28 BUREAU OF AMERICAN ETHNOLOGY [bull. 42 



V. SYMPTOMATOLOGY 



The symptoms manifested by tuberculous Indians are much hke 

 those seen in similar cases of the disease among the whites. Yet 

 there appear to be a few interesting differences, and more detailed 

 future studies may possibly establish others. 



The rapid cases are characterized by all of the well-known symp- 

 toms of galloping consumption. The fever, sweats, and a rapid ex- 

 haustion of the patient are especially noticeable in the Indian. 

 Emaciation in these cases is not extreme, while hemorrhages are 

 liable to be profuse. Fatal termination is almost the rule. 



The subacute, and especially the chronic cases, show, as among the 

 whites, a gradual emaciation, with loss of strength; cough, annoying 

 at night and especially in the morning; feverishness, particularly 

 toward evening or night; hemoptysis; night sweats, and also more 

 profuse sweating during the day. The feverishness is mostly irregu- 

 lar, and in some cases the patients complain more of chilliness than 

 of heat. Expectoration is so scanty in some instances that it requires 

 more than a day to obtain a fair sample of the sputum, while in other 

 cases it is profuse. Hemoptysis seems to be the rule, but in these 

 slower cases is rarely profuse. Subjective pains and tenderness on pal- 

 pitation are present in all cases, though they are seldom of more than 

 slight to moderate severity. Pain on pressure is especially noticeable 

 in the interscapular region, along both sides of the spinal column. 

 Pressure o\rer the apices of the lungs is also painful, and occasionally 

 there is hypersensitiveness here on percussion. The finger tips of 

 many of these patients become clubbed, as in white consumptives; 

 the supraclavicular, subclavicular, and intercostal spaces sink in, 

 while the clavicles and scapulae protrude. General but not excessive 

 emaciation is met with.- 



On auscultation it is found that the upper lobes — right and left 

 in about the same proportion — are generally affected first, and that 

 they always suffer more than the lower. There are prolonged and 

 audible expiration; sharp, harsh or hard inspiration; moist or crepi- 

 tant, diffused or localized rales, and pronounced bronchophony over 

 the infected areas. Occasionally there are plain signs of a cavity. 

 In very old cases, where extensive fibrous changes have doubtless 

 taken place, respiratory sounds over the apices may be quite audible. 



In the chronic forms of pulmonary tuberculosis in the Indians, 

 percussion is quite unsatisfactory. In a great majority of the 

 cases there is an absence of pronounced dullness. Among the 

 many chronic cases examined there was no instance in wliich the 

 dullness of the affected lobes was as marked as that which is found in 

 normal conditions, over the heart or liver. In numerous patients, 

 where the presence of the bacilli in the sputum confirmed the diag- 



