78 PRACTICE OF MEDICINE. 



of the chest, shooting from the clavicle to the subscapular regions, 

 and often occupying the articulations of the shoulder, when it is 

 often mistaken for rheumatism, or pain of hepatic disease ; it occurs 

 with various intensities, is generally remittent, and often relieved by 

 anodyne, or slightly stimulating applications. This pain is com- 

 monly accompanied by tenderness of the subclavicular region, and 

 often with that irritation of the muscular fibres which causes their 

 contraction on percussion ; the respiration is slightly hurried, and 

 the first approaches of hectic can be perceived. 



" Second stage. — This is characterized by the establishment of 

 decided symptoms ; the emaciation increases ; thfe pulse continues 

 quick; the countenance becomes characteristic; the sweatings are 

 more profuse ; the cough looser, the expectoration becoming puriform, 

 tubercular, and often bloody. The digestive system now begins to 

 suffer ; thirst, loss of appetite, and abdominal pains, torment the 

 patient, and the first indications of the wasting and persistent diar- 

 rhoea appear ; the patient feels he can lie better on one side than 

 the other, and begins to feel pain in the opposite side of the chest, 

 — a sure sign that his terrible disease has invaded the remaining 



lung. 



" Third stage. — In this condition, the patient is often apyrexial, 

 and the perspirations cease, particularly if the digestive system re- 

 mains healthy ; the pulse may be slow, though generally becoming 

 accelerated before death; emaciation proceeds to the last extremity. 

 The voice is sometimes lost, at others hollow and melancholy ; the 

 cough is loose, the respiration tranquil, and expectoration easy; 

 aphthcB appear on the tongue, and spread over the cavity of the 

 mouth ; the limbs become cold ; the breath gets a heavy odour, and 

 the appetite in general fails." Life may, however, even under these 

 circumstances, be protracted for a considerable lime. 



Fhysical sigjis. — These may be divided into two classes ; first, 

 those of the earlier stages, which betoken the presence of tubercles ; 

 secondly, those of the later stages which show the existence of 

 vomiccB, besides which, there are in the last stage of certain cases 

 the signs of pneumo-thorax. 



Of tubercle. — When a portion of lung is solidified by the deposit 

 of tubercle ; the corresponding part of the chest will be dull on per- 

 cussion. 



Vesicular breathing will be inaudible ; and instead of it the 

 whiffiing sound (called bronchial respiration, and arising from the 

 passage of air through the bronchial tubes), will be heard if any- 

 such tube is enclosed in the solidified portion of the lung. Before 

 the portion of lung is so filled with tubercle as to render its vesicles 

 quite impervious, there are heard a feebleness and roughness in the 

 respiratory murmur ; and the sound of expiration is prolonged. 



