This shows best the truly infectious nature of tuberculosis. In it
miliary tubercles develop in many and various parts of the body. In
some cases these growths seem to be uniformly distributed throughout
all the viscera. In other instances they are localized in the lungs
or in the meninges of the brain. In nearly every instance it is an
auto-infection, arising from an old tuberculous focus, which may be
latent and quite unsuspected. General infection, in most instances,
arises from the rupture of a nodule into a vein, from tuberculous lymph
glands, tuberculosis of the bones, joints, or even the skin.
=General Miliary Tuberculosis or Typhoid Form.=—This is similar to a
general infection of the body and resembles, to a marked degree, the
symptoms of typhoid fever. The onset is rarely rapid.
In most cases there is a period of incubation, during which the health
fails, the appetite is lost, headache occurs, and the patient soon
becomes feverish, with increased debility. The temperature rises and
the pulse is rapid and feeble. The tongue is dry. The respirations are
increased. Delirium may be present. In rare cases, there may be little
or no fever. The temperature ranges from 101 to 103 or even 105 degrees
F. It is irregular and marked by evening exacerbations and morning
remissions. Occasionally there is an inverse type of temperature in
which it rises in the morning and falls in the evening. In some cases
the pulmonary symptoms are marked, while in others the meningeal
symptoms are more prominent. Tubercle bacilli are rarely found in the
sputum.
The spleen is usually enlarged. Constipation is present, as a rule, but
there may be diarrhea, and hemorrhage from the bowels may occur. The
urine may contain traces of albumin. There may be excessive sweating,
and herpes is often present. Choroid tuberculosis is frequently met
with. In doubtful cases the blood should be examined for tubercle
bacilli, although they are not always present. The duration is from two
to four weeks, the disease usually terminating unfavorably.
=Diagnosis.=—It is often very hard to differentiate between this form
of tuberculosis and typhoid fever. In =typhoid fever= epistaxis is a
common, early symptom. The temperature curve of the continued type
is quite diagnostic. The Widal test should be made. The respirations
are moderately hurried and the pulse is often dicrotic. Diarrhea is
frequent. Typhoid rash is diagnostic. No tubercles are found on the
choroid. No tubercle bacilli are found in the blood. Hemorrhages from
the bowels are common.
=Pulmonary Form.=—When the lungs are chiefly affected the pulmonary
symptoms are marked from the onset. It may develop suddenly or there
may be a long period during which the general health fails markedly.
In children the disease may follow measles or whooping cough. There
is dyspnea, cough and the expectoration is mucopurulent. There is
broncho-vesicular breathing with sibilant and subcrepitant rales. The
temperature is high, ranging from 103 to 105 degrees F., or higher.
Respiration and pulse are rapid.
The disease may last from several weeks to months, or, on the other
hand, it may prove fatal within a few days. As the end draws near the
signs of suffocation become intensified.
=Diagnosis.=—The history and general symptoms, together with the
dyspnea and cyanosis, will generally decide the diagnosis. The blood
should be examined for malarial parasites. The Widal test will
differentiate typhoid.
=Cerebral or Meningeal= (Tuberculous Meningitis).—This form which is
sometimes called acute hydrocephalus, occurs quite frequently and is an
infection of the pia mater of the brain or cord.
It occurs most frequently in the first two years of life, although
it may occur later. It is usually tuberculous in some other region,
especially in the bronchial glands. Rarely does the disease involve the
meninges primarily.
The meninges at the base of the cerebrum is the principal involvement.
There is more or less inflammation, with fibrous purulent exudation.
There are tubercles along the blood vessels. The ventricles may be
distended.
=Symptoms.=—The onset is slow, lasting one or more weeks. Headache,
constipation, vomiting and chills, followed by a fever, are the initial
symptoms. When the onset is sudden, the disease is generally ushered in
with a convulsion. The fever rarely rises above 102 or 103 degrees F.
The pain is often severe, causing the child to give a sudden cry—the
hydrocephalic cry. During sleep the child is restless and there are
slight muscular twitchings.
The =irritative symptoms= now abate. The child becomes quiet and
is dull and apathetic. Constipation still persists. The abdomen is
boat-shaped, and the neck may be retracted. The pupils are dilated.
Convulsions and other cerebral symptoms may occur. The temperature
ranges from 100 to 103 degrees F. The respiration is irregular and
sighing.
Following this, the mental faculties are lost and coma occurs.
Convulsions or spasmodic contractions of the muscles of the neck,
back and limbs may occur. The pupils are dilated and do not respond
to light. The pulse is frequent, irregular and small. The temperature
rises to 103 to 105 degrees F., or it may be subnormal. The duration is
from two to five weeks; chronic cases may last for a number of months.
=Prognosis.=—Generally very unfavorable.