nly be
found at its highest about 4 P.M., daily. The pulse is also increased
in frequency. Night sweats are common in consumption, but not as a
rule in the first stage; they occur more often in the early morning
hours.

Chills, fever, and sweating are sometimes the first symptoms of
consumption, and in a malarial region would very probably lead to
error, since these symptoms may appear at about the same intervals as
in ague. But the chills and fever are not arrested by quinine, as in
malaria, and there are also present cough and loss of weight, not
commonly prominent in malaria. Persistently enlarged glands, which may
be felt as lumps beneath the skin along the sides of the neck, or in
the armpits, should be looked upon with suspicion as generally
tuberculous, containing the germ of consumption. They certainly demand
the attention of early removal by a surgeon.

The spitting of bright-red blood is one of the most certain signs of
consumption, and occurs in about eighty per cent of all cases, but
rarely appears as an early warning. The pupils of the eyes may be
constantly large at the onset of the disease, but this is a sign of
general weakness. Pain is also a frequent but not constant early
symptom in the form of "stitch in the side," or pain between or
beneath the shoulder blades, or in the region of the breastbone. This
pain is due to pleurisy accompanying the tuberculosis. Shortness of
breath on exertion is present when consumption is well established,
but is not so common as an early symptom. The voice is often somewhat
hoarse or husky at the onset of consumption, owing to tuberculous
laryngitis.

To sum up then, one should always suspect tuberculosis in a person
afflicted with chronic cough who is losing weight and strength,
especially if there is fever at some time during the day and any
additional symptoms, such as those described. Such a one should
immediately apply to a physician for examination of the chest, lungs,
and sputum (expectoration). If the germs of tuberculosis are found on
microscopical inspection of the sputum, the existence of consumption
is absolutely established. Failure to find the germs in this way does
not on the other hand prove that the patient is free from the
disease, except after repeated examinations at different times,
together with the inability to discover any signs by examination of
the chest. This examination in some instances produces no positive
results, and it may be imposs