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Chronic Tubercular Phthisis

disease, signs, symptoms, lungs, patient, physical and cough

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CHRONIC TUBERCULAR PHTHISIS.

In this form of the disease the illness begins in a very gradual manner, and the special symptoms arising from the lungs are preceded by others showing the existence of general disorder of health. The child is noticed to be languid and listless. He looks pallid ; has little appetite ; complains of pains in his legs, and is disinclined for his usual games. He is often found to flush at night and his hands are noticed to be hot. After these symptoms have continued for several weeks the patient begins to have a slight cough. This at first is merely a short occasional hack which excites little attention ; but after a time it becomes more frequent and annoying. The course of the illness in this variety is less irregular than in that previ ously described ; but still the downward progress is more rapid at some times than at others. The temperature, although it undergoes consider able variations, rarely stands at a normal level in the evening ; but unless the disease be complicated with catarrhal pneumonia the pyrexia is not high and seldom reaches 102°. Wasting is usually persistent ; but if the patient has been exposed to privation, the comforts of a hospital may in duce a temporary improvement in nutrition, although the pyrexia con tinues and the other symptoms remain unaltered. Cough for a long time may be a very insignificant symptom and, even with signs of extensive disease of the lungs, may be almost absent. The breathing is often rapid, rising to thirty or forty in the minute. Increased hurry of breathing, according to Niemeyer, may be one of the earliest local symptoms, occur ring before any physical signs of the disease can be discovered in the chest. The digestive organs are weak and irritable. Vomiting is common and is often excited by cough. Purging is also a symptom. In many cases examination of the belly discovers fatty enlargement of the liver, and oedema is often noticed in the limbs. Death may occur from general weakness, from catarrhal pneumonia, or from the extension of the tubercular formation to other parts.

The physical signs of tubercular phthisis appear late, and at first are curiously insignificant when compared with the severity of the general symptoms. We find a child pale and thin, with a depressed, saddened look.

The borders of his mouth have a faint blue tint ; he pants after exertion, and coughs occasionally a short bard hack. We are told that he has been failing for several months ; that he eats scarcely anything ; has lost all his spirits, and gets flushed and feverish at night. On examination of his chest we discbver merely some slight want of resonance at the apices of the lungs with weak, harsh breathing. A faint dry crackle of rhonchus is caught at the end of inspiration, and is brought out more clearly by a cough. The chest is elongated, with a narrow antero-posterior diameter, but the lungs, although naturally small, appear healthy except for the signs which have been mentioned.

As the disease progresses the physical phenomena become more pro nounced. They are always discoverable at both apices, although more marked on one side than on the other. Usually the area of dulness is in creased by a pneumonic process set up in the lung ; and marked dulness with blowing breathing and the ordinary signs of consolidation are dis covered. The disease then after a time presents much the same characters to physical examination as those referred to in describing the catarrhal variety of phthisis. In exceptional cases disorganisation goes on without the aid of a pneumonic process. We then find the feeble breath-sound to become gradually blowing, and eventually cavernous sounds are discovered at the apex.

Tubercular and tuberculo-pneumonic forms of phthisis are often met with in scrofulous children who suffer from long-standing disease of the joints. In such cases the articular affection has probably been the original cause of the pulmonary mischief ; and by the continual irritation to which it gives rise may influence the condition of the patient very unfavourably. In these cases it is often advisable to remove the diseased joint, even al though the amount of disease in the lung is too extensive to allow of last ing improvement. Life may be considerably prolonged and the comfort of the patient greatly promoted by this step.

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