy, so that numerous cavities are formed throughout the lung substance. Pro bably because of the rapidity of the process there is little of the formation of fibrous tissue surrounding the tubercular masses. The fea tures, then, of this type are the easily-dis covered changes in the lungs themselves, and the corresponding symptoms of lung destruc tion, which makes the disease recognizable to the patient and those about him.