In chronic tuberculosis of bovine animals bleeding from the lung is rare even when caverns exist, and Moussu, in spite of extensive experience, has seen only two cases. This is in striking contrast with the condition in human sufferers from pulmonary tuberculosis, two-thirds of whom bleed at the lungs.
TUBERCULOSIS OF SEROUS MEMBRANES.
After pulmonary tuberculosis, tuberculosis of the pleural and peritoneal serous membranes is the most frequent clinical form of this disease. Sometimes both forms exist, and although the pleural and peritoneal lesions predominate or alone attract attention, there are also lesions in the lung or mediastinal lymphatic glands.
It is difficult to explain how the pleural and peritoneal serous membranes can be seriously invaded without the lung becoming affected, though in point of fact such a state of things frequently exists.
Tuberculosis of the pleura without pulmonary lesions is suggested by very obscure symptoms. The general signs consist in diminution of appetite, loss of condition, tachycardia, elevation of temperature, and progressive organic wasting. These are always present, though in themselves they have no specific significance.
The local symptoms are still more vague. Percussion causes pain, and the practitioner might at first suspect peripneumonia. The patient edges away, and tries to avoid the application of the pleximeter hammer. Firm pressure over the intercostal spaces sometimes causes struggling, and produces indications of abnormal sensitiveness. There is generally extensive partial dulness, sometimes complete dulness towards the lower regions of the chest.
On auscultation the lung may reveal the different indications of chronic pulmonary tuberculosis, or simply diminution of the respiratory murmur at points, accompanied by crepitant, sibilant râles, and moist, crackling sounds. As the anterior portions of the pleural sacs are most commonly invaded, the anterior vena cava is compressed, causing some difficulty in the return circulation, and producing venous pulse, which may extend as high as the parotid gland; there is, however, no swelling of the dewlap.
Respiration is frequent and difficult in consequence of adhesions between the pleura and lungs, which are connected by bands of fibrous tissue of varying extent. Coughing is rarely absent, and if the lung is diseased may be followed by discharge containing numerous bacilli. Otherwise the cough exhibits the pleuritic character, that is, it remains slight, dry, paroxysmal, and painful. The pericardium may be affected as well as the pleura; if the conditions occur simultaneously the venous pulse in the jugulars will be particularly apparent.
The symptoms of tuberculous pericarditis are similar to those of ordinary pericarditis, except that the exudation is less abundant; in a word, the symptoms are those of rather trifling exudative pericarditis.
Tuberculosis of the peritoneum is frequently accompanied by that of the pleura or the abdominal viscera. The lesions are localised on the parietal peritoneum and epiploon, producing in time adhesions between the viscera and walls of the peritoneal cavity, which affect the action of the digestive organs, gradually causing interference with the peristaltic movement both of the rumen and the intestines. The stagnation of alimentary matter favours fermentation, so that the rumen becomes permanently distended. The right flank also is swollen, and the abdomen exhibits a change in shape similar to that in peritonism, which is a constant symptom of tuberculous peritonitis.