Prognosis.—The gravity of the case in the two forms of pulmonary phthisis is very different. In an early stage of catarrhal phthisis we may reasonably hope, by putting the patient into the best sanitary conditions, to effect removal of the caseous consolidation. Absorption of a chronic solidification left after an attack of catarrhal pneumonia may be effected in the young subject after the lapse of many mouths ; and I have often seen cases in which signs of pneumonic phthisis occurring at the apex, from slow extension of a catarrh to the alveoli, have disappeared when the child has been sent to winter in a suitable climate. Indeed, if we can protect the patient from fresh chills, and secure for him an adequate supply of perfectly pure air—such conditions with good and sufficient food will do much to help him on his way to recovery. It is difficult to say at what period of time it becomes hopeless to expect absorption of a cheesy deposit. I believe that so long as no active change has taken place at the affected spot this fortunate termination to the case is still possible if the patient be a child.
When a secondary catarrhal pneumonia occurs in a case of pneumonic phthisis the child will not necessarily die ; indeed, the acute attack usually runs a sub-acute course and is eventually recovered from. Still, the future prospects of the child are sensibly darkened by the addition usually made to the amount of previously existing disease by the passage of the com plication.
Cases of chronic tubercular phthisis always go on from bad to worse ; for although by a suitable climate and the careful avoidance of chills, at tacks of catarrhal pneumonia may be prevented, the normal course of the tubercular disease is little affected by the treatment.
In all cases, signs of very unfavourable import are :—Great rapidity of breathing, and signs of lividity ; a high evening temperature ; a red glazed tongue, with or without great disturbance of the stomach ; diarrhoea: The scrofulous constitution or a strong hereditary predisposition to phthisis is an element in the case of the utmost gravity. As far as is at present known, the quantity of the bacilli discovered in the sputa furnishes little informa tion of importance in prognosis ; for these organisms are not found to be necessarily most numerous in cases where the diseased processes are most active.
born into families in which there is a consump tive tendency require special care in their bringing up ; and every avail able means should be adopted to counteract their unfortunate predisposi tion. Infants should, if possible, be suckled by a healthy wet-nurse, and every precaution should be taken to ensure the purity of the air they breathe. As they grow, they should be accustomed to warm clothing,
perfect cleanliness, and regularity of meals. Their food should be plain and well selected, avoiding excess of sweets and farinaceous matters, which are so apt to excite and maintain an acid condition of the alimentary canal. Their residence should be, if possible, on a dry soil and in a bracing air. If this be not practicable, they should at any rate be sent away to a more suitable habitation during the spring and fall of the year—times when the changeable season is so prejudicial to delicate children. They should be trained regularly to strengthen their muscles by out-door games ; and if the lungs are small, and the chest consequently narrow, every means should be resorted to to invigorate the pectoral muscles and expand the cavity of the chest. All forms of catarrh should be attended to with peculiar care, and the parents shoilld be warned that neglect of such de rangements may entail the most serious consequences. By such means a child naturally delicate may, as he grows up, appear to cast off many of the external signs of his constitutional tendency ; and although, no doubt, still exceptionally sensitive to unhealthy influences, may preserve his vigour under conditions which would quickly prove injurious to another less care fully nurtured. A cold douche in the morning on rising from bed is of great service in these cases ; and if the shock is too great under ordinary conditions, the bath will be readily borne when given with the precautions recommended in a previous chapter (see page 17).
If a child with such a tendency be attacked by measles or whooping cough, the parents should be warned, as the disease subsides, of the dan ger of neglecting the catarrhal complications which are so liable to occur in the later stages of these specific maladies. In every case where it is possible the patient should be sent for his convalescence to a good sea-side air. If catarrhal pneunionia have occurred, the clearing up of the consoli dation must be carefully watched. Good ventilation and careful dieting are more than ever necessary ; and if absorption appear to flag, measures should be taken at once to alter the conditions under which the patient is living, and a change of air should be insisted upon. Alkalies and alkaline sprays are very useful in these cases, and the citrate of iron and quinine may be given with the citrate of potash with great advantage.