tubes to be a source of continued irritation. In such cases we shall best relieve the engorged state of the lung by the administration of remedies tending to produce a copious secretion from the congested mucous membrane, as in the following mixture* : B. Liquor ammoniæ acetatis, Ziv; Potas. bicarbonatis, 3jss; Sp. ætheris nitrici, 3jss ; Aquæ carui ad 3vj. M. 3ss tertiâ horâ. At the same time the chest should be kept covered with hot linseed-meal poultices, frequently renewed; and the child should be confined to his nursery or bed-room. After the cough has become looser, and the oppression of the chest has subsided, expectorants should be given with an alkali : B. Sp. ammoniæ aromat., Sp. ætheris nitrici, Vini ipecacuanhæ, āã 3j; Pot. bicarbonatis, 3j; Infusi calumbæ ad 3vj. M. 3ss sextâ horá; and afterwards, when the secretion is free, easily brought up, and the fever has disappeared, an astringent may be prescribed, with expectorants and a little opium : B. Liq. ferri pernitratis, Acidi nitrici diluti, āā 3j; Inf. calumbæ ad 3vj. M. 3ss ter die. On account of the derangement of the stomach, which is so apt to be produced by even small doses of the nauseating * For a child of six or seven years old. COUNTER-IRRITATION. 229 expectorants, such as ipecacuanha and squill, it is advisable to combine them with tonics when the state of the patient permits. In this way they are better borne by the stomach, and cause less impairment of the appetite. The alkaline mixtures should not be continued too long when the secretion is quite free, as shown by the looseness of the cough, the ease of expectoration, and the absence of fever, astringents are required to dry up the secretion, and give tone to the relaxed mucous membrane. In cases where we have reason to believe the consolidation to be owing to unabsorbed pneumonic deposits, alkalies are also extremely useful. Dr. Andrew Clark recommends a mixture containing bark, iodide of potassium, bicarbonate of potash, and ammonia, until the urine is alkaline. If there is much anæmia, he substitutes infusion of calumba for the bark, and adds a few grains of citrate of iron to each dose. The inhalation of sprays of weak solutions of bicarbonate, nitrate, or chlorate of potash, seem to have a very useful effect in promoting expectoration. A solution of bicarbonate of potash, ten grains to the ounce, may be inhaled in this way twice a day. At a later stage an astringent spray may be used, as three grains of tannin to the ounce of water. Counter-irritation in children must be used cautiously, and is seldom necessary. So long as there is fever, with dry cough, &c., hot linseed-meal poultices are the best applications and these, combined with the measures described above, soon relieve the more acute symptoms. Irritants applied to the chest appear to be most useful in cases where the consolidation is pneumonic in character. In such cases a liniment of croton oil (3j in 3j of linimentum saponis) may be rubbed into a limited spot twice a day till pustulation, and then once a day for a week. Dr. Buchanan states that he has used this method of counter-irritation to * See Lancet, Oct. 20, 1866, p. 439. children under two years of age. So long, however, as there is much heat of skin, counter-irritants should not be employed. Lecture I., On Diagnosis and Management of Lung Diseases in Children. Lancet, Feb. 1, 1868. CHAPTER IX. TUBERCULISATION OF GLANDS. TUBERCULISATION OF LYMPHATIC GLANDS.-Of glands in general. OF BRONCHIAL GLANDS OR BRONCHIAL PHTHISIS.-Symptoms-Produced by pressure on neighbouring organs-Pressure on Veins-On NervesPhysical signs-Alterations in respiratory sounds produced by pressure on trachea and bronchi-Modes of termination-Diagnosis. TUBERCULISATION OF MESENTERIC GLANDS OR MESENTERIC PHTHISIS (Tabes Mesenterica).-Symptoms-General-Local-Pressure on Veins-Ascites usually the result of peritonitis-Perforation of bowel-Diagnosis-Only to be made by feeling the glands-Diagnosis from fæcal accumulations-From tubercle of omentum. Anatomical Characters of Enlarged Tubercular Glands. Treatment. THE lymphatic glands often become the seat of tubercle, not only those which are external, but also those occupying the thoracic and abdominal cavities. In children, the lymphatic glands are exceedingly liable to become enlarged from neighbouring irritation or inflammation, some irritating matters being conveyed into them by the lymphatics coming from the inflamed part. This is well seen in the case of impetigo of the head or face, when the glands of the neck, or those under the chin-according to the seat of the eruption-become actively congested, serum is poured out, lymph is exuded, and the size of the glands is increased. In tuberculous children, active congestion of the glands tends to the formation of tubercle within them. If, then, after the cure of the primary disease the enlarged glands remain large, and this increase in size persists for a long time, without any tendency to diminish, they are probably tubercular.* Such glands are oval or round, hard, uneven on their surface, and their outline is irregular. They are not tender, and the skin over them is colourless, and is not adherent. Occasionally they inflame without evident cause: the skin then becomes red; attaches itself to the gland beneath it; an abscess forms, bursts, and the tuberculous matter is expelled; after which the wound heals, or a small opening is left through which a discharge occurs from time to time. This spontaneous inflammation and suppuration of a chronically enlarged gland, should always lead us to suspect tubercle. Sometimes several glands become enlarged and unite, forming a mass, the separate parts of which are connected by thickened and condensed cellular tissue. Glandular enlargement, then, is always an indication of pre-existing inflammation of the part from which the lymphatic vessels which pass through the gland have taken their origin, and if this enlargement continues a long time, it is strong evidence of tubercle. The same cause produces tuberculisation of the bronchial and mesenteric glands; catarrhs or inflammatory affections of the lungs in the one case, and diarrhoea or intestinal irritation in the other, leading to the tuberculous condition. While, however, in the case of tuberculisation of the external glands, no other ill effects follow than those due to impairment of function in the glands themselves; yet in the case of the bronchial and mesenteric glands, other evils are induced. These bodies-enclosed as they are in cavities, and in contact with compressible organs-when enlarged, produce by their pressure secondary disturbances, which vary according to the organ whose function is thus interfered with, and according to the more or less yielding material of which the walls of the cavity are composed. Enlargement of the bronchial glands will thus produce * Jenner on Tuberculosis, Medical Times and Gazette, Oct. 26, 1861. |