196 THE TREATMENT OF DISEASES. 



usually present ; there are other symptoms which are of occasional occurrence, and 

 will be considered in due course. 



Cough is usually one of the earliest symptoms of consumption, and is that which 

 commonly first attracts the attention, and awakens the fears of the patient or his 

 friends. Usually, to begin with, it is slight, occasional, and only occurs on getting 

 out of bed in the morning or making any unusual exertion in the course of the day. 

 Sometimes it will cease for a while, as in the warm weather of summer, and return 

 in winter, or on the approach of cold weather. After a time it begins to be trouble- 

 some at night, and is attended with more or less expectoration of mucus. The gradual 

 onset of a cough in this way is in itself a suspicious circumstance ; it may mean 

 nothing, probably does mean nothing, but still, as a matter of precaution, we should 

 advise you to go to a doctor and get your chest examined. It is very likely it is 

 all stomach, but if there is any doubt there is nothing like being on the safe side. In 

 chest complaints it is of vital importance to begin treatment at the earliest possible 

 moment. 



The expectoration in phthisis varies greatly both in quantity and character. 

 Some patients enquire most anxiously of the doctor if he is quite sure that what 

 they are spitting up contains no pus. This is a matter of little importance, for the 

 presence or absence of pus in the sputa affords no test at all of the presence or 

 absence of consumption. 



Spitting of blood is observed to a greater or less degree in the majority of cases 

 of phthisis, varying, however, considerably as regards the amount and the frequency 

 of its occurrence. The bleeding is frequently, but not of necessity, brought on by 

 an attack of coughing. When the blood occurs in mere streaks, or in quantities less 

 than a tea-spoonful, it probably means nothing, and is of little consequence. People 

 are often greatly and unnecessarily alarmed by expectorating a small quantity of 

 blood that could under no circumstances be of the slightest moment. In any case 

 in which more than a tea-spoonful of blood is spat up, you should consult your doctor. 

 Moreover, even when the quantity is smaller, and you feel anxious or not quite easy 

 about it, you had better obtain medical advice. 



Shortness of breath, although generally present to a greater or less extent, is not 

 a very important sign of phthisis. Many people anemic girls especially readily 

 get out of breath on exertion, and yet their lungs may be perfectly healthy. 



Night-sweating is often a most distressing symptom, and is especially injurious 

 by disturbing the rest and exhausting the strength. It seldom comes on in the 

 day-time, but the patient awakes in the middle of the night sweating profusely, 

 and perhaps drenched in perspiration. Sometimes the quantity is so great that it 

 wets not only the flannel and night-shirt, but even the sheets. 



Wasting is a symptom of very frequent occurrence. If a person loses a few 

 pounds, then regains it, then loses it again, and so on, it is of very little importance ; 

 but when there is progressive emaciation, it is a serious sign. It is often one of the 

 earliest, as it is one of the most alarming symptoms the patient presents. If a 

 person without any apparent cause grows thin and weak, and gets no better from 

 rest and change of air, he should consult his doctor, especially if there is any cough. 



In consumption there is always fever : the temperature is distinctly elevated. 



