PHTHISIS 



1076 



PHTHISIS 



most important symptoms of the fully-developed 

 disease are cough, at first hacking, later loud, hollow, 

 and paroxysmal ; expectoration, frothy and viscid at 

 first, later profuse, purulent, and nummular ; fever of 

 hectic type ; emaciation often very rapid, hemoptysis, 

 dyspnea, pain, night-sweats, anorexia, and digestive 

 disorders. The physical signs are flattening and re- 

 traction of the supra-clavicular and infra-clavicular 

 regions, restricted movement of these regions, dulness 

 on percussion over one or both apices extending to 

 other parts of the lungs, altered rhythm of the respi- 

 ratory sounds, adventitious sounds on auscultation, 

 such as the presence of rales of various kinds accord- 

 ing to the progress of the disease. The duration of 

 the disease varies from the rapidly fatal, in which death 

 may occur in a few weeks, to the very chronic, lasting 

 for years. The pathology usually consists in a deposit 

 of tuberculous nodules, especially in and around the 

 walls of the smallest bronchi ; these nodules coalesce 

 and eventually undergo caseation and softening. More 

 rarely a fibrous change takes place, with the production 

 of the more chronic form of the disease, fibroid phthi- 

 sis. Phthisis may occur at any age, and especially 

 attacks those in whom there is an inherited predispo- 

 sition or those who have been weakened by previous 

 disease, poor food, poor hygienic surroundings, frequent 

 pregnancies and prolonged lactation or the inhalation 

 of poisonous vapors or irritating particles. Those in 

 whom there is a strong family history of phthisis gen- 

 erally develop the disease before the twenty-fifth year. 

 It may occur in those of middle age, however, or in 

 old age. The usual seat for the primary lesion is in 

 one of the apices, the right a little more frequently 

 than the left. After one apex has been attacked, the 

 disease usually extends, first to the apex of the lower 

 lobe of the same side, then to the other apex. The 

 base is rarely primarily affected. P., Abdominal. 

 See Tabes mesenterica. P., Acute. See P., Acute 

 Pneumonic. P., Acute Pneumonic, a variety that 

 occurs in two forms : (a) the pneumonic or lobar and (b) 

 the broncho-pneumonic or lobular. In the former (a), 

 a lobe or an entire lung may be converted into a dry, 

 opaque, white or yellowish-white, cheesy substance, in 

 which tubercles are scattered here and there. Very 

 often there exists a cavity at the apex. The bronchial 

 glands may be tuberculous. The cases usually begin 

 with a chill and for a time run a course like that of 

 croupous pneumonia. The crisis, however, does not 

 occur; the fever becomes irregular, the sputum muco- 

 purulent, soon presenting tubercle-bacilli and elastic 

 tissue. Death may occur in a few weeks or in two or 

 three months, (b) Acute tuberculous broncho-pneu- 

 monia is most common in children and forms most cases 

 of so-called phthisis florida. The smaller bronchi and 

 air-cells become filled with a caseous material, consti- 

 tuting small grayish-white areas. These may coalesce 

 and produce a lobar caseous broncho-pneumonia ; but 

 usually some unaffected tissue can be seen among the 

 caseous areas. The symptoms of the disease are sim- 

 ilar to those of catarrhal pneumonia ; the tempera- 

 ture, however, is high ; there is rapid loss of flesh and 

 strength ; evidences of softening become manifest ; 

 tubercle-bacilli appear in the sputum. Death may 

 occur within three weeks or the disease may lead to 

 chronic phthisis. In children the disease commonly 

 follows one of the infectious fevers, particularly mea- 

 sles and whooping-cough. P., Amphiblestroid, 

 atrophy of the retina. P., Bacillary, phthisis due to 

 a bacillus. P., Basic, phthisis affecting primarily the 

 base of the lung. P., Black, anthracosis. P., 

 Bronchial, tuberculosis of the bronchial glands. P. 

 bulbi, progressive shrinkage and atrophy of the eye- 



ball. P. calculosa, pulmonary tuberculosis in 

 which the exudates in the smallest lobules become 

 infiltrated with lime. P., Cerebral, tuberculosis of 

 the brain or its membranes. P., Chronic, phthisis 

 running a slow course. P. combinata. Synonym 

 of P., Acute Pneumonic. P., Diabetic, pulmonary 

 tuberculosis in a diabetic patient, manifesting itself as 

 a caseous broncho-pneumonia. P., Embolic, de- 

 generation of areas in the lung, the seat of emboli 

 from other organs P. enterica, tuberculosis of the 

 intestines. P., Fibroid, P., Fibrous ; I. Inter- 

 stitial pneumonia. 2. Chronic tuberculosis of the 

 lungs attended with the formation of fibrous tissue, 

 which contracts, causes shrinking of the affected 

 lobe, and sometimes bronchiectasis by eccentric 

 traction on the bronchi. The pleura is usually very 

 much thickened and the layers may adhere so tightly 

 that it is impossible to separate them. P., Flax- 

 dressers', tabacosis occurring in flax-dressers. P. 

 florida, acute phthisis speedily fatal — also known as 

 galloping consumption. P., Galloping. Synonym of 

 P. fiorida. P., Glandular, tuberculosis of lymphatic 

 glands. P., Gouty, a chronic inflammation of the 

 bronchial tubes supposed to be due to gout. P., 

 Granular. Synonym of Tuberculosis, Acute Mil 

 P., Grinders'. See Grinders' 1 Asthma. P. ab 

 haemaptoe, pulmonary tuberculosis apparently follow- 

 ing hemorrhage from the lungs. It is not now belli 

 that pulmonary hemorrhage can be the starting-poii 

 tuberculosis, but it is looked upon rather as a possi 

 very early sign, or as accidental and having no ( 

 nection with the tuberculosis subsequently developed. 

 P., Hemorrhagic, pulmonary tuberculosis in which 

 extravasated blood is believed to have undergone < 

 ous degeneration. Its existence is questionable. P.. 

 Hepatic, tuberculosis of the liver ; formerly, 

 the term meant abscess of the liver. P. ex inanitione, 

 phthisis depending on inanition. P. intestinalis. 

 Synonym of P. enterica. P., Knife-grinders'. 

 Synonym of P., Grinders'. P. laryngea. 

 onym of Tuberculosis, Laryngeal. P., Latent. 

 Synonym of Tuberculosis, Latent. P. lienalis, 

 tuberculosis of the spleen ; also splenic abscess. P. 

 mammae, disorganization of the mammary gla 

 from suppuration. P. medullae spinalis. S 

 onym of Tabes dorsalis. P. mesaraica, P. mes- 

 enterica. Synonym of Tabes mesenterica. P.. 

 Miners'. See Miners' 1 Phthisis. P., Mucous. 

 Synonym of Tuberculosis, Miliary. P., Neurotic, 

 phthisis occurring in the course of neurasthenia. P.. 

 Neuro-vascular, phthisis associated with neuro 

 vascular disease. P. nodosa, miliary tuberculosis 

 the lungs. P., Non-bacillary, pulmonary destroc | 

 tion not due to bacilli. Miners' phthisis and grinders 

 phthisis are due to fibroid changes in the lung indu 

 by the irritation of the dust inhaled. Ulcerative 

 phthisis is probably always bacillary. P. oculi, 

 atrophy of the eye. P. pancreatica, marked eras 

 tion and general cachexia from disease oi the pan 

 creas. P. pharyngea, tuberculosis of the pharynx 

 P., Phlegmatic, phthisis occurring in persons who in 

 the earlier stages do not present emaciation. P 

 pituitosa. Synonym of P., Mucous. P. prostatica. 

 tuberculosis of the prostate gland. P. psoasum. 

 psoas abscess due to tuberculous infection. P. pul- 

 monalis, pulmonary tuberculosis. P., Pulmonary 

 See Phthisis. P. pulmonum. Synonym oi 

 Pulmonary. P. renalis, tuberculosis o( the kidne] 

 P., Rheumatic, phthisis said to be dependent ujx 

 rheumatic diathesis. P., Senile, pulmonar) lul " 

 losis in the aged. P., Specific, breaking down < 

 the lungs due to the bacillus of tuberculosis, P 



