Acute Pneumonic Phthisis.
In some particulars the pneumonic development of miliary tuberculosis, and the acute development of pulmonary tuberculosis, which is known as acute phthisis or galloping consumption, closely resemble each other, and yet a sharp distinction must be made between them. In 'the latter disease the infection is strictly local and the process of the tubercular development results in the rapid destruction of lung tissue, but is accompanied with pathological changes, which closely resemble either acute lobar pneumonia, or, as is common among children, it may show the characteristics of bronchopneumonia. Usually the condition occurs secondarily to an infection elsewhere, although in a very few cases it has occurred as a primary disorder. The preliminary phenomena of malaise, chill, fever, cough, more or less severe acute pain in the diseased area, and early night sweats, are characteristic phenomena. Hemorrhage is more common perhaps in this than in the chronic form. Whether slight or severe, there is much prostration and rapid emaciation.
The evidences obtained from a physical examination so closely resemble a typical case of pneumonia that it is with great difficulty that a distinction can be made. There is dulness on percussion, with evidences of hepatization and ultimate complete consolidation. There are bronchial breathing and crepitant rales, which are at first fine, but subsequently become loud and moist. These later give way to evidences of softening where a cavity ultimately appears. The respirations are rapid and shallow at first, and cyanosis ultimately develops. The expectoration may consist of a thick, colorless mucus at the onset, to be quickly streaked with blood later, or to present the characteristic rusty colored appearance of that of pneumonia, which has given the disease the name of tuberculous pneumonia. A fact used in the differential diagnosis of the two diseases is that actual free hemorrhage seldom occurs in pneumonia.
At first, after the appearance of marked pulmonary symptoms even, the patient may continue in an indifferent manner about his daily occupation. But the prostration is so rapid that he is obliged to yield entirely to the disease, which usually proves fatal in the course of six weeks. However, there is a type that is designated as sub-acute, in which the progress of the disease is less rapid, and the fatal termination may be delayed five or six months.
Treatment:—No specific measures can be suggested which are successful in acute phthisis. Those general measures which are adopted in the chronic form of the disease are applicable, except change of climate. So rapid is the progress of the disease that it is seldom that anything is accomplished by a change, and the worry, fatigue and exhaustion consequent upon making a change only advance the progress of the disease.
While this condition may run its entire course and terminate fatally in about the same time as that of a severe case of pneumonia, or a prolonged case of typhoid pneumonia, it usually lasts from two to three months, somewhat longer than that of the general miliary type of the disease. The course of the disease is very rapid in childhood.
