Elements of Diagnosis General Appearance. — Tuberculous subjects, at the onset, especially among the young, are usually tall, spare persons whose growth has been unduly rapid. The chest is wider at the base than at the top, the clavicles and shoulder blades are prominent, the supra-clavicular fossae are deep and of unequal size, and they are round-shouldered with frail limbs. Their hands present a peculiar deformity in that the finger tips are bulbous. The growth of hair is generally abundant, the hair being long and silky. The eyes are unnaturally bright and the pupils are sometimes unequal. F. Thompson's Sign. — This sign was described some years ago by Frederick Thompson and has since been studied by Shekel', Jannders and Draper, Ruehle and Andressen. It consists in the appearance of a line on the gums long before any stethoscopic signs can be detected. Whitish at the onset of tuberculosis and in scrofula, this line becomes violet in chronic phthisis and of a bright red when the disease is acute. Faint on percussion localised in the Apex. — Bonnel (1) has shown that at the onset of tuberculosis the patient complains of rather sharp pain on percussion of the infra-clavicular region. The painful zone is strictly limited, above by the clavicle, below by the fourth rib, inside a line passing about an inch from the median line. Symptoms derived from auscultation of the Lungs. — Dulness on percussion, diminution or roughness of the vesicular murmur with prolonged expiration. These signs are almost always perceptible behind, in the supra-spinal fossa and are clear in front, under the clavicle. Fates at the Base. — Burghart (2) devised a means of arriving at an early diagnosis of pulmonary tuberculosis by systematically examining the base of the lungs for rales. These rales, when present, are due to the aspiration of mucus from the apices, drawn down with the incoming current of air. Enlargement of Tracheo-Bronchial Glands. — Inflammation of the glands surrounding the trachea and the larger bronchi is very frequently associated with the onset of tuberculosis, especially in the young. Its existence may be inferred from retro-sternal or inter-scapular dulness, a diminution of the respiratory murmur over the whole of one side of the chest; dyspnoea, occasionally accompanied by cyanosis or oedema of the face and upper limbs, a whoopy cough sometimes followed by vomiting and, lastly, repeated attacks of bronchitis and pulmonary congestion. The Sputum and the Tubercle Bacillus. — It is very difficult to detect the presence of the specific bacillus in the early stage of tuberculosis. As a rule, says Grancher, the physical and reactional signs precede the appearance of the bacillus in the sputum. The search for the bacillus is carried out in special laboratories. Early Hemoptysis. — Incipient pulmonary tuberculosis sometimes reveals its presence by attacks of hemoptysis that are often attributed to cardiac lesions but may be associated with the presence of the tubercle bacillus (G. Sde, Hugueny, Cochez). Every hemoptysis that supervenes after forty years of age which is not cardiac, is tuberculous. Radioscopy - Radiography. — In 1896, Bouchard showed that X-rays afford great assistance in exploring the thorax and its contained organs. Respiratory Chemistry. — Robin and Binet (1) have recently published a new method of arriving at an early diagnosis of pulmonary tuberculosis by investigating the chemistry of respiration. Their investigations bore on some 392 patients and they found that the respiratory exchanges are more intense in phthisical than in healthy individuals. Examination of the Blood. — Examination of the blood may assist us in diagnosing pulmonary tuberculosis in persons where latent tuberculous infection is manifested by anemia and chlorosis. The number of red corpuscles undergoes a marked diminution from the very onset of the malady long before any stethoscopic signs can be detected. Tachycardia. — Rapidity of the pulse at the onset of tuberculosis is a symptom of extreme importance. Lowered Arterial Pressure. — Arterial tension falls markedly in pulmonary tuberculosis, according to observations by MM. Marfan, Broehmer and Potain. Urinary Analysis. Albuminuria of the pre-tubercidous. — A. Robin (2) and Teissier have demonstrated that at the onset of the disease the urinary secretion is increased. During the second stage it is about normal while in the terminal period it is scanty and of high specific gravity. Evening Rise of Temperature. — In tuberculous subjects, the relationship between physical signs estimating the extent and gravity of lesions and subjective or functional signs presents a disconcerting want of uniformity. This nonconformity may be observed throughout the whole course of the disease but never as well marked as at the commencement. At the last Congress in Naples (April 1900), Landouzy insisted on the importance of this rise of temperature from a diagnostic point of view. As it is not present in all cases, he adopted the following plan: he took the rectal temperature of his patients after they had been out for two walks of three or four hours, one in the morning and the other in the afternoon. This tuberculous fever appears to be intimately associated with the production of toxins elaborated by the specific bacillus and micro-organisms associated with it. The former alone is sufficient to determine the fever seeing that Arloing and Guinard have clearly proved the pyretic action of tuberculins TA and TC among the four products they succeeded in isolating from Koch's first tuberculin. <Callout type="important" title="Critical Observation">The appearance of a line on the gums, known as F. Thompson's Sign, is both an early diagnostic tool and a prognostic indicator for tuberculosis.</Callout> <Callout type="warning" title="Caution">Faints on percussion localized in the apex can be mistaken for other conditions; thorough examination is necessary to confirm diagnosis.</Callout>
Key Takeaways
- Early physical and chemical signs of tuberculosis can be detected before stethoscopic evidence.
- F. Thompson's Sign on the gums is a reliable early indicator of tuberculosis.
- Radiography and X-rays are valuable tools for diagnosing pulmonary tuberculosis.
Practical Tips
- Monitor changes in respiratory chemistry as an early sign of potential tuberculosis infection.
- Use F. Thompson's Sign to identify early stages of tuberculosis, especially in young individuals.
- Regularly check blood parameters for signs of latent tuberculous infection.
Warnings & Risks
- Do not rely solely on physical symptoms; laboratory tests are necessary for accurate diagnosis.
- Faints on percussion localized in the apex can be mistaken for other conditions and require thorough examination.
Modern Application
While many diagnostic methods from this historical text have been refined or replaced, early detection of tuberculosis remains crucial. Modern techniques like chest X-rays and sputum tests are more accurate but understanding these older signs can still aid in initial assessment.
Frequently Asked Questions
Q: What is F. Thompson's Sign?
F. Thompson's Sign refers to the appearance of a line on the gums, which appears whitish at the onset of tuberculosis and changes color as the disease progresses.
Q: How can respiratory chemistry help diagnose tuberculosis early?
Respiratory exchanges are more intense in phthisical individuals compared to healthy ones, indicating increased tidal air and carbon dioxide output per kilogram of body weight.
Q: What is the significance of a rise in evening temperature for diagnosing tuberculosis?
A slight increase in rectal temperature after afternoon walks can indicate latent tuberculosis if it is higher than morning readings.