Sy m pto ms. —The patient is suddenly attacked by what at first is called a feverish chill. This fever oscillates, as in the preceding type, and the pulse is quick. There is rapid loss of strength and flesh. Profuse sweating is fre quent, specially at night — "night sweats." There is often pain in the side, and cough with spit, at first suggesting pneumonia, and quite early in the attack much blood may be coughed up. Within a few days the changes going on in the lungs can be discovered by examining the chest, and a microscopic examination of the spit will make clear the nature of the disease. The breathing is rapid. As the lung tissue breaks down, the spit becomes more abundant, of a yellowish-green colour, and if expectorated into a dish with a little water, it floats in smali round clumps, the nummular spit of consump tion. If considerable cavities have formed, the cough will come in bouts, a large quantity of yellowish, and perhaps sickly-smelling matter being put up at a time, the cough then ceasing for a time. The case goes on from bad to worse till death occurs, maybe in a few weeks, from exhaustion. There are numerous cases of this same type only less acute, or in which a less extent of lung is involved. In the latter case the disease may cease in the area of lung attacked, fibrous tissue may form to surround and obliterate the tubercular nodules or cavities, and the person may recover with this part of the lung permanently damaged but without active disease going on. In such a case the fact will be revealed even to the eye in the flatten ing or indrawing of the chest-wall over the site of the impaired piece of lung.
Chronic other cases the changes in the lung, while of the same type as those in acute consumption, go on more slowly, invading one part of the lung after another, crossing over from the lung first attacked to the other. Such patients may go about, except when laid up by a fresh more acute outbreak. In such cases bleedings from the lung are apt to be frequent, because of erosion of vessels in the walls of cavities. Often the case may end by the opening into a large vessel and violent haemorrhage. Night sweats are more frequent in this form of the disease. In its course also a great variety of symptoms may occur, dependent upon the direction in which the disease is ex tending. Thus pleurisy and extensive effusion
may occur, and, if any cavity opens into the pleural space, matter may form, and the con dition called empyema arise, requiring opera tive interference.
In the progress of the disease other symptoms indicate that various other organs are affected. Notably in advanced phthisis is looseness of the bowels common. In some cases it is most in tracta.ble, increasing the exhaustion of the pa tient with great rapidity, being due to deposit of tuberculous matter in the bowels, and it may be accompanied by pain in the belly.
Fistula in the anus (p. 269) is frequent in consumptive patients, and the healing of the fis tula has, in many cases, been followed by rapid progress of the disease. On this account, though it is curable by a surgical operation, many, who fear consumption, prefer to leave it alone.
Alterations of voice, hoarseness or loss of voice, due to tubercular ulceration in the larynx, occur in the course of the disease. Whether this is the cause can be determined by an ex animation with the laryngoscope (p. 356).
Confirmed consumptive patients may be known by certain curious physical characters: clubbed form of the ends of the fingers and the nails, pearly - white colour of the white of the eye, wide condition of the pupil (the black of the eye), and the presence of a reddish or purplish line along the junction of the gums and teeth.
Death is due commonly to exhaustion, but may occur suddenly owing to great loss of blood by the lungs, or may be caused by some com plication. Dropsy, occurring usually in the feet and legs, and the presence of thrush in the mouth are signs of the approach of the end.
The very varying duration of consumptive disease is shown by the following table, which gives the results of 314 cases :— Fibroid Phthisis is a form of consumption which is characterized by the formation of patches and strands of connective tissue— fibrous tissue—replacing the tubercular nodules, in which the more imminent symptoms are of loss of breath, and laboured breathing on exer tion, the other symptoms of ordinary consump tion being less marked. (See p. 370.)