Recent investigations, conducted both in. the
post mortem room and by means of the various Tuberculin
.tests on.the living make it apparent.that Tuberculosis
in Children, is a much commoner form of disease, and
occurs at an earlier age,.than was formerly. imagined.
In conclusion we would urge the vital necessity
for early diagnosis in this.insidious disease, and the
need of utilising every possible means of establishing
the same. When the signs are definite, the symptoms
well marked, it is often too late for hope of any permanent cure, . the case is now no longer early, but advanced. It is in the early stages that we must look to
combat the disease with any degree of success.
Tuberculin as a means of diagnosis may be of use, but
it is a. two edged sword, and the danger of lighting
up quiescent fool is too real to be lightly disregarded.
In.the words of Sir Clifford Allbutt:
there is too much at stake; and even for, the expert
the number of 'normals' (or persons practically normal)
who react is embarrassing In the stage preceding
the presence of physical signs, we must look for
slight irregularity of temperature - a sub- normal temperature
in the morning is suspicious, 98.5 at that
hour is too high and even more suspicious (Clifford
Allbutt and most characteristic, one with a swing
from 97°-99° at night. A feeling of.tiredness,
general malnutrition, poor chest development and expansion,
with deficient air entry, all these go,towards establishing an affirmative diagnosis. A positive von
Pirquet's reaction - with certain reservations -'and,
on X raying, a restricted movement of the diaphragm on
one or other side, or shadows round. the roots of the
lungs are confirmatory; while a family history of
phthisis or exposure to infection must give additional
weight to the evidence. The opsofic Index in
skilled hands may afford valuable information.
The earliest physical sign of value is the continued presence of crepitations, brought out often only
by coughing. When expectoration is present the presence
of Tubercle bacilli makes the diagnosis certain.
With regard to treatment, we shall increase
the patient's resistance by an open air life, by a diet
With a due proportion of proteid and fat, the latter
added to by cod liver oil, and by.the exhibition of
creosote. We shall regulate his auto-innoculation by
rest, coupled with graduated exercises and labour, and
in suitable cases by the use of Tuberculin. The
exercises should aid in improving the general musculature,.the chest expansion and development and.the air
Preventitive treatment consists in removing
the child from debilitating: conditions, and surroundings, in his avoidance of chills and colds, and in
attending to his teeth, throat, bowels and other organs
and functions, so that a high standard of health may
be reached and maintained.