In infants and the youngest children expectoration is sometimes absent, but a gangrenous odour from the breath is seldom wanting. Fetor of the breath in such cases is the more characteristic, as fibroid induration of the lung is very rare below the age of six years, and gangrene of the mouth is not often met with during the first two years of life.
Prognosis.—Recovery is so exceptional a termination of the disease that in any particular case the patient's chance of escape is very small. Varia tions in the severity of the symptoms are a common feature of the illness, and we must not allow our hopes to rise too high merely because we find the child and more composed, and notice that the fetid odour from the breath is no longer to be perceived. Such a favourable too often only a temporary improvement, to be followed, perhaps in a few hours, by a return of all the worst symptoms. If, however, the char acteristic odour is not reproduced, and we find that the pulse becomes fuller and stronger, and the cough less distressing ; that the tongue begins to clean and the appetite to return, we may venture to hope that the favour able change may be maintained. Accordino. to Kohts, when the gangrene results from the presence of a foreign body in the lung the prospect is less desperate than in other cases, but this can only be if the irritating substance is expelled.
Treatment.—In the treatment of this distressing disease we must do our best to support the strength of the child and make energetic employ ment of disinfecting and stimulating inhalationT The chamber should, if possible, be large, and must be kept thoroughly ventilated. It should be continually disinfected by spraying with carbolic acid or Condy's fluid, and pans of either disinfectant should stand about the room.
The child should be made frequently to inhale vapours or sprays im pregnated with oil of turpentine (11l xx.-xxx.) to the pint of boiling water, or with creasote or carbolic acid (al, xx.-xxx. to the pint). Glycerine of
carbolic acid may be also given internally, in one or two drop doses, accord ing to the age of the child ; and Traube recommends the salicylate of soda or the acetate of lead. The sulpho-carbolates are said to be of service in removing fetor, if given freely. The sulpho-carbolate of soda may be given to a child of four years old in doses of four grains every six hours. Buc quoy recommends the tincture of eucalyptus for the same purpose, and states that the remedy not only reduces the offensive odour of the breath and sputum, but relieves the violence of the cough. A child of four years old may take five or six drops three times a day.
Quinine and the mineral acids are preferred by some ; and it is impor-, tant that the former, if employed, should be given in full doses. For each dose the quantity may be calculated at one grain and a half for each year of the child's age ; and this may be given three or four times in the twenty four hours. Ammonia and bark have also their advocates. The bowels must be kept regular. If they are confined a dose of castor-oil will usually relieve the constipation.
Alcoholic stimulants are always required. For an infant white wine whey, for an older child the brandy-and-egg mixture should be given at frequent intervals.
With regard to diet : an infant should be restricted to milk diluted with barley-water and guarded with a few drops of the sa,ccharated solution of lime (twenty drops to the teacupful). An older child can take milk, strong beef-tea, pounded meat, eggs, etc., in quantities regulated according to his age and powers of digestion. In this, as in all other cases where the de bility is great, we must remember that the digestion shares in the general weakness ; and must be careful not to overload the stomach or fill the blood with unassimilable nutriment in our anxiety to sustain the strength and obviate death from asthenia.