We do not consider it justifiable towards the attendants to make a diagnosis of pneumonia on theoretical grounds, so long as this cannot be made from the result of clinical examination. Acute miliary tubercu losis may produce similar syniptoms to bronehiolitis; and in cases of older children this possibility must be kept in mind. Bronchopneu monia differs from other pulmonary affections often more by its origin and by- its course than by its physical symptozns.
It is often difficult to differentiate the pseudolobar form from croupous pneumonia in so far as the early course is not definitely known, and only a few Mies limited to the consolidation are present. In favor of croupous pneumonia are the sudden onset ill the midst of perfect health, the high, continuous temperature, rapid development of dulness, and critical decline of temperature. Gradual development, bilateral occurrence, the seat of disease at the inferior posterior portion of the lower lobe, severe dyspneea, and cyanosis point to bronchopneumonia, as well as often the etiology (measles, etc.). Oceasionally, in influenza there is added to an extensive bronchitis a genuine croupous pneu monia. In this instance only the subsequent course of the disease will decide the nature of the pneumonia. At times, great and often for a long time insuperable. difficulty is presented in the differentiation from acute pulmonary tuberculosis, especially in the form of a caseous pneu monia which sometimes develops in the lower lobe in children. The physical finding is exactly the same as in bronchopneu monia. Developing during the course of measles, whooping cough, high grade rachitis, with pa tients less than three years old, indicate broncho pneumonia. In suspicious cases we are more likely to be dealing with a bronchopneumonia than with the more infrequent tuberculosis.
Slight pleuritic exudation (or adhesions) in the lower inferior portions nith accompanying catarrh may g,ive rise to confusion. The increased sensation of resistance, the diminished fremitus, point to pleurisy and speak against pneumonia. The differentiation of broncho pneumonia from hypostasis or extensive atelee tasis is very often found to be impossible and practically is of TIO great importance.
The prophylaxis coincides with that of simple bronchitis (page 344). It is important, but difficult to execute, to keep away from infants, all persons affected with colds and sore throats..
If it is possible to postpone infection of measles and whooping. cough until the third or fourth year, much is done towards the preven tion of brouchiolitis and bronchopneumonia. Catarrhs in young infants must be carefully treated. Every harmless coryza in a delicate
or rachitic infant may lead to a fatal bronchopneumonia. Small children who are bedridden must be guardedly carried about.
The treatment may affect the course of the disease to a great extent, and by rational methods may often act in a life-saving manner. As soon as a serious bronchitis occurs in a young infant, the best and sunniest. room in the house should be set apart, all superfluous furniture removed, and all unnecessary persons and visitors kept at a distance. Of the greatest advantage, especially (luting the cold season of the. year are two connecting rooms for alternate use, the vacant one being thoroughly aired and cleaned during the intervals. Provision should be made for frequent changes of air, and the temperature kept at 15°-16° (66° 68° F.). The air must be kept moist. This is best accomplished by me.ans of the croup kettle at the bedside, the vapor of which is directed towards the patient. The be.d must be free, and the head should not be buried in soft pillows. Small infants must be carefully carried about; and older children must frequently change their position. The infant should fre quently- be laid for one half hour on its abdomen for ft better a(iration of the posterior portions of the lungs.
The greatest care must be given to the nutrition. On account of tbe average long duration it is of importance to nourish the organism well from the start, and to avoid everything which might disturb the appetite and digestion. The diet in acute cases must be a fluid one, and should consist chiefly of milk, broths, gruels, etc. There is less likeli hood of diarrhcea and intestinal catarrh if the milk is diluted (with water, rice or barley water) from the start, in children from three to four years of age. For the purpose of supporting the nutrition small doses of enterorose, plasmon, nutrose, etc., are of advantage. Excellent results are obtained during the second year from the expressed juice of fresh beef. Drinks are to be offered freely, the best being boiled sugar water (with a tendency to diarrImea—milk-sugar). Ems Water readily causes diarrhcea. Teas are usually well borne if the tea is freshly pre pared and not allowed to stand on the stove for hours. Disturbances of digestion must immediately be combated by changes in the diet and ultimately the withdrawal of causiative drugs. Good digestion is of greater importance than expectorants. Care of the mouth and skin must be closely supervised; and the ears, on account of the frequent and unobtrusive occurrence of otitis media, should be examined frotu time to time.