. Prior to the advent of pulmonary symptoms, is the latent
period, which may extend over a variable length of time, from a few
months to several years; and, indeed, may never be developed any
farther. Until sufficient tubercular matter has been deposited in the
lungs to alter the sounds observed on auscultation and percussion, a
definite diagnosis of tubercular consumption cannot be made, even though
there may have been hemorrhage. Nevertheless, when we find _paleness,
emaciation, accelerated and difficult breathing, increased frequency of
the pulse, an increase of temperature_, and _general debility_ coming on
gradually without any apparent cause, we have sufficient grounds for
grave suspicions. These are increased if tenderness under the
collar-bone, with a slight, hacking cough is present. These symptoms
should be sufficient to warn any individual who has the slightest reason
to believe that he is disposed to consumption, to lose no time in
instituting the appropriate hygienic and medical treatment, for it is at
this stage that remedies will be found most effective. Unfortunately,
this period is too apt to pass unheeded, or receive but trifling
attention; the patient finds some trivial excuse for his present
condition, and believes that he will soon be well. But, alas for his
anticipations! The disease goes onward and onward, gradually gaining
ground, from which it will be with great difficulty dislodged.

The cough now becomes sufficiently harassing to attract attention, and
is generally worse in the morning. The expectoration is slight and
frothy; the pulse varies from ninety to one hundred and twenty beats in
a minute, and sometimes even exceeds this. Flushes of heat and a burning
sensation on the soles of the feet and palms of the hands are
experienced. A circumscribed redness of one or both cheeks is apparent.
These symptoms increase in the afternoon, and in the evening are
followed by a sense of chilliness more or less severe. The appetite may
be good, even voracious; but the patient remarks that his food "does not
seem to do him any good," and, to use a popular expression, "he is going
into a decline." As the strength wanes the cough becomes more and more
severe, as if occasioned by a fresh cold, in which way the patient
vainly tries to account for it. Expectoration increases, becomes more
opaque, and, perhaps, yellow, with occasionally slight dots or streaks
of blood. The fever increases, and there is more pai