is
followed by excessive and long-continued prostration. From this time
onward, the progress of the disease is more rapid. The liver and kidneys
are implicated. In addition to the pallor, the complexion becomes
jaundiced, giving the patient, who is now wasting to a mere skeleton, a
ghastly look. The urine is generally copious and limpid, though
occasionally scanty and yellow. The pulse increases to one hundred and
thirty or one hundred and forty beats in the minute, and is feeble and
thread-like. The cough harasses the patient so that he does not sleep,
or his rest is fitful and unrefreshing; whenever sleep does occur, the
patient wakes to find himself drenched with a cold, clammy perspiration.
The throat, mouth, and tongue now become tender, and occasionally
ulcerate. Expectoration is profuse, purulent, and viscid, clinging
tenaciously to the throat and mouth, and the patient no longer has
strength to eject it. The hair now falls off, the nails become livid,
and the breathing difficult and gasping; the patient has no longer
strength to move himself in bed and has to be propped up with pillows,
and suffocates on assuming the recumbent position. Drinks are swallowed
with difficulty. Diarrhea takes the place of constipation. The
extremities are cold, swollen, and dropsical; the voice feeble, hollow,
grating, husky, the patient gasping between each word; the respiration
is short and quick. A slight remission of these symptoms occurs. The
patient is more comfortable, lively, cheerful, and perhaps forms plans
for the future. But it is the last effort of expiring vitality, the last
flicker of the lamp of life, the candle burns brilliantly for a moment,
and with one last effort goes out, and death closes the scene.

The duration of the active stage of consumption varies from a few weeks
to several years, the average time being about eighteen months.

_Cough_ is always a prominent symptom throughout the entire course of
the disease, varying with its progress.

_Expectoration_, at first scanty, then slightly increased, colorless,
frothy, and mucous, is also a characteristic. After a time it becomes
opaque, yellow, and more or less watery; then muco-purulent and finally
purulent, copious, and viscid. When tubercular matter is freely
expectorated, with but little mucus, it sinks in water. This symptom
continues to the very last.

_Haemoptysis_ (bleeding from the lungs) may occur at any stage of the
disease, often being the fir