Chapter IV PRESENT ILLNESS SIGNS AND SYMPTOMS REFERRED TO THE LUNGS There is no typical cough of tuberculosis. Cough is usually present in some form or other, however, even if it be merely a slight hack or clearing of the throat in the morning. Any cough which lasts over four weeks requires careful investigation and should be considered as strongly suspicious of tuberculosis. Not infrequently the cough is a dry throat affair, or a mere clearing of the throat which has been considered of no importance by the patient. There may be an intolerable tickling in the larynx which no amount of coughing will relieve. Other causes of a chronic cough, such as enlarged tonsils, dry pharyngitis, etc., must be carefully looked into and ruled out before the cough is definitely set down as due to tuberculosis. A croupy barking or paroxysmal cough is often met with in children with enlarged tuberculous bronchial glands. Frequently there is no sputum just as there may be no cough. <A typical tuberculous sputum does not exist. When there is sputum, however, it should always be examined even if microscopically it appears to consist merely of clear saliva or mucus. Sputum examination is crucial for diagnosing tuberculosis. Syrup of hydriodic acid in teaspoonful doses after meals for three or four days will often so loosen up a process as to enable the patient to raise enough sputum for examination. If sufficient effort is made, some sputum can generally be obtained. The patient should be made to understand clearly that the sputum desired should come from down in the lungs after a cough forced or otherwise, and not from the naso-pharynx. Above all things the physician should bear in mind that a negative sputum examination or even repeated negative examinations does not rule out pulmonary tuberculosis. A negative sputum should be looked upon as the rule rather than the exception. If the sputum is found positive in the great majority of instances someone is to blame. Any hemorrhage from the mouth should be considered as definite evidence of pulmonary tuberculosis until proved to be the result of some other process. The great majority of hemorrhages are due to pulmonary tuberculosis. ‘Streaked spu-tum’ is of lesser significance than clear blood, but it is still a point of the greatest importance in diagnosis. <Callout type="important" title="Critical Symptom">Hemorrhage from the mouth should be considered as definite evidence of pulmonary tuberculosis until proven otherwise.</Callout> The patient should always be asked the question, ‘Have you ever raised any blood, either clear or mixed with the sputum? ’ If the answer is positive, one should next ascertain whether the blood came when the patient was resting quietly, or whether it followed a severe coughing spell or violent exercise. A hemorrhage usually occurs during or immediately after exercise. It is of all the more importance as a symptom of tuberculosis if it occurs during rest. Decayed teeth and diseased gums are very definite causes of small hemorrhages and streaked sputum. One such patient who gave a history of repeated small hemorrhages and who had been pronounced tuberculous on this account was entirely cured in body and mind by proper dentistry. Perhaps the most common cause of hemorrhages not due to tuberculosis is a lesion in the nose or naso-pharynx. In every case of obscure hemorrhage, therefore, the nose, naso-pharynx and throat should be given a most thorough examination. It not infrequently happens that the blood comes up without cough—the patient tasting or seeing it to his utter surprise, without knowing where it comes from.
Key Takeaways
- A persistent cough lasting over four weeks should be investigated for tuberculosis.
- Sputum examination is crucial in diagnosing pulmonary tuberculosis, even if it appears to consist of clear saliva or mucus.
- Any hemorrhage from the mouth should be considered as definite evidence of pulmonary tuberculosis until proven otherwise.
Practical Tips
- Use syrup of hydriodic acid to loosen up sputum for easier examination.
- Ask patients about any history of blood in their sputum, especially during rest periods.
- Thoroughly examine the nose, naso-pharynx and throat if a patient reports unexplained hemorrhages.
Warnings & Risks
- A negative sputum examination does not rule out pulmonary tuberculosis.
- Do not overlook other causes of chronic cough such as enlarged tonsils or dry pharyngitis.
- Be cautious about attributing bleeding to diseased tonsils in adults, as actual bleeding from tonsils is rare.
Modern Application
While the diagnostic methods described here are outdated, understanding the importance of persistent symptoms like a long-lasting cough and blood-tinged sputum remains crucial. Modern medical practices have advanced significantly with more accurate tests for tuberculosis, but recognizing early signs can still save lives.
Frequently Asked Questions
Q: What should be done if someone has a chronic cough lasting over four weeks?
A persistent cough lasting over four weeks is strongly suspicious of tuberculosis and requires careful investigation.
Q: Why is sputum examination important in diagnosing pulmonary tuberculosis?
Sputum examination is crucial because it can reveal the presence of tubercle bacilli, even if microscopically it appears to consist merely of clear saliva or mucus.
Q: What should be considered as definite evidence of pulmonary tuberculosis until proven otherwise?
Any hemorrhage from the mouth should be considered as definite evidence of pulmonary tuberculosis until proved to be the result of some other process.