Whenever the previous course is unknown and the consolidation rapidly increases, an acute tuberculous pneumonia may readily- pose as a croupous pneumonia. In these instances, the absence of sputum and the fact that tuberculosis in young infants frequently begins in a lower lobe renders the diagnosis more difficult. A rapid course, vith severe dyspncea and cyanosis without adequate physical signs in the lungs, often points to miliary tuberculosis. The previous condition of the lungs, course, and temperature, determine the diagnosis in these cases.
themorrhagie infarct is not frequent in children On mitral lesions). The symptoms are similar to a circumscribed, croupous pneumonia; but in embolism the fever is either absent or moderate. Owing to the absence of sputum the diagnosis is rendered difficult.
Chronic pneumonia and chronic pleurisy may sometimes be mistaken for croupous pneumonia, whenever, without a complete history, they come under treatment simultaneously vith a febrile affection. The sub sequent course of the disease will clear up the diagnosis; but, beforehand, the retraction of the affected side of the thorax should lead to the proper recognition of the existing all severe diseases of childhood the prognosis in croupous pneumonia is probably the most favorable. The mortality only amounts to a small percentage (3-5) and chiefly falls on the first, less on the second year of life. The prognosis is, therefore, very much better than in bronchopneumonia, and the treatment more satisfactory to the physician. Vigorous and previously healthy children very rarely succumb to croupous pneumonia. A delicate constitution, rachitis, and preceding acute infectious diseases (measles, typhoid fever, whooping cough), may prove dangerous. The most important complication, puru h•nt pleurisy, is usually cured by- early and proper treatment. Pericar ditis is a frequent cause of death. A very high temperature with severe dyspncea, crisis delayed beyond the 9th-llth day, and an unusually Protracted course of the Mscase, make the prognosis as to recovery gloomy. In individual cases, a general sepsis from pneumococcus infection causes death (Vierordt).
Prophylaxis is of less value than in bronchopneutnonia. Never theless, even in these cases, a general, rational,. hygiene and hardening are certainly of value, as are the protection of the organs of respiration front dust, and also the care of the mouth. Not infrequently, a mild catarrh precedes a pneumonia. Severe colds are to be avoided; for
instance, the rapid cooling of the perspiring body. It is wise to separate healthy individuals front one who is suffering from pneumonia, although positive evidence of direct contagion has never been submitted. Epi demics may also be explained on other grounds, and often occur in con nection with atypical, non-croupous pneunionias. I have at time.; observed two members of a family become ill with pneumonia simul taneously, but always as the result of grippe. The tendency of croupous pneumonia to always recur in certain dwellings (pneumonia houses) is unexplained. Perhaps it depends upon the demonstrated longevity of the pneumococcus in its dried state. Accordingly', disinfection as a pro phylatic measure -would be in place in these instances. In children, there is seldom an opportunity for disinfection of the sputum.
Treatment.—The majority of cases of croupous pneumonia in children previously healthy recover under any treatment, in so far that it is not directly- injmious. Copious blood-lettings, severe irritations of the skin, and powerful drugs, belong to the past. In robust children an expectant plan of treatment with mild hydrotherapy is amply suffi cient. Nevertheless, we must exercise the greatest care in our treatment of every case, for we do not know whether the greatest demands will not be made upon the system by the duration of the disease or by complications.
Provision must be made for proper bedding, airy room, and an equa ble temperature. Rendering the air moist is necessary only during the season of the year when the rooms are artificially heated, and never to such a degree as in cases of bronchopneumonia. Besides the care of the mouth and skin, attention must be paid to the diet. The diet should be free, but only fluid, and for infants (Muted. Older children may be allowed eggs, tapioca, farina, softened rusk, and fresh fruit juices from the beginning. VlIenever it is indicated, the nutrition may- be in creased by the expressed juice of meat. An abundant supply of water is of importance even in the form of sugar water and infusion of lime blossoms (if necessary by rectal irrigation), especially- in cases with ty phoid and cerebral sy-mptoms, for washing out the bacterial poisons. In older children the quantity' of urine voided daily is an important cri terion for the quantity of water to be given, and for the cardiac strength.