There is usually hoarseness, not constant, but coming on if the patient be tired, or toward the evening; there is also a sense of lassitude and depression, shortness of breathing, a feeling of being quickly wearied—more especially on the slightest exertion. The hair of a consumptive person usually falls off, and what little remains is weak and poor; the joints of the fingers become enlarged, or clubbed as it is sometimes called; the patient loses flesh, and, after some time, night-sweats make their appearance; then we may know that hectic fever has commenced. Hectic begins with chilliness, which is soon followed by flushings of the face, and by burning heat of the hands and feet, especially of the palms and the soles. This is soon succeeded by perspirations. The patient has generally, during the day, two decided paroxysms of hectic fever—the one at noon, which lasts about five hours, the other in the evening, which is more severe, and ends in violent perspirations, which perspirations continue the whole night through. He may, during the day, have several attacks of hectic flushes of the face, especially after eating; at one moment he complains of being too hot, and rushes to the cool air; the next moment he is too cold, and almost scorches himself by sitting too near the fire. Whenever the circumscribed hectic flush is on the cheek, it looks as though the cheek had been painted with vermilion, then is the time when the palms of the hands are burning hot. The expectoration at first is merely mucus, but after a time it assumes a characteristic appearance; it has a roundish, flocculent, wooly form, each portion of phlegm keeping, as it were, distinct; and if the expectoration be stirred in water, it has a milk-like appearance. The patient is commonly harassed by frequent bowel complaints, which rob him of what little strength he has left. The feet and ankles swell. The perspiration, as before remarked, comes on in the evening, continues all night, more especially toward morning and while the patient is asleep; during the time he is awake, even at night, he seldom sweats much. The thrush generally shows itself toward the close of the disease, attacking the tongue, the tonsils, and the soft palate, _and is a sure harbinger of approaching death_. Emaciation rapidly sets in. If we consider the immense engines of destruction at work—viz., the colliquative (melting) sweats, the violent bowel complaints, the vital parts that are affected, the harassing cough, the profuse expectoration, the hectic fever, the distressing exertion of struggling to breathe,—we cannot be surprised that “consumption had hung out her red flag of no surrender,” and that death soon closes the scene. In girls, provided they have been previously regular, menstruation gradually declines, and then entirely disappears. 362. _What are the causes of Consumption?_