In young children, in whom the disease may begin with violent convul sions, or with a drowsiness approaching to stupor, the diagnosis is very difficult, especially as there is often no cough. Usually until signs of con solidation are discovered at some part of the chest the nature of the illness must remain doubtful. Still, drowsiness and a temperature of 103° or 104°, without signs of severe headache, but with rapid, regular, breathing, a perverted pulk-respiration ratio, and pungent heat of skin should suggest the presence of pneumonia.
In the latent form, which usually occurs in wasted children, rapid breath ing and active nares ought always to lead us to make careful and repeated examination of the chest.
The distinguishing marks of catarrhal pneumonia and collapse of the lung are considered in the chapters treating of those subjects.
Pro gnosis.—Primary croupous pneumonia, unless very extensive, almost always •terminates favourably, and even in infants is seldom dangerous. Resolution takes place early, as a rule, and the consolidation clears com pletely away, leaving the lung as sound as before. The situation of the local lesion has no influence upon the prognosis, and no special danger is connected with inflammation of the apex of the lung. The nervous symp toms, however serious they may appear, need cause no alarm, for they sub side altogether when consolidation becomes established. Delirium in itself, without (Abrr signs of nervous disturbance, is rarely an unfavourable symp tom in a feverish child. It usually disappears after a few days, but may return again towards the end of the disease as a result of weakness ; but this recurrence, if the indication which it furnishes is attended to, is rarely followed by dangerous consequences.
The secondary forms of pneumonia are more serious than the primary, for the tendency to failure of the heart's action is increased by weakness induced by previous disease. So, also, the existence of a depressing corn plication adds to the danger of the case. Pneumonia occurring in the course of Bright's disease is an especially serious form of the complaint.
A very rapid pulse (over 140) is an unfavourable sign, especially if the pulsations are irregular in force and rhythm. So, also, a rise of temperature above 105° should be regarded with anxiety, although in early life this phenomenon is less serious than a similar elevation would be in the case of an adult.
Treatment.—In an ordinary case of primary croupous pneumonia little is required beyond keeping the child quiet in bed in a well ventilated room, wrapping the affected side of the chest in cotton wool or linseed meal poultices frequently renewed, and administering a simple effervescing saline or other febrifuge draught several times in the clay. The pain in the side is usually greatly relieved by the use of hot poultices and other applications. To be efficient, however, these should be used as hot as the skin can bear them ; and dry heat, such as a bag filled with heated bran or salt, is perhaps better—it is certainly more manageable—than hot flannels. If any severe pain is complained of, a proportion of mustard (one-fifth or one-sixth) may be added to the poultice, and this may be allowed to remain for six or eight hours in contact with the skin. If the cough is distressing a few drops of ipecacuanha wine and of compound tincture of camphor may be included in the mixture ; and a few drops of antimonial wine may be added with advantage on account of its diaphoretic action upon the skin. The old plan of attempting to reduce the inflammation by large closes of antimony is one to be very strongly deprecated. If the bowels are confined, or the complexion has a sallow cast and there is tenderness over the liver, an aperient powder should be prescribed, such as a grain of calomel with two or three grains of jalapine ; but the aperient seldom re quires repetition. Violent purgation in this disease is decidedly injurious.
The diet should consist of meat broths and milk until the consolidation is complete. When the establishment of blowing breathing and the dis appearance of crepitation show that the process of repair is about to begin the diet can be improved. Strong beef-tea should then be given at proper intervals, and a yolk of egg may be added to the diet. The thirst may be relieved as often as the child requires drink, but he must not be allowed to take a large quantity of fluid at one time. In the case of an infant at the breast, or one who is brought up by hand, some thin barley water should be given from time to time to relieve thirst, so that the quantity of food the child takes may be restricted.