Emaciation, one of the earliest symptoms, extends to nearly every tissue of the body; it often proceeds uniformly from the commencement to the termination, and appears to bear a closer connection with the constitutional than with the local affection. Though liable to be increased by extensive disease of the lungs, intestines, and mesenteric glands, and by Hectic fever, still, in the absence of these conditions in their ordinary intense form, wasting goes on to the fatal termination, the patient sustaining a total loss of from one-third to half of his entire weight. Slow and gradual emaciation – the grain-by-grain decay – is far more indicative of Phthisis than a rapid or irregular diminution of weight; and emaciation is more marked, and also more dangerous, in individuals who have been previously stout. To detect the continuously progressive emaciation, it is necessary to have patients accurately weighed from time to time. By this means a physician is also able to judge of the proportion of the weight of a patient to his height, age, breathing, and other functions.
Hectic fever at length makes its appearance, and its coincidence with the symptoms already mentioned confirms our diagnosis of Tubercle. This is a much more marked fever than the rise of temperature in the early stages spoken of above. The patient is feverish and flushed in the evening, and in the morning may be found drenched with perspiration. The pulse is small and weak, uniformly too high, but greatly accelerated towards evening, reaching 120 beats in the minute, or more; the beat being performed with a jerk, as if result of irritation upon a weakened heart. The bowels are relaxed, especially in advanced stages of the disease, the Diarrhoea aggravating the effects of the sweating, and consequently the exhaustion is greater; the tongue is furred white or brown in the centre, but unnaturally red round the tip and edges, and, immediately preceding the final break-up, is covered with the eruption of Thrush. The urine deposits red brick-dust or pink sediment, consisting of the urates of soda and ammonia; the skin is clammy except during the evening exacerbation, when it is burning hot; the complexion is clear, the eyes are bright and sparkling, and there is marked emaciation, especially as death approaches.
Finally, all the symptoms are gradually intensified; the dyspnoea becomes very distressing, so that the patient is unable to make any active exertion, or even to read a short paragraph without pausing; the sputa is more purulent; the pus is often expectorated pure, in roundish masses, that remain distinct in the vessel; the disease often spreads to other organs, as the lymphatic system and the intestinal canal, in which a deposit of tubercle takes place similar to that in the lungs, and which afterwards bursts into the intestines, leaving an Ulcer; and thus the alimentary canal is affected and Diarrhoea produced. The larynx may be affected producing huskiness, and even loss of voice, but more frequently the former, from the thickening and increase in vascularity which it undergoes. Aphthae of the mouth, pharynx, etc., or oedema of the lower extremities, ensue. It is, therefore, but seldom that the local affection of the lungs alone causes death.
The mind usually remains bright, often vigorous, and so hopeful that, even amidst this general wreck of the material frame, the patient dreads not the future, and thinks he would be well but for his Cough towards the end, however, slight Delirium sometimes occurs, from circulation of venous blood in the brain, or a deposit of tubercles in its membranes.
The most characteristic symptoms are – undue shortness of breath after exercise; Cough; Spitting of blood; progressive emaciation; heightened temperature; rapid pulse; Hectic and Diarrhoea.
PHYSICAL SIGNS AND METHODS OF DETECTING THEM. – Notwithstanding the comparative conclusiveness of symptoms, a physician does not rely on them alone, but calls in the aid of other evidence. In consequence of the frequent obscurity that surrounds symptoms, or of the possibility that they admit of explanation by causes distinct from Phthisis, a physical examination is necessary to remove all uncertainty; and if conducted with care, and aided by the study of natural science, the diagnosis of this disease may be rendered almost as clear as if the morbid may be rendered almost as clear as if the morbid processes beneath the chest walls were exposed to view.
The following are the methods of physical examination – Inspection, or ocular observance of the form, size, and movements of the bare chest; Mensuration, by which the comparative volume of the two sides of the chest, and also the degree of expansion and retraction during respiration, are determined by measurement; Percussion, or tapping the chest to ascertain the relative degree of dullness of resonance; Auscultation, or listening over the chest to discover the condition of the respiratory murmurs, either with or without a stethoscope; Thermometry, which indicates the temperature of the patient apart from his own sensations. The weight and height of the patient are also considered in connection with his age. Microscopy will determine the character of the expectoration and the presence or otherwise of tubercle bacilli.
TEMPERATURE. – The value of the aid of the thermometer in the diagnosis of Phthisis will be recognized by the fact that during the growth of tubercle in the lungs, or in any organ of the body, the temperature of the patient is raised from 98* Fahr. the normal temperature, to 102* or 103* or even 104*, the temperature increasing in proportion to the rapidity of tubercular growth. This sign may occasionally be detected several weeks before reduced weight or other signs indicate the undoubted existence of tubercle; and, in the absence of other signs peculiar to the disease, will determine the diagnosis of Tubercle from Chlorosis or Heart-disease.
CAUSES. – The final cause is infection with tubercle bacilli, but there are many other factors in every case. The germ probably gains access to the body mainly by being swallowed in dust, etc., which contains germs from expectoration or the minute spray from the mouth, which accompanies not only sneezing, but even loud speaking. Being swallowed the germs get into the lymphatics and affected the glands at the back of abdomen and chest, and so gain access to the pleura and thence to the lungs. Infection by inhalation is also possible.
The bacillus is received with impunity by thousands who have no constitutional susceptibility to its growth. Among predisposing causes are Pneumonia, Capillary Bronchitis, Haemoptysis, Hyperaemia of the lungs, the irritation of foreign bodies – coal, iron, or slate dust, etc. Also hereditary taint, contagion, dampness of soil, and the impoverished nutrition resulting from impure air, and an improper quantity, quality, or assimilation of food, and so long as misery and poverty exist on the one hand, or dissipation and enervating luxuries on the other, so long will the causes be in operation which induce this terrible disease. (Bennett).
DURATION. – The average may be said to be from nine months to two or more years; but in acute cases the disease advances rapidly through the entire substance of both lungs, and it may prove fatal in two or three months, or even in as many weeks. The influence of the digestive organs is very considerable. An irritable mucous membrane-indicated by loss of appetite, furred tongue, Diarrhoea, etc. – will hurry the morbid deposit through its stage; while a healthy digestive apparatus may prolong the stages indefinitely. Other circumstances must also be considered – age, amount of hereditary influence, Haemoptysis, fever, etc. Lastly, the type of disease greatly influences the duration.
TREATMENT. – Phthisis being a disease in which the assistance of a medical man is necessarily required, we only give a few general indications for the sake of those to whom professional homoeopathic skill is not accessible. Each case must be treated according to the individual nature and extent of the local and constitutional disease. Useful remedies may be found among those recommended for Dyspepsia; also Bronchitis, Pneumonia, and other diseases of the respiratory system. Preventive treatment is of great importance. The general measures, are also of paramount importance.
EPITOME OF TREATMENT.- 1. Cachexia. – Sulph., Calcarea carb., Iodium, Arsenicum, Phosphorus, Nux Jug., Mercurius-Iodium, Ferrum, Arsenicum-Iodium, Calcarea-Iodium, Sanguinaria
2. Indigestion. – Pulsatilla, Nux vomica, Calcarea carb., Lycopodium, Mercurius, K.- Bich., Ant.-C., Carbo V.
3. Cough, etc. – Phosphorus, Bell, Drosera, Hyoscyamus, Conium (nightly dry cough); Bryonia (stitching pains in the side); Stramonium (profuse expectoration and night sweats) Ant.-T., K.-Bich., Kali Carb. (cough worse from 2 to 5 a.m. Stitches in chest).
4. Haemoptysis. – Hamamelis, Ipecac., Drosera, Arnica, Ledum, Sabi., Mille.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."