Tuberculosis claims more victims than any other disease. It spares no class, no age, and no sex. Although some districts are less visited by the malady than others, the disease is met with even in climates that are naturally It is generally assumed that about one-seventh of all deaths is due to tuberculosis, but this figure by no means expresses the frequency of the disease. About 1,250,000 individuals die every year in Europe as the victims of this scourge ; and in 19oo more people in the United States died of the " White Plague " than of any other single disease.
On comparing the number of cases of death due to tuberculosis with the total mortality at different ages, it will be found that the greatest number of victims succumb between the twentieth and the thirtieth year ; hence, while in the prime of life. Industrial communities are very prone to suffer from tuberculosis ; agricultural communities less so, though these are not exempt.
The course of tuberculosis presents a great variety of forms. Whereas in some persons the disease terminates fatally within a few months, even in a few weeks, in other patients it remains stationary for years, or progresses very slowly.
Acute miliary tuberculosis, an especially acute form of consumption, occupies a unique position. In this form of tuberculosis, numerous tubercles, of about the size of millet-seeds, form in a very short time—not only in the lung, but in other organs of the body as well. Their origin can be explained on the hypothesis that a bacillus-containing area, situated in some part of the body, softens and breaks down, whereupon the circulating blood carries with it numerous tubercle-bacilli, which flood the body. It is a type of infection resembling acute pTemia, the only difference being the infecting agent. This form of pulmonary tuberculosis is difficult to recognise, par ticularly at the onset, as the symptoms of the disease vary greatly, often being of a general, uncertain nature. In some cases the disturbances are general ; in other cases they are localised, either in the lung (cough, stitches in the side, shortness of breath), or in the brain (headache, fever, stiffness of the neck and back, etc.). When the disturbances affect the general health, the condition is sometimes confused with typhoid fever ; but gradually the characteristic pulmonary or cerebral symptoms become manifest, rendering diagnosis certain. There is no hope of recovery from acute miliary tuberculosis, even if the disease be recognised at the very onset. The efforts of the physician, as well as of the patient's friends, can he directed only toward affording the sufferer some relief from the more distressing symptoms. Death generally takes place in three to four weeks.
The course of chronic pulmonary tuberculosis likewise shows great varia tions with reference to the changes taking place in the lungs, as well as with regard to subsequent affections and to the severity and duration of the disease as a whole. In the large majority of cases, the onset of chronic consumption is an extremely insidious one. The patient is at first thought to be suffering from an apparently harmless attack of anxmia, a persistent catarrh of the stomach, or from a slight bronchial catarrh, until at last a medical examination of the lungs and of the sputum reveals the true nature of the malady.
The first striking symptoms pointing to an affection of the respiratory passages are cough, expectoration, and pain in the chest. The pain is usually situated in the region between the shoulder-blades or in the sides, and is caused by an inflammation of the pleura. It is possible that pain of a similar nature may be due also to disturbances of the diaphragm and of the chest muscles, which are strained by coughing. Pulmonary tuberculosis, however, may be present for some time without causing pain, even if exten sive destruction may have taken place in the lung. The cough, which is one of the most tormenting symptoms of the disease, often becomes worse at night or just on arising in the morning. Expectoration may be entirely absent at the onset of the disease, or, if present, it may consist of mucus only. Later it may become a mixture of mucus, pus, and epithelium. When cavities have commenced to form in the lungs, the sputum becomes more intermixed with pus ; and its original white or whitish-grey colour takes on a yellow or yellowish-green tinge.
The patients are most violently agitated by the appearance of blood in the sputum. Slight, streak-like admixtures of blood frequently occur in the sputum of tuberculous patients without being of any dangerous significance. They should not be overlooked, however, as they may be the precursors of a Profuse hEemorrhages may persist for weeks or months, but are rarely an immediate cause of death. It sometimes happens that a hmor rhage from the lungs takes place without any demonstrable external cause. This is due to the progress of a destructive process which gradually opens blood-vessels in the lung. In some patients may be ascribed to excessive bodily exertions, violent straining during severe attack of cough, and, occasionally, to mental emotions.