Part 3

Furthermore it has been found, that pulmonary consumptives on an average have a smaller heart than is essential to a healthy body. On the other hand the volume of the lungs of consumptives is very often abnormally large.

There are a large number of diseases that predispose to pulmonary consumption. It is mainly the enfeebling action of the same, which brings about such results. For this reason the chronic diseases contribute so much toward the multiplication of the number of consumptives, because they stipulate a continuous weakening of the organism and an emaciation of the system. To these belong Bright's disease, which very often turns into pulmonary consumption, greensickness or chlorosis, anaemia, continued febrile diseases, severe chronic suppuration, chronic catarrh of the stomach, frequent pregnancies, childbed diseases. Thus we may often see young chlorotic girls afflicted with consumption, especially when they marry young and enjoy the honeymoon to its utmost limits. Then also women will easily become consumptive when they give birth to a child every year, especially when the social conditions in which they live are of an unfavorable nature, and they are perhaps inclined to consumption already. Childbed on the whole inclines to arousing the dormant inclination toward pulmonary consumption.

Of other diseases we have mentioned measles and whooping cough, as diseases that are only too easily succeeded by consumption. To these may be added typhus, especially when it is of a more protracted nature, and the reconvalescence is slow and incomplete.

Furthermore all those workmen that have to do with dust, are exposed to the danger of being stricken with pulmonary consumption. The dust enters the lungs, irritates and injures the same and so produces a favorable soil for any tubercle bacilli that may happen to penetrate. On the whole metal dust is more injurious than mineral dust. Workmen, that are exposed to animal dust, as furriers, saddlers, brushmakers, fall prey to consumption much oftener than those, that fulfill their vocation in air pregnant with vegetable dust. According to statistics workingmen are stricken with pulmonary consumption as follows: of glass workers 80 per cent., needle grinders 70, filemakers 62, stone cutters 40, mill grinders, lithographers, cigarmakers, brushmakers, stone-polishers 40-50, millers 10, coal workers 1 per cent.

Pneumonia may culminate in pulmonary consumption: but on the whole this rarely happens. Much oftener it is the case with Pleurisy. But it is assumed and rightly, that most people who are attacked by pleurisy, are already consumptive.

A hemorrhage of the lungs may nearly always be considered a sure sign that consumption has taken hold of the respective individual; but such a hemorrhage certainly forms considerable danger to falling a victim to tuberculosis, if the individual is as yet free from the same.

Age has a particularly decided influence on the origin of consumption; it is extremely rare before the third or fourth year, from that to the seventh it is more frequent; it most frequently occurs in the age from the fifteenth to the thirtieth year, and from there on the chances are again fewer. In very old age it is again very rare.

There seems to be no essential difference as regards sex.

Insufficient or defective nourishment acts as a promoter in various ways. Even the nourishing of infants with poor milk, with bread or flour-pap increases the disposition to pulmonary consumption. If this defective nourishment is continued, scrofula will surely follow and this is a stage antecedent to consumption.

Pulmonary consumption is relatively more frequent among the poorer than the well to do people, this is partly due to the meagre and scanty food of the poorer, and that they are obliged to subsist almost exclusively on vegetable diet. The higher the meat prices rise and the less the majority of the people can afford to procure meat, the larger will be the number of consumptives. The poorly nourished offer a good soil for the tubercle bacilli in consequence of their weakness. The tissue offers little or no resistance to the growth of the bacilli, these propagate and destroy the powerless and yielding organism with fearful rapidity.

The frequency of pulmonary consumption increases with the size of the cities, or, which is the same, with the number of proletarians. Extreme hunger and want are less frequent in the country than in the city.

That the climate has an important influence on the appearance of pulmonary consumption has long been known. In certain elevated regions this disease seldom or never appears. This experience has been attained in Switzerland and many other mountain regions. Furthermore the Plateaux of Peru and Mexico are considered free from consumption, but also lowlands like Iceland, the Kirgheez steppes and the interior of Egypt are known to be exempt.

Damp and windy climate, especially with very high temperature, or abrupt changes in the temperature promotes consumption; on the other hand it is less frequent in the more moderated climates, especially if they are dry.

Now when the tubercle bacilli have settled in the lungs, they cause various symptoms. One of the most frequent is cough. In the beginning of the disease a short, clear but light, very often dry cough appears. During the further development of pulmonary consumption the cough becomes more periodic; it appears early after awaking, in the afternoon after dinner, and evenings at lying down; it may disappear entirely in the meantime or may be light only; but then as a rule it is no longer dry, but may be attended by expectorations of a varied nature.

To the left bacilli without spores, to the right bacilli with colorless sections which are thought to be spores.]

The tubercle bacilli destroy the lung tissue and change it into pus, which is coughed out. In this way larger and smaller cavities are formed in the lungs; finally the cavities may even take more space than the remaining lung tissue. When cavities have already been formed, coughing comes easy and with abundant expectoration. Toward the end of life the coughing and spitting stops as a result of the extreme feebleness and weakness.

The violence and frequency of the cough depends mainly whether the larger bronchial tubes and the trachea are affected; the more this is the case, the more violent the inclination to cough. Further the strength of the cough depends on the excitability of the patient; the greater this is, the more as a rule will he cough. Sometimes the position of the patient is of influence; if he lies mostly on the diseased side the expectoration becomes more difficult and coughing increases.

Coughing is generally that symptom which soonest attracts the attention of the patient and his surroundings. For that very reason consumption is in its beginning stages easily confounded with such other diseases as are also accompanied by cough.

At the same time we know of exceptional cases where cough was entirely absent in the first stages of the disease, or was at least so slight that it was overlooked, and under such conditions the pale and poor appearance and reduced strength is mistaken for chlorosis or some other anaemic affection, also the existing febrile excitements are wrongly judged, or on account of lack of appetite or light derangements of the stomach a stomachic affection is surmised, until suddenly a hemorrhage of the lungs clearly defines the true nature of the ailment.

On the other hand the cough may become so violent that vomiting is caused at the same time. Nevertheless many consumptives describe their cough as very unimportant on account of their innate sorrowless nature, and they will not even be discouraged by the gravest symptoms. Often however it is fear that induces the patients to make light of their coughing, their spitting blood, their losing flesh and to place but little importance on these circumstances. A hoarse cough is a sure sign of a diseased larynx.

Many consumptives complain of cutting pains between the shoulderblades, under the clavicles or in the side; but these are rarely intense and are often entirely wanting. Unfortunately it is unknown to the average layman that the internal organs may suffer extensive tearing down without an indication of pain.

The Expectoration of consumptives which is thrown out by coughing with great exertion, is but scant in the beginning, as a rule phlegmy, glassy transparent and sticky. It is one of the suspicious symptoms of developing pulmonary consumption if this lasts for any greater length of time. Sometimes sharply defined, yellowish stripes, at times branching, appear in the same. Later on the expectoration becomes more purulent, and of greenish-yellow or greenish-gray color.

Still later the patients throw out rounded lumps of greenish yellow or yellowish green color, which flatten out like a coin in the spittoon. They sink in water which is a sign of forboding evil.

Blood appears in different quantities in the sputum of consumptives. Bloody streaks are of no importance; they may appear with every violent cough. On the other hand the casting out of pure blood is indeed serious.

The quantity of blood thrown out during an attack may be very different, varying from a few drops hardly a teaspoonful, to hundreds of grammes, even more than a liter. It is generally light red, filled with airbubbles, foamy, and is largely coughed out in coagulated lumps. The coughing of blood is sometimes preceded by a feeling of oppression, rushing of blood to the head and palpitation. Some patients experience a sweet taste in the mouth even before the bleeding. In many cases all preceding symptoms are missing and the patient is suddenly attacked by blood coughing during some more vigorous movement, during the exertion of coughing or even without any direct cause.

Blood coughing seems to appear somewhat more frequently with the female sex than with the male and has with them unmistakable relations to menstruation, as with the sick it often sets in before, often after or even during the same and at such times more frequently than at others.

It is of great importance for the layman to know that a hemorrhage rarely leads to inevitable death. Fatal hemorrhages are always preceded by warning attacks. Blood coughing may appear at any stage of consumption. In some cases it is particularly lasting. Sometimes the patients experience considerable relief from their feeling of oppression after a hemorrhage.

A number of the consumptives as a rule complain of difficulty in deglutition. This is caused by ulcers on the posterior wall of the larynx.