Tuberculosis. 447 



condition, the coat loses its lustre somewhat, the hair becomes 

 dry and stares in patches, and the skin loses its mobility and 

 mellowness. The cough may be more frequent, perhaps paroxysmal 

 under excitement, harsher, more short and broken, and either 

 dry and husky or moist and gurgling, with a succeeding deep in- 

 spiration perhaps a moist rale. When the skin on the last ribs 

 is pinched up between the fingers and thumb it is slower in flat- 

 tening down to its normal smoothness, pinching of the spine at 

 the shoulder or back, or it may be of the sternum, may cause 

 wincing and even moaning, and the same may come of percussing 

 the ribs smartly with the closed fist. There is now more decided 

 evidence of flatness on percussion on the various affected points, 

 and of abolition or lessening of the respiratory murmur, which 

 is replaced by wheezing, or by bronchial blowing sound, heart 

 beats and abdominal crepitation or gurgling, conveyed to the ear 

 more clearly through the intervening consolidated tissue. The 

 breathing may be slightly accelerated even at rest, and becomes 

 distinctly so on exertion. The appetite fails somewhat and the 

 secretion of milk lessens, or it may become more pale and watery. 

 Chronic tympany occurring after meals occasionally appears, 

 usually indicating tuberculosis of the glands along the oesophagus 

 with pressure on that organ impairing eructation, and on the 

 vagus nerve so as to impair nervous control. In connection with 

 this there come on signs of generalization of the tubercle, as 

 irregularity of the bowels, or enlargement or nodular induration 

 of some of the superficial lymph glands, as the pharyngeal, pre- 

 scapular, prepectoral, axillary, prefemoral, inguinal or mam- 

 mary. Expectoration is usually abundant but it is difficult to 

 secure it for diagnostic purposes since the moment it reaches the 

 pharynx it is instantly swallowed, while any that may have been 

 projected into the anterior nares is licked out by the pointed 

 tongue. Nocard tried to secure this through a cannula passed in 

 between the tracheal rings but with very little success, Others 

 have introduced the hand into the pharynx, rousing the cough by 

 tickling the larynx, and attempting to bring out the expectora- 

 tion in the hand. When it can be secured its solid and opaque 

 flocculi may be stained and examined for the bacillus, or it ma}' 

 be inoculated on a Guinea pig, intraperitoneally, to test its viru- 

 lence. If there are open vomicae or complex infection the breath 

 is usually heavy and mawkish. 



