TUBERCULOSIS. 57 



many children also who are not otherwise out of health, suffer from great enlargement 

 of the tonsils the two almond-like lumps which are seen at the back of the mouth. 

 Children who have large tonsils usually snore; and if a child snores, its mouth should 

 nl ways be examined. The tonsils may swell up to five or six times their natural size, 

 and may, in fact, become so large as to seriously interfere with respiration. The 

 tonsils may become acutely enlarged in many conditions, as, for example, inflam- 

 mation of the tonsils themselves (or quinsy), scarlet fever, and diphtheria. Having 

 been enlarged from any of these causes, they are slow to return to their natural size. 

 The treatment of enlarged tonsils must be both constitutional and local, and in 

 many cases the constitutional treatment alone (consisting of the administration of 

 good wholesome food, tonic medicines, cod liver oil, and syrup of the iodide of iron) 

 will be found sufficient to effect a cure. If, however, they remain obstinately 

 enlarged, and seriously interfere with the child's comfort, they had better be removed, 

 a question which will have to be decided by a surgeon. 



Tuberculosis. The tendency to this constitutional disease must be looked upon as 

 the weakness, par excellence, of the whole of the inhabitants of Northern Europe. It 

 is the form of constitution in which we find phthisis, or consumption of the lungs, 

 occurring ; in which children are liable to be attacked with inflammation of the 

 membranes of their brains ; and in which, if the disease fly to the glands of the 

 abdomen, we get marasmus or wasting from mesenteric disease. It is distinctly 

 hereditary, and we find the disease " cropping up " in its various forms in the 

 different generations of a family, and among the different members of the same 

 generation. Thus, when we hear of two or three members of a family dying of 

 consumption, we shall very often, on inquiry, learn that others have died in infancy 

 of diarrhoea (which may have been due to tubercles in the intestine), or marasmus, or 

 atrophy (tubercle of mesenteric glands), or symptoms referable to the brain (tubercle 

 of the membranes of the brain). There is no fact more clearly established than that 

 tuberculosis is hereditary ; a fact which has been proved with regard to the lower 

 animals as well as man. Those, therefore, who, having shown symptoms of this 

 disease, persist in marrying, do so at the risk of having children who may inherit 

 from them disease instead of health. 



"With regard to the causes which seem to help in the production of tuberculosis, 

 certainly in those who are, and probably also in those who are not, predisposed to it 

 by inheritance, we may mention, first, overcrowding, for certainly this disease is most 

 common among those who work in crowded, ill-ventilated workshops, and who sleep 

 in overcrowded apartments as is too often the case among the poor. Secondly, we 

 may mention that a damp, ill-drained soil seems to predispose to tuberculosis, or at 

 least to that form of it which attacks the lungs ; for Dr. George Buchanan, one of the 

 medical inspectors of the Local Government Board, has clearly shown that since the 

 effectual draining of certain towns, the number of deaths from phthisis in them has 

 materially decreased. Thirdly, we may mention as a probable source of tuberculosis 

 any irritation which may persist in the body of an individual. Thus, if bronchitis, or 

 what only seems to be a common cold, be allowed to go on unchecked, the glands of 

 the chest become irritated and inflamed, and when this is the case, the risk of general 



