In the absence of pulmonary lesions it is extremely difficult to arrive at an exact diagnosis except after injection of tuberculin, for the above symptoms very closely resemble those of cœnurosis, brain tumours, and even tumours in the frontal sinuses.
TUBERCULOSIS OF THE SKIN.
Cutaneous tuberculosis is one of the rarest forms of the disease. It is distinguished by the formation beneath the skin of little hardened swellings varying in size between a hazel-nut and a walnut, and containing caseous or calcareous material. These swellings have no connection with the superficial lymphatic glands. They may be found grouped together within certain areas, or distributed irregularly over the whole body, particularly towards the base of the tail.
The condition may be mistaken for generalised sarcomatosis, from which, however, it is readily distinguished by microscopic examination of the contents of the swellings.
ACUTE TUBERCULOSIS—TUBERCULOUS SEPTICÆMIA.
However rapidly the above-described forms of tuberculosis may develop, the disease as a whole is always of long duration, and continues for months, or even for years. The development of these chronic forms may, however, be interrupted by various influences which cause it to assume an acute character, either for a time or continuously. Each intermittent attack aggravates the condition of the patient, but gradually subsides, with or without treatment. Continued attacks, however, rapidly lead to death; they may be seen in animals previously unsuspected of any grave disorder.
Fig. 282.—General appearance of a case of cutaneous tuberculosis.
The dominant symptom is continuous fever, accompanied by signs of disturbance of any or all of the chief bodily functions.
The temperature rises to 102° Fahr. (39° C.), or even to 104° or 105° Fahr. (40° or 41° C.), with morning and evening remissions of some hours. The respiration is accelerated. On auscultation it is often difficult to discover signs of chronic tuberculosis. The lung is the site of repeated congestive changes, resembling those of broncho-pneumonia or contagious pleuro-pneumonia. The pleura and walls of the chest become extremely sensitive, as in the last-named disease, and the abdomen may exhibit signs of peritonism, as at the beginning of acute peritonitis. The pulse rises to 80, 90, 100, or even 120 beats per minute, and the urine contains albumen in notable quantities. This condition continues for weeks without apparent diminution, the patients refuse food, lose flesh with startling rapidity, and finally die of exhaustion.