Tuberculous disease of the cecal region and the vermiform ap pendix gives rise to the clinical signs of chronic appendicitis. It may lead to abscess formation and the production of a fistula; often it runs its course quite latent and suddenly exhibits the symptoms of intestinal perforation and its sequele.
In general there are so few definite symptoms: that, without the positive finding of the bacilli in the stools, no certain diagnosis is possible.
The prognosis is in general unfavorable, and the more so the younger the child. The appearance of intercurrent intestinal symptoms of a nonspecific nature hastens the end which occurs usually under the picture of chronic cachekia with slight variations in the tempera ture, more seldom accompanied by symptoms of intestinal perforation.
Prophylaxis is the mo.st prominent and by till odds the most suc cessful form of treatment. The separation of the child from its tuber culous surroundings is necessary if one would be successful, however cruel it may seem at first. The destruction of bovine tubercle bacilli by proper heating of suspected milk is a precaution which should be employed. The inoculation of cattle with tuberculin, for the purpose of disclosing latent tuberculous deposits, careful veterinary inspection, proper hygiene of the stable, control of the personnel of the dairy; in short, all the precautions recently suggested in the fight against bovine tuberculosis must be observed, since a speeific therapy, such as Behring has in view, does not now exist, and immunizing procedures are not yet avallable.
The symptoms developing in the disease can lie considerably benefited by symptomatic therapy: thus we use dietetic measures, medi cines (tannigen, tannalbin, bismuth, opium, etc., enemata of alum water, etc.) ill the treatment of diarrhosa, although in the majority of cases little is accomplished. The feeding of yaw meat, recently recom mended by the French authors, can be tried in thc severest eases.
Where a local disease of the ileocecal region or the appendix is present an operation should be performed, and such eases offer the best outlook.
Experiences with Koch's Lymph have proved unsatisfactory, especially in intestinal tuberculosis, so that its use in this form of the disease has been entirely discontinued. Lately, Canghofner has obtained favorable results in some eases of tuberculous peritonitis with ascites, by using minimal slowly increasing doses of old tuberculin according to the method of Goetsch. The method is worth trying.
It is to be hoped that Behring will soon keep Ills promise, given at the Faris Tuberculos:s Congress, and place in our hands a specific remedy.