Part 7

In most children an extreme sensibility at being touched is observed. They may be handled with the greatest possible care and lifted most tenderly, a slight pressure on the head, body or hands in changing their position will be violently resisted with obvious expressions of pain. In the latter stages this extreme sensibility gives way to insensibility.

Then the children may be pinched and poked, they may be turned and moved from one side to the other without any consideration, they will not resist and only give expression to the remaining sensibility by a low whimper. The lack of sensibility may be especially marked in the eyes; these can be touched with the fingers, without causing a closing of the lids.

The sense of hearing seems to continue its functions until very late. Children show that they hear as long as they are not completely unconscious; even when addressed in a low tone of voice they react somewhat. The sense of smell and taste also are lost toward the very end of the disease.

Paralytic affections appear during the final stages. It has been observed in some cases that the arm and limb are paralyzed on one side only. Often one upper eyelid is paralyzed and hangs down on one side of the face and the muscles of the tongue may be affected.

Generally the patient dies after violent general convulsions that last for hours. Exceptionally only the paralytic symptoms increase gradually and cause death without any agony or struggle, simply a discontinuance of the functions constituting life.

The duration of the disease varies from 2-4 weeks from the beginning of the characteristic symptoms. Generally the day when the children take to the bed is fixed as the beginning of the disease.

The former methods of treatment have been a signal and absolute failure in every case. Every child that has once been attacked with this disease has heretofore died. Until now Koch has not been able to make any experiments with acute hydrocephalus, so that it remains an open question whether it is now possible to cure this disease.

Besides tuberculosis of the cerebral membranes with which children are afflicted, tuberculosis of the brain may occur, although this disease is very rare. Tuberculosis of the brain appears in the shape of small tumors in all parts of the brain. After longer duration of tuberculosis of the brain, tubercular meningitis appears.

The process of this disease may be varied. In some cases the development of cerebral tuberculosis is manifested by the sudden appearance of high fever temperatures or violent headache; to this may be added, slackening of the pulse, vomiting, stiff neck and isolated cases of palsy; sometimes an attack of convulsions is the first manifestation.

In other cases the beginning can not be accurately determined, as the beginning symptoms of the disease are so slight as to escape notice. Impaired process of nutrition, languor and headache are symptoms from which the existence of some serious affliction may be inferred without being able to determine its nature in the earlier stages.

Again in other cases the disease may proceed through all its stages without any cerebral appearances whatever. This is especially true of small tubercles and of diseases of infants. However, we more frequently observe in children than in adults convulsions of varied intensity and distribution.

Nutrition is more and more impaired as the disease progresses, in isolated cases only, a temporary improvement may be observed.

The end of cerebral tuberculosis has been death before this. Ten days to two weeks, even three weeks may pass from the first appearance of tubercular meningitis to the completion of the process of the disease, attended by feverish motions characteristic of this condition and by cerebral symptoms, first with the character of excitement, later on with that of palsy.

The treatment of cerebral tuberculosis has been entirely insufficient before this. Let us hope that it will be possible to effect a cure by means of Koch's new method.

Tuberculosis of the Kidneys is met with from the earliest childhood till old age. Most frequently the male sex is afflicted during manhood.

In most cases tuberculosis also exists in other organs, especially in the urinary and sexual apparatus. The existence of pulmonary or intestinal tuberculosis is not essential.

The symptoms of renal tuberculosis are of such general and indefinite character, that it is often impossible to fully determine the disease. Now, however, it will be more easily possible on account of Koch's discovery.

The urine may, but need not contain pus and blood. Sometimes small lumps are found in the urine.

Pains are only sometimes felt in the renal regions; fever may be occasionally attendant.

The disease lasts for months and years; though before now it has inevitably resulted in death, though it has in exceptional cases taken ten years or more.

The internal treatment of renal tuberculosis was ineffectual, surgical treatment has been attended with greater success. This consisted in removing the diseased kidney. Now good results will possibly be attained by the application of Koch's method to cure and resource to surgery will be taken in exceptional cases only.

Tuberculosis of the suprarenal capsules is of very rare occurrence. It leads to a peculiar change in the color of the skin; the same turns dark brown or bronze color. Sooner or later death results.

Perhaps the application of Koch's method will, besides curing the disease, give us information regarding the functions of the suprarenal capsules about which nothing whatever is as yet known.

A large space in the realm of disease is claimed by tuberculous affections of the bones and joints. These afflictions appear particularly in childhood though manhood is by no means exempt. They may appear in all portions of the body, although a marked preference is shown for certain parts. Although the tubercle-bacilli are infinitely small, they possess the power to cause suppuration of the bones and joints and to produce acute inflammation of these parts.

Most frequently tubercular affections of the bones are found in the hip-joints, the knee and the spinal column.

Tuberculous inflammation of the hip-joint is principally a disease occurring in childhood; though it rarely appears before the third year. It is most frequent from the fifth to the tenth year.

Inflammation of the hip-joint developes very slowly in children, it generally takes months before the slightest beginning symptoms reach a threatening appearance. The first sign is lameness; among laymen tuberculous inflammation of the hip-joints is known as "voluntary limping."

By limping we understand that mode of walking in which one leg is spared and by this the trunk is supported only a short time by one extremity and all the longer by the other. In every painful affection of the lower extremity limping results as the weight of the body increases the pain. The lameness in the case of diseased hip-joint has something peculiar about it, inasmuch as not only a part of the extremity but the whole of it is dragged. For this very reason parents of children afflicted with inflammation of the hip-joint use the expression "the child draws" or "drags the leg".