DISEASES OF CHILDREN. 



tuberculosis being set up from these infecting centres seems to be very much 

 increased. Irritations of all kinds are apt to cause glandular enlargements, and a 

 glandular enlargement once set up (in the lungs, bowels, or elsewhere) in a person 

 predisposed to tuberculosis, the risk of that predisposition being confirmed is very 

 greatly increased. This mention of glandular enlargements must not lead the reader 

 to confound the tuberculous with the scrofulous constitution. The two conditions- 

 differ widely, as he will see if he turns to the article on scrofula. 



Tuberculosis is characterised by the presence of " tubercles " in the body, and to- 

 the uninitiated it is no easy matter to convey a notion as to what tubercles are. 

 They are little white particles, insignificant in size and appearance ; but wherever 

 they are inflammation is apt to occur, and it is this tendency to chronic inflam- 

 mation in tissues which are the seat of tubercles which constitutes the danger of the 

 condition. The most common positions for tubercles are (as we have said) the 

 intestines and their glands, the lungs, and the brain. 



Children who are prone to tuberculosis are generally pretty. They are slim, fair- 

 haired, with lithe active figures, delicately-formed limbs, slender chests and waists, 

 blue eyes and clear red and white complexions. They are the favourite little heroes 

 and heroines of the novelists, who appear like fairies to gladden the hearts of parents 

 and friends for a short season ; whom the gods love, and who die young. They are 

 intelligent, quick, and volatile, and are a source of pride to their mothers and nurses. 



The onset of tuberculosis may be sudden or gradual. When sudden, it very 

 slosely resembles an attack of fever. The child is probably convalescent after one of 

 the diseases of childhood measles, whooping cough, chicken pox, or scarlet fever 

 when its convalescence seems arrested. It becomes languid, irritable, peevish, dull, 

 and heavy. It neglects its playthings, and its appetite fails. Then it becomes, 

 feverish, has a dry skin, and complains of thirst. The cheeks are flushed, or 

 are alternately flushed and pale. The eyes are bright and glistening, the pulse 

 is quick, and the temperature (as measured by a thermometer) rises considerably. 

 The lips are dry, and the edges of the nostrils also are inflamed, and the child picks 

 them and makes them sore. The loss of flesh is rapid rapid in proportion to 

 the rise of temperature ; and, in fact, the state of fever and the increasing wasting 

 are often the main features of the condition. The child may die, worn out 

 by its persistent febrile condition, but this is rarely the case, and usually the disease 

 terminates by determining, as it were, to one or other of the organs which are prone 

 to be attacked. 



If the lungs are attacked, the child coughs, and sometimes coughs up a little blood, 

 which is always a serious symptom. Sometimes it coughs up a little matter from 

 the lungs, but this is not often the case, and it should be borne in mind that 

 children may have, and often do have, very serious disease of their lungs without 

 coughing up anything at all. We have known the lungs of children almost 

 completely ulcerated away, and yet the little patient has never raised any matter by 

 coughing during life. One may often hear the rattling and wheezing within 

 the chest, and sometimes the wheezing may be felt when the child is taken in 

 the arms, but the certain determination of the amount and character of the disease 

 in the lungs is only to be made by a practised ear, aided by a stethoscope. This 



