440 



CONSUMPTION 



respiration are more especially affected, seems to 

 point to the conclusion that the bacilli are present 

 in the air. But their presence there is not easily 

 proved. On the other hand, the expectoration of 

 consumptive patients is found to be loaded with 

 the organism. It has further been demonstrated 

 that the bacillus occurs abundantly in the milk of 

 cows suffering from tubercular disease of the udder ; 

 and meat obtained from the carcasses of tubercular 

 , animals, particularly the liver, kidneys, and glands, 

 cannot be regarded without suspicion. The preval- 

 ence of abdominal consumption in young children 

 has been attributed to the ingestion of the bacilli 

 by means of milk. It has further been shown that 

 tubercular disease may be induced through an open 

 wound, to which the bacilli have obtained access. 



The symptoms of consumption cannot be fully 

 discussed in the present article. As seen in 

 advanced cases, they are pretty generally appreci- 

 ated by the non-professional eye ; but at first they 

 are treacherous and frequently remain undetected. 

 The early symptoms vary much. There may be 

 nothing but a gradual loss of strength, it may be of 

 flesh ; there may be a slight discharge of blood from 

 the throat or chest ; there may be a more or less 

 persistent, tickling cough ; there may be breathless- 

 ness, with or without pain in the chest ; or there 

 may be little save an increased tendency to take 

 cold easily, with but tardy power of throwing it off. 

 Or again, the slow beginnings may be expressed by 

 a gradually progressing pallor, and, in the female, 

 by diminution or cessation of the menstrual dis- 

 charge. Any of those conditions, especially when 

 they show themselves in the adolescent or young 

 adult, are to be viewed with suspicion, and 

 regarded as a sure indication that medical help is 

 necessary. The more experience physicians have in 

 the treatment of consumption, the stronger becomes 

 the conviction that many lives might be saved, if 

 only an opportunity were afforded of arresting the 

 disease at an early stage. It is peculiarly at 

 this point that the greatest skill and prudence are 

 required from the physician. The appreciation of 

 the signs which indicate the presence of consump- 

 tion, both at this early stage and later, must be 

 left in his hands, and cannot, of course, be treated 

 of here. The later symptoms of consumption are 

 better defined, and are, unhappily, too well known. 

 They are, more particularly, cough, expectoration 

 of a more or less thick, opaque substance, of vary- 

 ing colour, from whitish-gray to green, sometimes 

 of blood, shortness of breath, pain in the chest, 

 gradually advancing emaciation and loss of weight 

 and strength, profuse sweating, especially in sleep, 

 feverishness, diarrhoea. As the disease advances 

 further, there frequently occur swelling of the feet 

 and sores about the mouth. Accompanying these 

 symptoms, grave changes occur within the lungs. 

 These are appreciated with ease by the trained 

 observer. It should be added that all the above- 

 mentioned symptoms must not be looked for in 

 every case of consumption. The type varies end- 

 lessly, and some cases run towards a fatal issue 

 with relatively few signs or symptoms, while 

 anatomically the disease is the same. 



The duration of consumption varies greatly. In 

 a certain proportion of cases the destructive process 

 is very rapid, and, if unchecked, may lead to death 

 within a few weeks. To this variety the name 

 Galloping Consumption has been applied. The great 

 majority of cases are extremely chronic, and the 

 disease seems from time to time to become station- 

 ary. Consumption may terminate fatally only 

 after many years. 



As to the curability of consumption opinion 

 has differed much. For long and, unfortunately, 

 to a considerable extent at the present day con- 

 sumption was regarded as incurable, and treatment 



adopted in the direction of palliation. More 

 recently, however, the view of its curability, main- 

 tained both by Laennec and Niemeyer, leaders of 

 opposite schools of pathology, has received fresh 

 life through Koch's discovery. During the last few 

 years many cases of recovery have been recorded. 

 If those who have reported such have sometimes 

 been affected with that peculiar hopefulness spes 

 phthisica which is a frequent attribute of the 

 consumptive patient, it must be regarded as a more 

 pleasing indication than the apathy which was 

 formerly too often displayed in respect of such 

 patients, as evidently appointed to die. There is, 

 moreover, reason to hope that we are on the eve of 

 greater possibilities. Never was attention so 

 keenly directed to this once neglected problem. In 

 illustration of this may be cited the institution at 

 Paris in 1888 of an International Congress, which 

 is to meet once in two years for the consideration, 

 and elucidation of all questions relating to con- 

 sumption, with a view to its prevention and 

 treatment. Meanwhile, it may be affirmed that 

 consumption, if suitably treated in the early stage, 

 is curable ; that occasionally more advanced cases 

 are cured, and that for all cases much may be done 

 in the Avay of prolonging life and relieving suffering. 

 The popular mind must be disabused of the idea of 

 the hopelessness of consumption. 



The treatment of consumption is one of the most 

 complicated problems which the physician has to 

 face. In its wide sense, it involves a consideration 

 of some of the largest questions relating to social 

 and individual hygiene. From the prophylactic 

 point of view, it includes the study of all points 

 bearing on the causation of consumption. Only 

 thus can the attempt be made to cope effectively 

 with the evil on the large scale. A knowledge of 

 the dependence of consumption on overcrowding, 

 vitiated air, improper ventilation, and other insani- 

 tary conditions, ought to lead the responsible 

 authorities to adopt and enforce such regulations 

 as will remedy the evil. Within recent years much 

 has doubtless been effected in this direction. The 

 legislature has taken in hand several departments 

 of this work ; and employers, in many instances, 

 have shown a proper interest in the welfare of 

 their employees. But more remains to be done. 

 There is need of increased popular instruction, 

 so that working-people and others may them- 

 selves appreciate the dangers which they run by 

 neglect of simple precautions. Further, having 

 regard to the communicability of consumption from 

 the lower animals to man, means should be devised 

 whereby the milk from tubercular cows may be= 

 excluded from the market, and the flesh of tuber- 

 cular animals condemned. These provisions have 

 been embodied in the recommendations of the 

 Paris congress (1888), that tuberculosis in animals 

 should be included in the list of contagious diseases, 

 the animals seized and destroyed, and dairies and 

 milk-houses be subjected to strict scrutiny by 

 competent officers. The danger of phthisical ex- 

 pectoration as a means of transmission has been 

 already alluded to. It is therefore advisable that 

 this, whenever possible, be destroyed by burning, 

 or rendered innocuous by scalding or other satis- 

 factory method. 



In respect of the treatment of individuals, much 

 may be expected from prevention. Though lacunae 

 exist in our knowledge of the life-history of the 

 tubercle bacillus more especially as regards its 

 access to, and development in, the human body 

 there is good ground for believing that general 

 depreciation of the system is a favouring factor of 

 much importance. Hence all measures are to be 

 adopted which will place the body under as good 

 conditions as possible, more especially when there 

 is suspicion of a family tendency towards consump- 



