In cases of acute phthisis energetic measures must be adopted. We should at once take steps to reduce the pyrexia, which is considerable, and to maintain the strength of the patient. Dr. McCall Anderson recommends the application of cold, either by iced cloths, Leiter's temperature tors, or, if these means fail, by cold baths. He has found the application to the abdomen of cloths wrung out of ice-cold water and frequently re newed, very useful in lowering the temperature, and speaks highly of Nie meyer's combination of digitalis, quinine, and opium. I cannot myself say that I have seen much benefit result from this form of medication, but if thought desirable, half a grain each of the two former drugs may be given with an eighth or tenth of a grain of opium every four hours to a child of ten years old. Of other drugs, large doses of quinine seem to have only a temporary effect, and the salicylates in my hands have proved worse than useless as antipyretics. They seem to exert little influence upon the tem perature, while they irritate the stomach and cause nausea. Our chief re source for reducing the temperature in this as in other forms of febrile disease, consists in the application of cold.
In order to maintain the strength Dr. Anderson recommends hourly feeding, both day and night, with simple food, such as milk, broths, etc., and gives brandy or other stimulant as seems to be required. The profuse sweats must be controlled by the subcutaneous injection of atropine According to this author the most striking results may be sometimes ob tained, and a complete cure occasionally effected by the above means.
In the chronic forms of phthisis it is also of the utmost importance to improve the nutrition of the body. The absorption of recent deposits and the obsolescence of more chronic consolidations are best promoted by plenty of fresh air, the avoidance of chills, and a liberal supply of good food. In order, however, that the child may profit by an abundant dietary, it is essential that his digestive organs should be maintained in a high state of efficiency. The subjects of pulmonary phthisis resemble in one respect band-fed infants. Like them they are liable to repeated attacks of gastro intestinal catarrh, which gives rise to indigestion and flatulence. These attacks, by the influence they exercise upon general nutrition, may produce very serious consequences. If a child. with disordered stomach be fed con tinually with food which he has no means of digesting, not only is the gastric derangement protracted, but his system is kept in a state of fever which often culminates in a fresh attack of pneumonia. In any case, such a condition of the body is not calculated to encourage the healthy removal of morbid products. In all these attacks the diet should be at once al tered. The child should take for food little but milk alkalinised with lime drops and diluted with barley water, weak broth, and dry toast. For medi cine he may have an alkali with nux vomica to act as an antacid and stom achic. By this means the gastric derangement will be quickly overcome.
In all cases where the parents are in a position to afford the expense, a change of climate is of great service. A child who is the subject of an un absorbed pneumonic deposit, whether this succeed to an attack of broncho pneumonia, or have occurred more slowly from neglected catarrh, should change the.conditions under which he has been living. If he reside at the sea-side, he should be sent inland ; if inland, he should be sent to the sea side. A good sea voyage often brings about a complete cure in these cases. The body should be warmly clothed, the bed-room should be large, airy, and well ventilated, and the child should pass a large part of the day out of doors whenever the weather permits. Cod-liver oil is useful as a help to the treatment, but not as a substitute for it ; and iron and quinine with an alkali should be prescribed as already recommended.
When softening begins at the seat of mischief and evident constitutional symptoms are observed, the child should be carefully protected from chills, and at the same time be insured a plentiful supply of fresh air. Mild counter-irritants should be applied to the chest over the diseased spot, such as painting with tincture of iodine or rubbing in a weak croton-oil lin iment. The hypophosphite of lime (gr. iij.—v.) is of sensible value in these
cases, and will often, when debility and weariness are complained of, cause an immediate improvement in the strength. In other cases arsenic is of great service; and may be given with quinine in doses of three to five minims of the arsenical solution three times a clay. Lately iodoform has been recommended with the object of reducing secretion, moderating fever and cough, and arresting the progress of caseation. I have seen benefit result from half-grain doses of the remedy given three times a day with extract of gentian. If the pyrexia is high, it may be reduced by sponging the surface with tepid water ; and night-sweats are usually readily con trolled by one or two drops of the liq. atropiaa at bedtime given in a tea spoonful of water.
For some years, and especially since the discovery by Koch of the "tubercle bacillus," antiseptic inhalations have come greatly into favour. At night the air of the bed-room may be impregnated with the fumes of tar or creasote by Dr. J. R. Lee's " steam-draught inhaler " or some similar instrument. In the day-time, by means of a perforated metal respirator, such as that devised by Dr. Coghill, of Ventnor, various antiseptic sub stances may be inhaled for an hour at a time more or less frequently dur ing the day. At the Victoria Park Hospital we have been in the habit of using for this purpose a preparation composed of two drachms each of the etherial tincture of iodine and carbolic acid, one drachm of creasote, and one ounce of rectified spirit. Of this ten drops are poured upon a piece of cotton wool and used in the respirator several times in the day. In many cases it is well to use the antiseptic frequently ; and if the child will submit to the inconvenience he may be made to wear the respirator all day long. In such a case the antiseptic drops can be renewed every two or three hours. Very good results are often obtained by the help of this method of medication. The violence of the cough is often diminished after the respirator has been worn for a short time, and the sputum is more readily brought away from the lungs. Expectorant mixtures will often have to be given in addition. The disadvantage of all these drugs, however, is their unfortunate tendency to cause derangement of the stomach. When made use of it is advisable, if possible, to combine the expectorant with an alkali or a mineral acid. If the is hard and tight, a few drops of ipecacuanha wine should be given, with five or six grains of bicarbonate of soda, in a draught sweetened with glycerine. Afterwards, when secretion is more copious, four or five drops of sal volatile may be combined with a drop or two of liq. morphia, or five to fifteen drops of paregoric, in glycerine and water. These may be followed by an alka line and iron mixture, or a draught containing pernitrate of iron and dilute nitric acid. Cod-liver oil should always be given if it can be borne. When this does not agree, maltine often proves a good substitute, and is usually taken readily by a child.
In all cases the state of the digestive organs must be watched with the greatest vigilance, and any sign of acidity or flatulence must be a signal for a prompt reconsideration of the dietary. Pepsin is often useful given with dilute hydrochloric acid and strychnia, as recommended elsewhere (see page 641). If a difficulty is found in digesting starches, the liq. pepticus (Benger) given with an alkali about an hour after meals is of service. In such cases, also, the measures recommended for the treat ment of chronic diarrhoea may be adopted with advantage (see page 640).
If the cough excite vomiting, this symptom can be generally allayed by the administration of one drop of Fowler's solution of arsenic before a meal ; or half a drop of liq. strychnine often has an equally beneficial action. If hmoptysis occur, the child should be kept perfectly quiet in bed ; fluids should be given to him in small quantities at a time, and he may take fif teen to twenty drops of the liquid extract of ergot with mildly aperient doses of Epsom salts three times a day. If, however, the bowels are ulcerated, the saline laxative must be omitted. DiaiThcea dependent upon this in testinal lesion must be treated as recommended elsewhere (see page 666).