CONSUMPTION OF THE LUNGS. 24:3 



treatment, and especially to dietetic treatment, in the wider sense of 

 the word, is perfectly comprehensible when looked at from our point 

 of view, and furnishes an argument in favor of the theory. 



The development of tuberculosis in lungs which are already con- 

 sumptive, as a result of inflammatory action, sometimes takes place in 

 a manner so latent as to make it extremely difficult, if not quite im- 

 possible, to recognize the fact with certainty. On the other hand, 

 there are many instances, especially where the lungs are the seat of 

 very numerous tubercles, and when the tuberculosis involves other 

 organs, in which the diagnosis presents no difficulty. Where we find 

 a consumptive patient to be growing very short of breath, there being 

 no perceptible increase in the dulness upon percussion to account for it ; 

 if, in spite of the most careful treatment the fever continue, and if it 

 change from the remitting to the continued form ; should diarrhoea set in 

 in a patient who hitherto has been somewhat inclined to constipation ; 

 if hoarseness and aphonia be combined with the other symptoms of 

 consumption, or if signs appear of disease of the meninges of the 

 brain, we may confidently infer that tuberculosis has developed in the 

 already consumptive lung. In young subjects, who are peculiarly 

 liable to tuberculosis of the cerebral membranes, brain-symptoms may 

 aid in forming a diagnosis, while in persons of more advanced years 

 the appearance of intestinal or laryngeal symptoms may do the same. 



The development and progress of a tuberculous consumption differ 

 essentially in type from any thing hitherto described, and its symptoms 

 are so characteristic that the diagnosis of this form of consumption 

 (which is not common) is, as a rule, easy. In the first place, it has no 

 precursory catarrh. The fever and wasting are not deferred until the 

 sputa become profuse and purulent, the tubercular eruption being ac- 

 companied by a marked elevation of the temperature and rapid emaci- 

 ation of the body from excessive calorification. If we are informed 

 that a patient did not begin to cough and expectorate until several 

 weeks after he had begun to decline in strength, and to grow pale and 

 thin, there is always reason to fear that he has tuberculous consump- 

 tion. Our suspicion will receive confirmation if the patient be un 

 wontedly short of breath, and if, at first, physical examination of the 

 chest give negative results. At a later period the percussion-sound 

 may grow dull from consecutive pneumonia, the respiratory murmur 

 becoming bronchial, and the rdles ringing, but the solidification is 

 rarely as extensive as in the forms of consumption previously described. 



The sound of the voice and of the cough soon grows hoarse, and 

 if there be much tuberculous disease of the larynx, arid if it spread 

 rapidly, the well-known distressing symptoms of laryngeal consump- 

 tion make their appearance. Nor is it long before the signs of intes- 



