Prognosis.—The prospects of a child in whom acute tuberculosis has revealed itself unmistakably are very desperate. In the earlier stage of the disease, while any uncertainty exists as to the nature of the illness, we can still hope ; but when a secondary bronchitis or catarrhal pneumonia arises, or signs of intracranial mischief are noticed, death may be considered cer tain. Attacks of gastric catarrh in children with tuberculous and scrofu lous tendencies are almost invariably accompanied by fever. If the attack is protracted or rapidly recurs, an intermittent pyrexia may continue for some weeks, and on recovery the child may be thought to have passed through an attack of tuberculosis. Probably most instances of alleged recovery from acute tuberculosis are cases of this kind.
Treatment.—When a case of acute tuberculosis has occurred amongst the younger members of a family very special measures should be taken to preserve the health of those who remain. They should sleep in well ventilated rooms, be warmly clothed, and be taken out of doors regularly for exercise. Such children should, if possible, live much in the country on a sandy or gravelly soil, and should avoid the vitiated air of towns. Their diet should be plain, and excess of sweets and fermentable matter should be forbidden. Children with tubercular tendencies should not be taught too early. It is wise to postpone regular education until they reach their sixth or seventh year ; and every care should be taken that their sensitive brains are not overtasked. The mother, if herself of frail constitution, should be forbidden to suckle her infant, and a healthy wet-nurse should be provided. Any signs of indigestion in such sub jects should be promptly treated, and the utmost vigilance should be exercised to maintain the nutritive processes of the body at a healthy standard.
All catarrhs, however mild they may be, should at once receive atten tion, and the parents should be warned of the danger of treating the child as if he were well before all signs of his temporary ailment have disap peared. Acute diseases, especially the exanthemata, have peculiar dangers for these children ; and during the period of convalescence the patients should be put into the most favourable conditions for insuring complete recovery. A good sea air should be always advised in these cases as soon as the child is well enough to be moved from his home.
When the disease declares itself no drugs appear to have any value in arresting its course, and very little in retarding the fatal issue. Some
thing may be done by treating symptoms and putting a stop to enfeebling complications. Thus the looseness of the bowels, which is often an early symptom of the disease, may be usually controlled by a powder containing three or four grains of rhubarb with double the quantity of aromatic chalk powder every night ; and twice a day a draught containing dilute sulphuric acid (Th, iij.–v.), with tinct. opii j.–ij.), and a few drops of glycerine in a teaspoonful of water. Sometimes the carbonate of bismuth in full doses (gr. x.–xx.) may be substituted with advantage for the rhubarb in the powder. If in spite of these remedies the looseness still continues, gallic acid (gr. can be given with laudanum.
It is very difficult to reduce the pyrexia in acute tuberculosis. Large doses of quinine have no more than a temporary effect, and often appear to be quite useless ; salicylic acid and its compounds have little beneficial influence ; and the hypophosphites have not in my hands been followed by satisfactory results. The hypophosphite of lime, however, although it does not reduce the heat, is useful in alleviating the various forms of catarrh so common in tuberculous children, and often has a sensible influence in improving the appetite, and sometimes, temporarily, the strength.
Inflammatory chest affections must be treated upon ordinary principles. As the strength of the child declines, stimulants will be required, and the brandy-and-egg mixture must be resorted to. The diet should be such as is recommended for other febrile diseases.
Sr mils in the infant is generally the consequence of an inherited taint. It then presents a combination of the so-called secondary and tertiary stages of the disease. Sometimes, however, it is acquired, and there is then a primary lesion as in the adult. In this latter case the symptoms resemble more those of constitutional syphilis acquired after puberty. Still, the progress of the disease is not entirely uninfluenced by the tender age of the patient, for in after-childhood we can often discover many symptoms which are common to the inherited form of the malady.
congenital taint may be derived from either the father or the mother ; and the severity of the transmitted disease is in direct proportion to the shortness of the time which has elapsed since the appearance of constitutional symptoms in the parent.