If the pyrexia ride to a high level and the child seem distressed by the intensity of the fever, the temperature may be reduced by sponging the surface of the body with tepid water ; or if absolutely necessary, the child may be placed in a tepid bath of the temperature of 70°. If, however, the bath be used, great care must be taken not to depress the child, as failure of the heart's action is one of the dangers to be apprehended in cases of pneumonia. Both before immersion and after removal from the bath a stimulant should be given, and if the feet feel cold, a hot bottle should be put into the bottom of the cot. Quinine is strongly recommended by some authors as a valuable remedy at an early period of the illness. It is given partly as an anti-pyretic, for it is said quickly to reduce the temperature without weakening the heart ; partly for its supposed influence in checking the spread of the disease over the lung. To be of service as an anti-pyretic the drug must be given in full doses ; and it must be remembered that children bear the remedy well. For an infant of twelve months one grain should be administered three times a day. This quantity can be increased by one grain and a half for every year of the child's life. Aconite and other depressing anti-pyretic drugs are dangerous remedies to employ in cases of pneumonia on account of their weakening influence on the heart.
In cases where great dyspncea and threatened cardiac failure arise from over-distention of the right side of the heart, it becomes a serious question whether abstraction of a small quantity of blood is not called for. If the danger is imminent I should not hesitate to take one, two, or more ounces of blood from the arm. Life can often be saved by this means. Even while the blood is flowing the inspirations become slower and quieter and expand the chest more fully ; the pulse gains in fulness and force ; and the anxiety and feeling of oppression subside. I can look back upon several fatal cases which I now believe might have been saved had I had the courage to relieve the labouring heart by the judicious removal of blood. It is in such cases alone that bleeding is justifiable in this disease ;
and here the treatment is directed not against the inflammation, but against one of its consequences, viz., the overtaxing of the heart by the impedi ment to the pulmonary circulation.
It is not often that stimulants are required in cases of primary pneu monia in children, but if the disease is secondary they may have to be resorted to. Great rapidity of the pulse is an indication for stimulants which must not be disregarded ; and if a pulse of 140 is found to be inter mittent in force and rhythm, doses of egg-and-brandy should be given at regular intervals until improvement occurs.
Delirium at the beginning of the disease, if noisy, may be usually quieted by tepid sponging of the surface of the body. If necessary, a small close of Dover's powder can be given at night. Chloral, on account of its depressing effect, must not be used. If delirium occur later in the illness it is a sign of debility, and energetic stimulation will be required. SleepleSsness can also be usually removed by tepid sponging in the evening.
If diarrhoea occur, it may often be promptly checked by a dose of castor oil or of rhubarb (gr. iij.—v.), with double the quantity of the aromatic chalk powder given every night. Astringents are rarely necessary in these cases ; but if the purging continue, sal volatile may be given with spirits of chloroform and a drop or two of laudanum, according to the age of the child, three or four times a clay. A layer of cotton wadding should be applied to the belly under a flannel binder for the sake of warmth ; and food should be given in small quantities at a time.
Directly the temperature falls tonics should be given ; and the diet of health may be returned to ; taking care that the food is digestible in kind,, and that it is given in quantities suitable to a convalescent.