In cases of continuous high temperature -with absence of bronchitic signs one should think of central croupous pneumonia. Confusion with whooping-cough and tuberculosis of the bronchial glands is often to be considered. One must think of -whooping-cough especially, whenever there is present an obstinate dry cough without bronchitic signs, gradu ally increasing, assuming a spasmodic character, and also appearing at intervals during the night.
Presenting the same picture or associated with chronic bronchial catarrh, tuberculosis of the lungs at times develops, whereby, owing to the absence of sputum, the distinction is rendered more difficult. It is also of importance to (liagnose the cause of the bronchitis; for instance, whether it has arisen independently (colds, local infection, mouth breathing) or occurs as the result of rachifis, pertussis, grippe, etc. (in this instance often the only manifestation of the disease).
By periodical night-cough is understood attacks of coughing in older children, awakening them from their sleep, and in some cases occurring regularly and lasting for several hours. The finding in the lungs is en tirely negative. The disease is mostly of a nervous character and is cured by quinine or broinide. Frequently, however, an unrecognized nasopharyngeal catarrh lies at the basis.
The prognosis in older children is good. In infants with florid rachitis it is doubtful, especially when bronchitis occurs as an accom paniment of some febrile disease or pertussis.
Prophylaxis exercises an extraordinary influence. Nasopharyngeal affections are to be carefully treated, and rachitis and scrofulosis ener getically combated. Intercourse with those affected with colds and sore-throats is to be strictly avoided. Should the mother or nurse be thus afflicted, she must not kiss the child and must turn her head away while coughing. Beyond this, the general prophylaxis embraces the whole hygiene of the infant; but only the most important points per taining to the diseases of the respiratory system will be especially mentioned here.
Of primary importance is the unlimited supply of fresh air not only by plenty of outdoor exercise but in the house as well, the poor ventila tion of which produces the majority of the diseases of the respiratory system. The best and sunniest rooms w-here no heavy curtains shut off the light should be used for children, and provision made for frequent changes of air. During the period of heating, the temperature of the room for nurslings should he about 15° R. (66° F.); while for older children the living room should be 11°-12° R. (W-59° F.), and the sleeping apartment 12°-S° R. (59°-50° 17.). Children should be accus tomed to sleep with the window's open during the summer months, and for older children with sufficient covering for the upper portion of the body the windows inay be left partially open during the winter. The
best niethod of heating is with tile stoves, as they also ventilate well when the lid is allowed to remain open after the room is heated. Hot water heating is good, in so far as provision is made for the necessary moisture. During the winter, moreover, the air of the room usually becomes too dry (a chief cause of many catarrhs), and nuist be artifi cially moistened by placing a basin of water on the stove, or more effec tually by hanging up dampened cloths (60-70 per cent. of moisture is desirable). The air must have free access to the bed; curtained beds are detrimental. Large carpets are dust catchers and are not to be tol erated in children's rooms. The clothing must be adapted to the season of the year and to the weather and should not be too warm nor too light. During winter, woolen stockings, ancl for many children woolen waists, are of advantage. Drawers which LITC too thin are frequent defi ciencies of the customary dress during the first years. Warm petticoats in children who frequently sit on the floor, are no substitute for them. If, after going out during the uinter, covered portions of the body feel cold to the touch, the clothing has not been warm enough. The custom of having the limbs bare is responsible for frequent colds. For the care of the skin, in addition to sponging and baths, dry rubbing with the hand or cloth is very useful. In children over two years of age after a warm bath, and before drying, the skin should be qttickly sponged uith a wet and cold sponge. From three years on, for the purpose of hardening, frictions of the whole body with a wet cloth (temperature of the room), or later douches from spout of a sprinkling-can, are often useful. The procedure should take place in the morning immediately on arising, should last only one quarter of a minute, and should be followed by ener getic friction with a tlry cloth. Hydriatic hardening is not suitable for many of the yonnger and feeble children, especially if reaction of the skin remains absent. Hecker properly emphasizes the disadvantages of routine "hardening" which often brings about the opposite result. There is need of careful watching, and prudence and practice are required, a difficult art, naturally. Clothing which is not too warm, moderately heated roorns, and the custom of going out even when the weather is unfavorable, often increase the power of resistance much more than the so-called hardening.