Prof. Koch's Method to Cure Tuberculosis Popularly Treated Part 3

The _pulse_ is characteristic in many cases. In the beginning of the disease the pulse is quickened only to slacken after a few days. The number of beats may be reduced to 40-60 a minute (normal 90-100), however it does not commonly remain at a certain figure, but varies, often inside of an hour, so that at one time 40, then 60 and again 80 beats may be counted inside of twenty-four hours.

The pulse again increases 1-3 days before death and then to such a rate that it is almost impossible to count it. It may reach 180 and 200 beats a minute. As soon as this rate of the pulse follows one of the reductions described above a speedy death may be predicted.

Of great importance are the variations in respiration. In the beginning stages of the disease breathing is normal except in such case where tuberculosis has made great progress in the lungs and in the case of high fever. Then of course breathing becomes more rapid. Acute hydrocephalus influences respiration in such a way that it slackens and becomes irregular. In one minute children may breath fifteen times, in another thirty, then again 20 times; at one time breathing may be very slight with almost invisible expansion of the chest and without any noise whatever, then again it may consist of deep sighs; these are also characteristic of this particular disease. Sometimes breathing is completely discontinued for ten seconds and more.

If the pulse attains that extreme rate shortly before death the rate of breathing will also be increased.

As regards the _skin_, the same is generally damp from the beginning of the disease; severe sweats are observed on the head; with progressing disease the skin becomes dry, brittle, comes off in flake-like scales and only when the death-predicting increase of the pulse sets in, there appears a profuse sweat, the cold sweat of death.

_Headache_ is also a prominent and pretty nearly constant symptom. As has been mentioned before, it does not as a rule attend the precursory symptoms. It generally begins with vomiting and soon becomes so violent that older children constantly cry aloud and lament, while the smaller ones put their little hands up to their head, pull their hair and ears and restlessly roll about on the pillow.

These expressions of pain last as long as children retain consciousness, a particular part of the head is not commonly pointed out, but asked about it the majority point to the forehead. With small children automatic movements are noticed that also seem to refer to headache, and which consist in rapidly placing the hand on the head and then drawing it back.

The larger children complain of _pains in the bowels_, especially in the region of the stomach, which remarkably often, though not regularly, become more intense by pressing and may become so violent that the children cry out aloud with pain, when the stomach or other portion of the abdomen is but slightly touched. But these pains do not last as long as the headache, they often stop suddenly, at times return.

The shape of the _abdomen_ is extraordinarily characteristic. In the beginning nothing remarkable can be noticed, but after the symptoms of acute hydrocephalus, vomiting, constipation, etc., have lasted for some time, the abdomen gradually decreases in size, becomes wrinkled and collapses until it finally a.s.sumes a scaphoid shape and by slight pressure the large iliac artery can be felt on the spinal column.

This contraction of the abdomen is attendant in every case of tuberculous meningitis.

If the large _fontanel_ on the head is not yet closed, the same will gradually bulge out as the disease progresses.

The _mental activity_ suffers premature derangements, such as have been fully mentioned in the description of the precursory symptoms. The most striking is the confused, staring look, the peevish and surly behavior, and again in other cases the extreme indifference toward otherwise well-liked persons and things. Later on actual delirium sets in, but generally of a quiet nature.

A very common symptom is a loud, plaintive outcry, that is repeated at longer or shorter intervals. Children often cry out at partly regular intervals during a whole night; these cries are always accompanied by a loud sigh. These symptoms of excitement being extremely tormenting and depressing for the sympathizing relatives, fortunately last no longer than 6-8 days at the most, and are succeeded by a deep _stupor_.

If the children have once become _unconscious_, they do not recover again as a rule but remain so until death; delirium and stupor may alternate with each other in certain cases, but the former process is by far the most frequent.

_Convulsions_ appear only in the later stages. At first the interval between the attacks are long, often as many as three or four days intervene. Commonly however they come much oftener and may in some cases last for hours. All extremities are affected by these convulsions, the eyes become red, are rolled in every direction and turning way up are fixed so that nothing but the whites is visible. After several minutes, often after two or three hours, these general convulsions subside, the children, now very pale, drop into a deep sleep and their general condition appears much reduced.

Different muscular groups especially those of the face are subject to _local cramps_. The upper lip may become distorted, convulsive smiles have been observed, also peculiar sucking motions. The children point their lips and flatten them again, sometimes for hours in succession.

In the latter stages a squinting of one or both eyes may be noticed but this may again disappear.

_Grinding of the teeth_ is another very peculiar symptom which is well-known and feared by experienced nurses. The _arms_ are subject to various motions, at times sweeping automaton like, then again convulsive contractions, sometimes trembling of the muscles, at others a throbbing of the tendons. Many patients put their hands to their s.e.xual organs and make motions tending to onanism.

The _legs_ are not subject to cramps as much as the arms; they are mostly bent and drawn up in a half paralyzed condition.

The _muscles of the neck and back_ are very much contracted and most children, when raised or laid on their side, bend the head far back.

In most children an extreme sensibility at being touched is observed.

They may be handled with the greatest possible care and lifted most tenderly, a slight pressure on the head, body or hands in changing their position will be violently resisted with obvious expressions of pain. In the latter stages this extreme sensibility gives way to _insensibility_.

Then the children may be pinched and poked, they may be turned and moved from one side to the other without any consideration, they will not resist and only give expression to the remaining sensibility by a low whimper. The lack of sensibility may be especially marked in the eyes; these can be touched with the fingers, without causing a closing of the lids.

The sense of _hearing_ seems to continue its functions until very late.

Children show that they hear as long as they are not completely unconscious; even when addressed in a low tone of voice they react somewhat. The sense of _smell and taste_ also are lost toward the very end of the disease.

_Paralytic_ affections appear during the final stages. It has been observed in some cases that the arm and limb are paralyzed on one side only. Often one upper eyelid is paralyzed and hangs down on one side of the face and the muscles of the tongue may be affected.

Generally the patient dies after violent general convulsions that last for hours. Exceptionally only the paralytic symptoms increase gradually and cause death without any agony or struggle, simply a discontinuance of the functions const.i.tuting life.

The duration of the disease varies from 2-4 weeks from the beginning of the characteristic symptoms. Generally the day when the children take to the bed is fixed as the beginning of the disease.

The former methods of treatment have been a signal and absolute failure in every case. Every child that has once been attacked with this disease has heretofore died. Until now Koch has not been able to make any experiments with acute hydrocephalus, so that it remains an open question whether it is now possible to cure this disease.

Besides tuberculosis of the cerebral membranes with which children are afflicted, _tuberculosis of the brain_ may occur, although this disease is very rare. Tuberculosis of the brain appears in the shape of small tumors in all parts of the brain. After longer duration of tuberculosis of the brain, tubercular meningitis appears.

The process of this disease may be varied. In some cases the development of cerebral tuberculosis is manifested by the sudden appearance of high fever temperatures or violent headache; to this may be added, slackening of the pulse, vomiting, stiff neck and isolated cases of palsy; sometimes an attack of convulsions is the first manifestation.

In other cases the beginning can not be accurately determined, as the beginning symptoms of the disease are so slight as to escape notice.

Impaired process of nutrition, languor and headache are symptoms from which the existence of some serious affliction may be inferred without being able to determine its nature in the earlier stages.

Again in other cases the disease may proceed through all its stages without any cerebral appearances whatever. This is especially true of small tubercles and of diseases of infants. However, we more frequently observe in children than in adults convulsions of varied intensity and distribution.

Nutrition is more and more impaired as the disease progresses, in isolated cases only, a temporary improvement may be observed.

The _end_ of cerebral tuberculosis has been _death_ before this. Ten days to two weeks, even three weeks may pa.s.s from the first appearance of tubercular meningitis to the completion of the process of the disease, attended by feverish motions characteristic of this condition and by cerebral symptoms, first with the character of excitement, later on with that of palsy.

The treatment of cerebral tuberculosis has been entirely insufficient before this. Let us hope that it will be possible to effect a cure by means of Koch's new method.

_Tuberculosis of the Kidneys_ is met with from the earliest childhood till old age. Most frequently the male s.e.x is afflicted during manhood.

In most cases tuberculosis also exists in other organs, especially in the urinary and s.e.xual apparatus. The existence of pulmonary or intestinal tuberculosis is not essential.

The symptoms of renal tuberculosis are of such general and indefinite character, that it is often impossible to fully determine the disease.

Now, however, it will be more easily possible on account of Koch's discovery.

The _urine_ may, but need not contain pus and blood. Sometimes small lumps are found in the urine.

_Pains_ are only sometimes felt in the renal regions; _fever_ may be occasionally attendant.

The disease lasts for months and years; though before now it has inevitably resulted in death, though it has in exceptional cases taken ten years or more.

The internal treatment of renal tuberculosis was ineffectual, surgical treatment has been attended with greater success. This consisted in removing the diseased kidney. Now good results will possibly be attained by the application of Koch's method to cure and resource to surgery will be taken in exceptional cases only.

_Tuberculosis of the suprarenal capsules_ is of very rare occurrence. It leads to a peculiar change in the color of the skin; the same turns dark brown or bronze color. Sooner or later death results.

Perhaps the application of Koch's method will, besides curing the disease, give us information regarding the functions of the suprarenal capsules about which nothing whatever is as yet known.

A large s.p.a.ce in the realm of disease is claimed by _tuberculous affections of the bones and joints_. These afflictions appear particularly in childhood though manhood is by no means exempt. They may appear in all portions of the body, although a marked preference is shown for certain parts. Although the tubercle-bacilli are infinitely small, they possess the power to cause suppuration of the bones and joints and to produce acute inflammation of these parts.

Most frequently tubercular affections of the bones are found in the hip-joints, the knee and the spinal column.

_Tuberculous inflammation of the hip-joint_ is princ.i.p.ally a disease occurring in childhood; though it rarely appears before the third year.

It is most frequent from the fifth to the tenth year.

Inflammation of the hip-joint developes very slowly in children, it generally takes months before the slightest beginning symptoms reach a threatening appearance. The first sign is _lameness_; among laymen tuberculous inflammation of the hip-joints is known as "voluntary limping."

By limping we understand that mode of walking in which one leg is spared and by this the trunk is supported only a short time by one extremity and all the longer by the other. In every painful affection of the lower extremity limping results as the weight of the body increases the pain.