Symptoms of Pulmonary Tuberculosis

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVI, Issue 4, 1 October 1927, Page 206

Symptoms of Pulmonary Tuberculosis

These depend on two factors: 1. The local effect of the disease. These are cough, sputum, haemoptysis, pleurisy and pain. 2. Symptoms caused by a very virulent poison produced by the germs and distributed by way of the blood stream over the body, i.e., lassitude., loss of weight, loss of appetite, dyspepsia, lack of nerve tone, rapid pulse and temperature, wasting of muscle. Cough may or may not be present m early disease of the lungs. At first the tubercles are m the lung tissue, and do not communicate with the bronchi. Any sputum at this time is merely an increase, m the normal secretion of the bronchi' later, when the tubercle communicates with a bronchiole, we get true infective sputum. The dry cough is often caused by irritation m the lungs of a nerve, the vagus. Blood-spitting or haemoptysis may occur very early m the disease. It is then due to the rupture of very small blood vessels, and is as a rule small m amount, varying from blood-stained sputum up to a few ounces of blood. Later, when the disease had advanced to cavity formation, the haemorrhage is usually due to the rupture of a large blood vessel. As the lung tissue breaks down and is discharged from the cavity a vein or an artery may be left unsupported, thus allowing the walls to stretch and an aneurism or dilatation of the vessel occurs. On this bursting a very severe haemoptysis may occur.

Pleurisy, when not associated with any other disease, is practically always tuberculous m origin. It maybe of a dry type or fluid may form. At first a sharp stitchlike pain is present on taking a deep inspiration. When fluid forms the pain lessens. Various pains referred to the upper part of the chest and shoulders sometimes occur.

The symptoms due to the tubercular poison are of paramount importance, as the}' occur very early m the disease, and their dimunition is a sign of improvement.

Lassitude is often the first indication that the patient's health is below par. That "tired feeling" is not always due to tuberculosis, but when an ordinary energetic person finds that together with this feeling there is a loss of weight, then he or she should certainly seek medical advice. Indigestion due to the poison affecting the digestive apparatus is very often complained of. Under suitable treatment for tuberculosis this usually clears up. Temperature and rapid pulse rate give us an indication of the toxaemia. Very little will cause the temperature of a tuberculosis patient to rise, i.e., excitement, over-exercise, etc. Besides the above, the toxins cause the wasting of the muscles, especially on the infected side of the chest. Naturally with this wasting there is weakness as well. PULMONARY TUBERCULOSIS TREATMENT. We can enumerate many measures for combating the disease, but one and all have for their object the raising of the patient's power of resistance, thus preventing further spread of the disease, and ultimately to bring about healing the lesion. The tubercle bacillus digs itself well m, m the tissue of the lung, and it is therefore safe from any antiseptic drugs given either by mouth or inhalation. Moreover, it is surrounded by a layer of fat which makes it resistant to Aveak antiseptics.

It is not so many years ago that consumption was looked upon as a most deadly disease — m fact, as a hopeless disease. Night air was bad, colds and draughts were most dangerous, so the poor consumptive was confined to a room with practically all fresh air excluded, and he gradually drifted downhill to his grave. Occasionally someone defied these rules, and to the surprise of all his friends began to improve. These cases were noted, and gradually what was known as the " Open-Air treatment " came into vogue. It was left to a German — Otto Walther — to realise what might be done

by combining* fresh air, rest, and regulated exercise, and he founded the Sanatorium of Nordrach-Colonie m the Baden Black Forest. Success attended his efforts, and perhaps the only treatment of his that could be found fault with was his system of forced feeding. Let us now consider m detail our present-day methods of treatment m a sanatorium.

Rest.— Temperature and rapid pulse rate are symptoms of a poisoning by the disease. This poison is produced m the lungs, and passing into the blood vessels is carried all over the body, producing its deleterious effects. While this poisoning is going on, improvement is not possible, as the w r hite corpuscles of the blood are affected, and the tissue cells of the body which produce a substance which neutralises this poison cannot act. Now, anything m the way of exercise — mental or physical — increases the pulse rate, and thus increases the amount of blood passing through the lungs, with the result that more poison is picked up. Lying quietly m bed reduces this pulse rate, and leads to quieter breathing; less poison is distributed, some of the tissue cells begin to produce this anti-body substance, and the poisoning begins to lessen, the temperature to come down. The time necessary for this varies greatly — it may be from a few days to even a year, or more — but no real progress towards cure can be made until the temperature is normal. Sometimes ordinary rest m bed is sufficient; at other times absolute rest is essential.

With temperature and pulse rate normal for some time, we can begin on a little exercise. To keep on resting indefinitely would not cure the disease, because the tissue cells will not produce the anti-bod)' substance unless stimulated to do so by the presence of some toxins m the blood. We therefore try to keep on liberating successively increasing amount of poison by increasing the amount of exercise, but always trying to avoid an overdose. An overdose will immediately cause a rise m temperature and other toxic conditions. Hence the reason why we allow one hour or more up, and gradually increase. This brings us to

treatment by regulated exercise and work. We wish to fill up the blood with antibodies., and we therefore graduate the exercise, each patient doing more and more, always being guided by the thermometer and weight chart. Of exercises, hill-climbing is perhaps one of the best, any exercise throwing too severe a strain on the arms being avoided. In our last lecture we dealt with Rest and Graduated Exercise. It is necessary if the disease is to make steady progress towards healing that nothing may happen to lower the resistance for even a short time. Now it is possible to do this with over-exercise. Nature knows thisj and so responds by creating fatigue. A consumptive with active disease should never tire himself ; he may do so once or twice with impunity, but to persist will eventually cause a further breaking down of the tissues. He may risk an overload once or twice without actually causing an extension of the disease, but undoubtedly for the time healing is at a standstill. When you are put on work do not attempt more than you are allotted. Work m a sanatorium is just as much part of the treatment as rest, but if that work causes fatigue then it must be reduced. Again, if you shirk your work you are hindering your own cure. It is difficult to judge exactly the amount of work necessary m each individual case; some are used to harder work than others, and feel the effect less, and it is only by exercising a careful look-out on the weight, pulse, temperature and lung changes that danger can be avoided. It is not practical or necessary to examine everyone daily, for fortunately symptoms appear before and give warning. The result of exercise mentioned m a previous article is to cause an outpouring of toxins from the seat of the disease. We call this Auto-Inoculation. If a patient is steadily getting better the amount of toxins begins to decrease, and when the disease becomes quiescent, practically no toxin is given off. We have noted that the presence of toxin causes an anti-toxin to be produced by the tissue cells of the body, and our ob-

ject is to produce these anti-bodies m excess. Unfortunately, the tissue cells will not produce them, unless stimulated to do so by the presence of the toxins, so to get this excess we fall back on Tuberculin.

Tuberculin corresponds to these toxins, and we are able to inject increasing doses, and to bring about the desirable effect of loading the body up with anti-toxin substances. — From "The Journal" of the Waipiata Sanatorium.