The greater tendency to pulmonary collapse and to severe capillary bronchitis in young children justifies Jürgensen's generalization, that before the age of puberty the danger from catarrhal pneumonia grows greater in proportion to the youth of the individual. Partly because the disease is more apt to assume the subacute form in feeble and sickly individuals, partly because in this form the pneumonic process is more apt to run into destructive lesions of the lung-tissue or to induce tuberculosis, it is found that the mortality from the subacute is even greater than from the ordinary acute form.

It is needless to detail the special symptoms of unfavorable significance. The most important considerations to guide us in prognosis are, therefore, the age, constitution, and vital resistance of the individual; the extent of the pneumonia and of the associated pulmonary collapse and capillary bronchitis; the degree of gastro-intestinal irritation; the vigor of the circulation and respiration, and the manner in which aëration of the blood is maintained; and, finally, the grade of the fever and the character of the nervous symptoms.

TREATMENT.—It is difficult to lay down definite rules for the treatment of catarrhal pneumonia, as the indications are extremely variable and complicated.

In the first place, it is scarcely necessary to call attention to the importance of guarding against the development of this disease in all cases of bronchitis occurring in children or in delicate adults. This care is essential not only in idiopathic bronchitis, but in those general diseases, such as measles and whooping cough, in which bronchitis is constantly present. As children of bad constitution and those exposed to depressing hygienic conditions, such as over-crowding, bad air, and the like, are most liable to become attacked with this form of pneumonia during the course of a bronchitis, it is especially in such cases that our precautions must be most stringent. They should include a strict attention to the condition of the sick-room, which should be well ventilated, but free from drafts, the temperature not being allowed to rise above 68° or 70°, and the air being kept moist by the generation of steam. The diet must be carefully regulated, so that the child's strength shall be as far as possible maintained, and stimulants must be used if indicated by weakness of the pulse or by a tendency to failure of respiratory power. Stimulating applications should be made to the chest, both to serve as counter-irritants and because they stimulate respiration. It would be manifestly unsuitable to enter here into the details of the treatment of such cases of bronchitis, and the above remarks have been made chiefly for the purpose of calling attention in an emphatic manner to the great importance and value of strict and thorough treatment of all severe cases of bronchitis, especially in children, not only with a view to the prompt cure of the primary disease, but because thus also will the development of the more serious conditions of pulmonary collapse and of pneumonia most surely be prevented.

So soon, however, as the coexistence of catarrhal pneumonia is established the gravity of the disease should be promptly recognized, and the closest attention should be paid to every detail of treatment. The condition of the sick-room as to temperature, ventilation, the absence of drafts, and the suitable moisture of the air must be even more carefully watched. The clothing of the child and the bed-covers must be adapted to the season, the weather, and the patient's habit and strength. It is certainly true that aggravations of the disease are often induced by apparently slight indiscretions in the above respects. It is rarely desirable to employ poultices. Unless skilfully made and dexterously applied, they fatigue by their weight; dangerous exposure is incurred in the frequent changing necessary; and, especially in the case of children, they do not keep their position well. A layer of cotton batting stitched inside of a merino shirt of suitable weight, upon the outside of which oiled silk may be stitched, forms an equally efficient and vastly more comfortable and convenient protection. This should be directed when the bronchitis assumes a severe type, or certainly as soon as pneumonia is suspected. It will not be necessary to change this for a week or ten days, unless copious sweating calls for its more frequent renewal. Among the advantages of this application must be reckoned the fact that it allows us to employ at any part of the chest, and as often as desired, local stimulants or counter-irritants, such as turpentine liniment, mustard plasters, or, what is one of the most valuable, the repeated application of tincture of iodine of suitable strength so as not to cause too severe irritation.

The next most important part of the treatment relates to the restoration and maintenance of the digestive function, which is so commonly disturbed in this disease. No one factor contributes more powerfully to produce vital debility, which in turn rapidly increases the gravity of the lung disease by the failure of respiration and the development of collapse, than does gastro-intestinal disorder. Not only the diet, but the entire medication, must therefore be rendered subordinate to the conditions of the digestive tract. It has been seen that, at the onset of the attack, vomiting and diarrhoea are not rare symptoms, and that throughout the course of the disease the condition of the tongue, of the appetite, and of digestion often shows that a catarrhal process exists in the gastro-intestinal as well as in the bronchial mucous membrane. It is therefore frequently advisable for a day or two to avoid all remedies directed to the condition of the lung, and to address the treatment, dietetic and medicinal, solely to the state of the alimentary canal. Thus it will often be of service to employ minute doses of calomel and bicarbonate of soda or of Dover's powder, as in the following formulas, adapted for children of five years of age:

Rx. Hydrargyri chloridi mitis, gr. j;
Sodii bicarb. gr. xxiv;
M. et div. in Chart No. xij or No. xvj.

S. One every two or three hours until the bowels are moved once or twice.

Or, Rx. Hydrargyri chloridi mitis, gr. j;
Pulv. ipecac. composit. gr. x;
M. et div. in Chart No. xij or No. xvj.

S. One every three or four hours.