. Medical diagnosis for the student and practitioner. imes of peace these peripatetic andgregarious possessors of rebellious stomachs and tittery nerves nil thespas and the more bizarre of the sanatoria of Europe. Preferential Site of Tuberculous Lesions.—Almost any portion of thebody may be involved, the lungs most frequently in adults, the bones, lymphglands and intestines in children, while the peritoneum, kidneys or brainmay be involved at any age. Secondary involvement of the intestines is verycommon in advanced pulmonary tuberculosis. Modes of Onset.—It should never be forgotten that nea
. Medical diagnosis for the student and practitioner. imes of peace these peripatetic andgregarious possessors of rebellious stomachs and tittery nerves nil thespas and the more bizarre of the sanatoria of Europe. Preferential Site of Tuberculous Lesions.—Almost any portion of thebody may be involved, the lungs most frequently in adults, the bones, lymphglands and intestines in children, while the peritoneum, kidneys or brainmay be involved at any age. Secondary involvement of the intestines is verycommon in advanced pulmonary tuberculosis. Modes of Onset.—It should never be forgotten that nearly every case oftuberculosis, whatever its form or apparent suddenness of onset, gives a historyof previous impairment of health. * Unfortunately, however, an expensive matter, as it often involves prolonged hospitaltreatment. DISEASES OF THE LUNGS AND PLEURA 405 As regards actual onset, it may be acute miliary and widespread, orastonishingly insidious, slow and chronic, wholly glandular or osteal, or triable,peritoneal, pleuritic or Fig. 151.—Acute miliary tuberculosis in a child. Note diffuse studding of lung fieldswith miliary tubercles. {Dr. Frank S. Bissell.) ACUTE MILIARY TUBERCULOSIS {Acute Tuberculosis. General Diffuse Tuberculosis. Acute Disseminated Tuberculosis) Usual Cause.—The introduction of an adequate dose of virulenttubercle bacilli, from a latent or active glandular, osseous, or pulmonaryfocus, into the blood stream. 406 MEDICAL DIAGNOSIS Wide dissem-ination oflesions. A deceptivetype. Importantsigns. Bacilli may beabsent. Usually scant. Hyper-resonance. Usuallybroncho-pneumonic. Morbid Anatomy.—The viscera show general changes of an acute febrileinfection and a general distribution of miliary tubercles; the lesions in thelung, pleura or brain predominating and the peritoneum or more often itsdiaphragmatic surface, being frequently much affected. Symptoms.—Typhoidal Form.—The onset may be gradual and exactlysimulate typhoid. The feve
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