244 DISEASES OF THE PARENCHYMA OF THE LUNG. 



tinal tuberculosis and intestinal consumption set in. Exhaustion is 

 accelerated by profuse diarrhoea. The abdomen becomes sensitive to 

 pressure. The malady seldom lasts over a few months, and most pa- 

 tients succumb even sooner. 



It would lead us too far were we to attempt to make a detailed 

 description of the numerous modifications to which the different forms 

 of consumption are subjected by the manifold changes of acute and 

 chronic disease, and the various intercurrent accidents and complica- 

 tions. I am sure, however, that most cases of consumption which we 

 observe ourselves, or which are properly reported to us, may be as- 

 signed without difficulty to one or other of the above-given categories. 



It follows, from what has been said, that death is the most frequent 

 result of all forms of pulmonary consumption, and that it is the sole 

 termination of tuberculosis, but that, in the forms of the malady which 

 are dependent upon pneumonia, an improvement and approximative 

 recovery are not as rare an occurrence as is usually supposed. It has 

 been satisfactorily established, moreover, that even persons in whom 

 all evidences of consumption have disappeared, and who are completely 

 well of the malady, are still in greater danger than other persons of 

 dying of a fresh attack of the pneumonic process or of tuberculosis. 



The fatal termination usually takes place through gradual con. 

 sumption, " wasting away," " decline." The emaciation of the patient, 

 finally becomes extreme. The skin seems too loose for the body, 

 owing to disappearance of the fat and atrophy of the muscles. The 

 zygomatic bones project from the sunken cheeks, the nose seems 

 longer and more pointed, the orbits from which all the fat has disap- 

 peared seem too large for the eyes, the nails become incurved, the pad 

 of fat upon the last phalanges being gone. Not unfrequently the tem- 

 per of the patient, which at first was sullen and perverse, now grows 

 cheerful and kindly. Many have perfect confidence in their recovery 

 up to the moment of death, and expire in the midst of plans looking 

 far into the future. Toward the last, however, the suffering is often 

 severe. If the larynx be also " consumptive," there is an incessant 

 cough which robs the patient of his rest at night ; aphthae form in the 

 mouth and pharynx, rendering chewing and deglutition difficult ; the 

 decubitus causes severe pain ; one or both of the feet become the seat 

 of an extremely painful oedema, owing to thrombosis of the femoral 

 vein. In such cases the final stage seems extremely wearisome to the 

 physician and attendants, and even to the patient himself, who often 

 longs for his release. 



Very much more rarely consumption results in death from haemor- 

 rhage. This is most usually the consequence of erosion of an unoblit- 

 erated vessel in the wall of a cavity, or else of an aneurismal expansion 



