232 DISEASES OF THE PARENCHYMA OF THE LUXG. 



the catarrh is seated in the finer bronchi, and that its product is full 

 of cells. It is when thus situated and of this character, that its 

 implication of the air-vesicles is most to be dreaded. According to 

 most clinical teachers and physicians who do not share our views, 

 and who ascribe all consumption to tuberculosis, this " expectoration 

 streaked with yellow" (Louis) is of course regarded as a symp- 

 tom of an incipient phthisis or tuberculosis, instead of a sign of a mere 

 preliminary catarrh. 



Absence of cough and expectoration during the disease itself is 

 very rare ; yet instances are met with now and then, in which infiltra- 

 tion of the lung and caseous degeneration have taken place without 

 previous or concomitant disease of the bronchial mucous membrane. 

 Such patients, at first, often have neither cough nor expectoration. 

 Fever, general malaise, loss of appetite, debility, and emaciation, form 

 a group of symptoms which are often difficult to account for, until 

 physical examination reveals the actual condition. When the pul- 

 monary disease is accompanied by intestinal consumption with violent 

 diarrhoea, the cough and expectoration may decrease or cease entirely, 

 even in advanced stages of consumption of the lungs. This may in 

 some degree be ascribed to the derivative action from the bronchi, 

 caused by the intense intestinal irritation. 



A hoarse or inaudible cough is one of the chief signs of tuberculous 

 consumption, or of the complication with tuberculosis of a consumption 

 originating in destructive inflammation. The exceedingly interesting 

 cases in which alteration of the voice or of the tone of the cough of 

 phthisical patients results from palsy of the vocal chords, from pres- 

 sure upon the recurrent nerve by indurated pleuritic membranes, are 

 of extreme rarity, in comparison with the instances in which similar 

 symptoms arise from tuberculous ulceration of the mucous membrane. 

 The non-occurrence of hoarseness and inaudibleness of the cough, until 

 an advanced period of the malady, is indicative of consecutive tuber- 

 culosis. On the contrary, if the cough have been hoarse from the 

 beginning, especially while the sputa were still viscid and transparent, 

 and before physical examination showed any irregularity, the exist- 

 ence of primary tuberculosis may be suspected. As we have said 

 already, tuberculosis often begins in the trachea or larynx, and only 

 extends into the finer bronchi at a later period. 



Although the sputa of consumption are mainly the products of the 

 catarrh which complicates the disease, yet they may exhibit certain 

 peculiarities which serve materially to help the diagnosis. 



We thoroughly indorse the assertion of Canstatt, that it is a most 

 suspicious sign, and one highly calculated to awaken our apprehension 

 of tuberculosis, when the sputa of a persistent cough, accompanied by 



