In its general influence on the body phthisis pulmonalis is of great importance.

Its most constant effects are Emaciation and Anaemia,. the former of which, as we have seen, was the main element in suggesting the name phthisis. These conditions have their source chiefly in fever.

Fever is an almost constant accompaniment of phthisis, altogether apart from any general tuberculosis. It is to be referred to the presence in the blood of the various products evolved in the course of the local processes. These consist in part of the products of the specific microbe, which will pass into the blood, even when the microbes themselves do not. There will also be the products of the disintegration of blood, and of inflammatory exudations, such as those in pleurisy. In pulmonary cavities again, various forms of decomposition, putrid and other, are liable to occur, and the products naturally lead to fever.

Amyloid disease occurs in about a fourth of the cases of phthisis, and is more-frequent proportionally in the fibroid than in the caseous form. It usually affects the spleen, kidneys, liver, intestine, and lymphatic glands, but there are great differences in its distribution and extent. It may be absent in any one of the situations mentioned while present in the others, or it may be greatly exaggerated in one while very inconsiderable in others. (See the author's " Lectures to Practitioners.") It is typically present in the spleen in the majority of cases, and takes the form of the sago spleen.

Disease of the kidneys is a frequent concomitant of phthisis. It may be amyloid disease, complicated (as amyloid disease regularly is) with chronic nephritis, or it may be a tuberculosis. On the other hand there is not uncommonly a nephritis, sometimes in an acute or subacute form so as to produce enlargement with fatty epithelium, sometimes in a more chronic form, with contraction and granulation of the kidneys.

In cases of amyloid disease the mere presence of the amyloid material may induce chronic inflammation, but there is a considerable number of cases in which nephritis is present in an acute form. In these cases we may suppose that the products from the disintegrating processes going on in the lungs lead, by their discharge through the kidneys, to an inflammation of these organs (see author, I.e.).

General tuberculosis not infrequently follows phthisis pulmonalis. We have seen that the disease in the lungs is a local tuberculosis, and as a general rule it extends along mucous surfaces and lymphatic channels. In a considerable proportion of cases, however, the tubercle bacilli to some extent reach the blood and are carried throughout the body. If the liver be examined microscopically there will usually be found a few tubercles, generally in various stages of degeneration. There are also not infrequently a few tubercles in the kidneys visible to the naked eye. We sometimes meet even with a more considerable tuberculosis in the kidney and elsewhere, constituting a Chronic general tuberculosis (see p. 313), especially in children.

Acute general tuberculosis is a less frequent result and is generally due to a definite extension of the local tuberculosis to a branch of the pulmonary vein which has not become occluded by the advancing lesion (see p. 313). It may also arise by an extension of the tuberculosis from the bronchial glands to the thoracic duct.

Literature

The literature of phthisis is very extensive. The older literature will be found in Waldenburg, Tuberculose, Lungenschwindsucht u. Scrofulose, 1869. See further, Carswell, Illustrations of path, anat., 1838; Virchow, Lehrb. d. spec. Path., i.; Niemeyer, Klin. Vortr., 1867; Buhl, Lungenentz. Tuberc. u. Schwindsucht, 1872; Ruhle und Rindfleisch, Ziemssen's Handb., v.; Weigert, Virch. Arch., lxxvii., lxxxviii., civ.; Koch, Etiology of tuberculosis, Syd. Soc. transl., 1886; Baumgarten, Tuberkel und Tuberculose, 1885; Kidd, in Allbutt's System of Med., v., 1898; Weichselbaum, (Inhalation) Wien. med. Wochenschr., 1883; Tappeiner, Virch. Arch., lxxiv. and lxxxii.; Ziegler, Volkmann's Samml. No. 151, and Lehrb.; Hamilton, Path, of bronchitis, etc., 1883; Ewart, (Position of cavities) Gulstonian lectures, 1882, in Brit. Med. Jour.; Prudden, (Formation of cavities, etc.) New York Med. Jour., 1894; Thompson, Family phthisis, 1884; Jaccotjd, Curability of pulm. phthisis, 1885; Powell, Dis. of lungs and pleura, 1886; Williams, Pulmonary consumption, 1887; Kidd, (Distrib. of bacilli in the lung) Med. chir. trans., lxviii., 1885; Yeo, (Contagiousness) Brit. Med. Jour., 1885, i.; Coats, Lect. to practitioners, 1888; Germain See, Bacillary phthisis; James, Pulmonary phthisis, 1888; Dobell, Bacillary consumption, 1889. Healing of phthins - Harris, Brit. Med. Jour., 1889, ii.; Coats, ibid.