TUBERCULOSIS. 5 ( J 



condition of the lungs is exactly comparable to " consumption " in the adult, and is 

 usiuilly tolerably rapid in its course. 



If the bowels are the parts mainly attacked, we have, in addition to the symptoms 

 attributable to the constitutional state, special symptoms referable to the intestines, 

 the liver, the mesenteric glands, and other organs of the abdomen, as the kidneys and 

 spleen. When tubercular disease attacks the lining coat of the bowels, it causes 

 extensive ulceration of them, and round the ulcerations the bowel gets inflamed. 

 As a result of this, the child complains of pain, usually little twis tings and gripings, 

 which elicit slight expressions of pain, and are then forgotten. The condition of the 

 bowels is variable, but usually diarrhoea is a marked symptom, and sometimes this 

 diarrhoea is so profuse as to rapidly exhaust the patient. These cases of tuberculosis 

 accompanied by diarrhoea are often mistaken for typhoid fever ; and, indeed, the two 

 diseases are often so alike that even the most practised eye is unable to distinguish 

 them. Alternating with the diarrhoea we get periods of constipation occasionally. 

 The motions are usually of a pale yellow colour, and offensive, and contain sometimes 

 a little blood. The abdomen of the child may be normal in appearance, and not the 

 least tender ; but if the ulceration should cause, as it occasionally does, general 

 inflammation of the cavity of the abdomen (peritonitis), the symptoms are very 

 different. The abdomen becomes tender to the touch, and is usually blown up with 

 wind. The peritonitis in these cases, however, runs a gradual and not a rapid course 

 as a rule. 



If the kidneys are attacked, which is by no means uncommon, we get a little 

 tenderness in one or both loins. The child complains of pain, and the urine is 

 occasionally, when passed, thick with the matter which has been discharged by the 

 damaged organs. 



When tJie disease attacks the head we are confronted with one of the most terrible 

 of the diseases to which children are liable, and which is known technically 

 as tubercular meningitis known also as acute hydrocephalus, but to be carefully 

 distinguished from chronic hydrocephalus, or water on the brain (which see). 

 Before describing the symptoms of this disease, we would remind the reader that 

 it often happens that the local disease in tuberculosis precedes the general con- 

 dition, and the symptoms of the one are frequently the cause of our distinguishing 

 the other. Thus the symptoms of tubercular meningitis may make their appearance 

 in a healthy child, as may also the symptoms of tuberculous disease of the lungs or 

 bowels. The child complains of its head. It stops suddenly, perhaps in its play, 

 cries out, " Oh, my head ! " and then resumes its game. Any child complaining of 

 its head should be carefully watched, and should have the advantage of medical 

 supervision for a time. The headache varies in severity from a trifling pain to agony. 

 The child avoids the light, and prefers the blinds down, and turns its head from a 

 glass. The face is alternately flushed and pale, and if the fontanel (the opening 

 between the bones on the crown of the head) be open, it will be found to be 

 prominent and not depressed. The appetite fails, the bowels are usually confined, 

 and the child is troubled by persistent vomiting. This is a very characteristic 

 symptom, and whenever a child vomits persistently, and without adequate cause 

 referable to the stomach, one must always be uneasy lest it be the premonitory 



