Page:The American Cyclopædia (1879) Volume V.djvu/287

CONSUMPTION 283 morbid product which has been known as yel- low and crude tubercle, or tuberculous infiltra- tion. This is now generally regarded as an in- flammatory product, and hence the propriety of calling the affection a form of pneumonia. The point of departure of the process of inflam- mation which occasions this product is sup- posed to be the membrane lining the air cells of the minute bronchial tubes. This product un- dergoes a cheesy degeneration, so called be- cause it has the consistence of cheese. At length it softens so as to become changed into a thick liquid resembling purulent matter or pus. Ulceration then takes place, the liquefied product is discharged into the bronchial tubes, and it forms a certain proportion of the matter which is expectorated, leaving cavities. As a rare exception to the general rule, the dis- charge takes place into the pleural cavity, giv- ing rise to a perforation of the lung, and as a consequence to the affection known as pneumo- hydrothorax. In most cases, after death from consumption, the several stages of the char- acteristic changes in the lungs are associated, because different portions of the organs are af- fected at successive periods of time. It is a law of the disease, to which there are occasional exceptions, that the upper part of one lung is first affected ; but shortly afterward the upper part of the other is invaded ; the affection then extends downward after variable intervals. Hence it is that often different sections of the lungs represent the series of changes which have taken place. In addition to the changes just noticed, in most cases miliary tubercles are found, being sometimes few in number and sometimes abundant. There is evidently some pathological connection between these tubercles and the other changes ; but, as regards this con- nection, the views of different pathologists dif- fer; some considering the tubercles as prece- ding and giving rise to the other changes, and some regarding the latter as primary, and stand- ing in a causative relation to the former. Fur- ther morbid changes generally found on post- mortem examinations are those denoting pleuri- sy. As a rule, affected portions of the lungs are adherent to the walls of the chest, this being a result of circumscribed pleuritic inflammation ; and in some cases the pleurisy gives rise to an effusion of liquid in greater or less quantity between the pleural surfaces, in other words within the cavity of the pleura. The disease in the majority of cases is developed slowly and often almost imperceptibly. Usually cough is the primary pulmonary symptom. It is at first slight and dry, after a variable period becoming more marked and accom- panied by expectoration. The early cough and expectoration represent a circumscribed bron- chitis. As the disease progresses, the expecto- ration becomes abundant, consisting of mucous secretions, the liquefied tuberculous product, and purulent matter. Spitting of blood (hemop- tysis) is sometimes the first symptom pointing to the pulmonary affection. This symptom in some cases precedes the cough, and perhaps occurs when the health is apparently perfect. It is absent in a minority of the cases of con- sumption, and is apt to occur repeatedly, and in some cases a great number of times at variable intervals. The quantity of blood ex- pectorated varies, being sometimes small and sometimes profuse. In some very rare instances the loss of blood is the immediate cause of death. In general, however, there is no danger from the haemorrhage, and, so far as its apparent effect upon the progress of the disease is con- cerned, it is favorable. Statistics show that out of a considerable number of cases, the dis- ease is non -progressive, or progresses slowly, in those in which the spitting of blood is frequent and profuse. Pain in the chest is not infre- quently entirely wanting, and it is seldom a prominent symptom. The pulmonary affection in itself occasions no pain ; when it occurs it is due to the pleurisy which is developed as a complication of the affection of the lungs. The pain which denotes pleuritic inflammation is short and stitch-like, and is referred by the patient to the upper part of the chest, or be- neath the shoulder blade. Pain of this descrip- tion occurring at intervals denotes successive attacks of circumscribed pleurisy; the pain, however, is rarely sufficient to occasion much inconvenience. The frequency of respiration is in proportion to the extent of the pulmonary affection, and the breathing becomes panting on exercise ; but it is not common for patients to suffer greatly from a sense of the want of breath. With these symptoms referable to the chest are associated symptoms which it is cus- tomary to distinguish as constitutional. The pulse is more or less accelerated, and the heat of the body, as determined by the thermome- ter, increased. These constitutional symptoms are marked in proportion as the disease is ac- tively advancing. Paroxysms of hectic fever occur daily in the afternoon, often commencing with a chill, and generally ending with profuse perspiration. Perspirations are of frequent oc- currence without being preceded by marked fe- brile paroxysms, especially during sleep, whence they are known as night sweats. Chills also, or chilly sensations, are not infrequent with- out being followed by fever and sweating. Sooner or later the appetite fails, and there is sometimes an invincible repugnance to food. The digestion is sometimes disordered, but in many cases the food which is taken occasions no ailments referable to the stomach. As the pulmonary disease advances, there is progres- sive reduction of the weight of the body, end- ing at length in notable and sometimes extreme emaciation ; and the muscular strength propor- tionally decreases. In females the menses di- minish and at length cease. Diarrhoea is some- times a prominent symptom, and occurring in a late period, it has been called, from the exhaus tion which it occasions, colliquative diarrhoea. The ends of the fingers sometimes become enlarged or bulbous, forming the " clubbed