The infection of the lungs is rapid and may be primary or secondary.
This form is met with most frequently in children and young adults, but
may occur at any age.
The =Pneumonic form= is more rare than the bronchopneumonic form and
may be very rapid in its course. The attack sets in abruptly with a
chill and the temperature rises rapidly. There is pain in the side;
cough; dyspnea and mucous and rusty sputum, which may contain tubercle
bacilli. There is impairment of resonance, increased fremitus, and
bronchial breathing. The whole or part of the lung may show signs
of consolidation and dullness, all the symptoms of pneumonia being
present. The patient rapidly loses flesh. This attack may come on a
person in good health after exposure to cold; but there may have been a
debilitated condition, or a predisposition to phthisis. Death may occur
in the second or third week or the case may continue from three to four
months.
One or both lungs may be involved. The lung is heavy and airless,
sinking quickly in water. There is destruction of lung tissue and upon
section, cavities are found. The cavities are generally small and are
surrounded by tubercles. Older caseous areas of a yellowish white color
may be visible. Miliary tubercles are found upon careful examination.
The =bronchopneumonic form= is the most common and occurs most
frequently in children. It often follows the infectious diseases,
especially measles and whooping cough. The child may be taken ill
suddenly with what seems to be an ordinary bronchitis, the temperature
rises, the cough is severe, and there may be consolidation with
submucous and subcrepitant rales. Rapid respiration and sweating are
often marked. The course of the disease varies. There is rapid loss of
flesh, and in many cases the disease develops into chronic phthisis. In
other instances death occurs in from three to eight weeks.
The disease may attack the adult whose resistance is impaired. Chills,
fever, pain in the chest, hemorrhages, wasting are most noticeable
symptoms; these are the various signs of bronchopneumonia. Tubercle
bacilli are often found in the sputum. The course is usually from three
to eight weeks, while a number pass into a chronic stage.
Areas of caseous tubercles are found, which later suppurate, break down
and form cavities. The bronchial lymph nodes are found enlarged, and
usually there is acute tuberculous pleurisy.
=Diagnosis.=—In the =pneumonic form= it may be impossible to make a
diagnosis early in the disease. Tuberculosis may be suspected if the
patient has been in bad health, has a predisposition to phthisis, or
has had any pulmonary disorder. Pneumonia will present the typical
symptoms, but if fever continues, tuberculosis will be suspected.
Examination of the sputum will probably decide.
In the =bronchopneumonic= form it is very difficult, in the early
stages, to distinguish it from simple bronchitis and bronchopneumonia.
The irregular fever and rapid loss of flesh are important signs. The
sputum will show elastic tissue and tubercle bacilli early in the
disease and should be carefully examined.