60 DISEASES OP CHILDREN. 



symptom of tubercular meningitis. The surface of the abdomen is flat and pinched 

 in. The pulse is rapid at first, but when the child gets drowsy and dull it usually 

 becomes slow. After the child has been ill a week or ten days, and sometimes earlier, 

 the head symptoms are more marked. There may be attacks of convulsions, and 

 occasionally the child has a habit of sighing deeply. Then wandering comes on, and 

 drowsiness makes its appearance, and gradually deepens into coma. The child may 

 squint, or one eyelid may droop, or one or both pupils may become enormously 

 dilated. Sometimes there is paralysis of one side of the body. Death occurs in 

 these cases either from the general weakness, or in a fit of convulsions, or by a 

 deepening of the insensibility. 



The duration of this disease varies a good deal, and this seems to depend on 

 whether or not it appears at the beginning or the close of a general attack of 

 tuberculosis. It rarely lasts more than six weeks or a couple of months, and 

 is sometimes fatal within a week of the first appearance of the symptoms. 



We have purposely included in our description of the general disease known as 

 tuberculosis a detailed enumeration of the symptoms of the chief local manifestations, 

 because we thought that by so doing we should be able to give a better general idea 

 of what is meant by a "constitutional tendency," and of the consequences which may 

 result therefrom. This method of treating the subject, too, has this advantage, that 

 the remarks which we purpose making on treatment will appear more coherent and 

 more rational than would otherwise be the case. 



In discussing the treatment of tuberculosis, then, it will be necessary to bear in 

 mind its causes and its consequences, and it will be found that the former may not 

 unfrequently be prevented, and the latter averted. First and foremost, then, we 

 would impress upon our readers that tubercular people before marriage should 

 be made well aware of the possible consequences of the step. They should take the 

 best advice before doing so, and, although the blindness of love is a fact which 

 nobody can doubt, they should be advised not to select as their partners for life those 

 who are prone to the same constitutional conditions as themselves. If a child have 

 the tubercular appearance, and come of a tubercular stock, we may still do much to 

 ward off that which threatens it, and if the remarks we have made about 

 over-crowding and damp soils be borne in mind, and if the circumstances of the 

 parents are such as to allow of a choice in such matters, they will be particularly 

 careful not to allow it to run the risk of sleeping in a close bedroom, of working in 

 an over-crowded schoolroom, or of living in a damp cold situation. 



These children require more than ordinary care during and after their children's 

 diseases, for these periods, which are trying to all children, are often fatal to the 

 tubercular. As long as a child who inherits tuberculosis be kept in perfect health, 

 it may escape its inheritance, but if, through want of proper supervision, its health 

 fails, it is at once laid open to the attacks of its acknowledged enemy, and if any 

 organ become diseased it may prove the centre and starting-point of the constitutional 

 disorder. Any irritation or undue excitement of any part may determine the 

 tuberculous change in that part. Many a child has had its tubercular meningitis 

 started by the carelessness of its nurse, who has neglected to properly protect 

 the child from the heat of the sun. Or, again, we believe that the eternal worrying 



