On the wasting diseases of infants and children

Front matter

rr

"I give theft Booh I for the founding of a College in this Coiony"\

• ILHIBIS^IKF -

Preface

The extensive use of such terms as " marasmus," "tabes," "atrophy," as denoting vaguely some slow disease fatal to children, affords a strong presumption that diseases of which wasting is a prominent symptom, are but little understood ; and that much loss of life is due to insufficient knowledge of their nature.

The Author had not long begun the study of children's diseases before he found that even the best systematic treatises dealt but imperfectly with the clinical condition of chronic wasting, and did not consider together — in the way required for every-day use in practice — tbe various disorders to which it may be due.

He was, accordingly, induced to devote considerable attention to this subject, with the view of forming some practical classification, by means of which the diseases giving rise to this slow wasting might be more readily recognised and controlled.

vi PREFACE.

As a result of the experience thus acquired, he offers the present volume as a contribution to the literature of the diseases of children, in the hope that it may be found of practical value in the treatment of this exceedingly common and fatal condition.

In the chapter on pulmonary phthisis, the Author has endeavoured to utilize recent views on the nature of the phthisical process ; but as his aim has been primarily to make his little book clinically useful, he has limited himself to matters of direct practical significance, and has indulged little in considerations of a purely speculative kind.

28, (teorse Street, Hanover Square.

September, 1868.

Introduction

l'AGE

Wasting, a sign of defective nutrition . 1

Importance of detecting the cause of malnutrition . . 1 Wasting not always the first sign, and may even be absent in

slight cases 2

Defective nutrition may be the result of acute disease . 2

Liability of badly nourished children to secondary acute diseases 3

Peculiarities of these secondary diseases . 3

Insensibility of the nervous system in cachectic children 4

Infrequency of reflex convulsions ... 4

Importance of diagnosing the secondary diseases 5

Information to be derived from examining the face of the infant 5

M. Jadelot's traits ... 5

Colour of face . . b'

Breathing . . . 6

Causes of large belly in infants 7

Infrequency of mesenteric disease . . . 8

Mode of examining liver and spleen . 9

General treatment of wasting ..... 9 Uselessness of tonics so long as there remains any derangement of

the stomach and bowels .... 9

Importance of minuteness in giving directions about diet 9

Frictions . . ... 10

Counter-irritants . . . . . 10

Baths— Hot bath . 11

Mustard bath . . . 11

Cold bath . . 12

Cod's liver oil must not be given in too large doses . . 13

Stimulants .

viii CONTENTS.

Chapter I. Page

Simple Atrophy from insufficient Nourishment.

Insufficient supply of food . . 14

Varieties of breast milk . . . .15

Effect of preponderance of butter in milk . . 16

Test of a good nurse . . ... 16

Unsuitable food .... . . 17

Dependence of nutrition upon powers of digestion 17

Over-feeding ....... 17

Varieties of food required for perfect nutrition 18

Differences between woman's and cow's milk . 19

Cow's milk cannot always be digested . .20

Htimploms .... . .21

Two classes according to cause . . 21

Food suitable, but insufficient . . 21

Food unsuitable . 22

Wasting . ... 22

Constipation . . . . .22

Cause of inactivity of bowels 22

Flatulence . 23

Colic . , 23

Kavenous appetite 24

Eruptions on skin . 24

Stropbulus. . .... 24

Urticaria 24

Thrusb, its importance in prognosis . . 24

Inward fits . 26

Attacks of vomiting and diarrhoea 26

Convulsions . 26

Danger of secondary diseases . . .28

Mode of death . , ■ . 28

Suckling, by mother . 29

by nurse . . 29

Eules for choosing nurse . . 30

Directions for efficient suckling . .30

Advantages of putting child early to breast after birth . 31

Times of suckling . ... 31

Artificial feeding . . 33

Directions . . ... 33

Feeding-bottle . . . . 34

Importance of cleanliness of bottle . 34

CONTENTS.

Different infants' foods Liebig's food

Cow's milk may disagree .

Weaning ....

Usual time

Must sometimes be anticipated Method of weaning .

Reasons why a child may refuse breast Diet after weaning ....

General management of infants Treatment of constipation

Flatulence and acidity

Convulsions and colic .

Thrush .

Aphtha;

Diarrhoea and vomiting ,

PAGE 35

CHAPTER II. Chkonic Diarrhqsa

May be secondary to acute disease . . 48

Or may be primary .... 48

Mode of commencement when primary 48

Increased peristaltic action of bowels ... 49

When disease established .49

Character of the stools . . 49

Other symptoms . ... 50

Complications . . . . . .51

Serous effusions . ... 51

Exanthemata ....... .52

Convulsions rarely except towards commencement . 52

Thrombosis of cerebral sinuses . . .53

Death without complication . . 54

Diarrhoea may cease before death . . 54

Influence of the disease upon dentition . . 55

Causes — In infants, bad hygiene .... 56 previous acute disease . . 58

In older children, worms . . .58

tubercular ulceration of bowels . . 58

Anatomical diameters ...... .59

Simple ulceration of mucous membrane . . 59 Tubercular ulceration ...... 60 x CONTENTS.

TAGE

Prognosis— Unfavourable signs . . 62

Favourable signs 62

Prevention .... . 62

Attention to diet . . 63

Avoidance of cold . . 63

Influence of dentition ... 64

General management . ■ 65

Antacids . . 69

Astringents . . , 71

Opium . . .71

Nitrate of silver . 72

Raw meat plan . 73

CHAPTER III. Chuonio Vomiting

Frequency of slight attacks of gastric disturbance 76

Such attacks easily remedied . . 76

Chronic vomiting non-febrile ... 76

Character of vomited matters , 77

Constipation .... . ... 77

Interference with nutrition . . 77

After a time vomiting almost constant . , 77

Exhaustion ... 78

Spurious hydrocephalus . ... 78

From tubercular meningitis . . .79

Of spurious hydrocephalus . . . .80

Treatment . . so

Attention to diet . ..." .80

Eeturn to breast . . ... 80

Substitute for wet-nurse . . .... 81

Warmth .... 81

Baths 82

CONTENTS. xi

PAGE

Medicines ..... . . 82

Bismuth and magnesia . . . ... 82

Calomel . . . 83

Dilute hydrocyanic acid . . , .83

Emetics ... 84

Stimulants ....... 84

CHAPTER IV. RlCKKTS

Preliminary symptoms those of general malnutrition . . 85 Symptoms of commencement ..... 86

Deformities of bone . . . 88

Enlargement of ends of bone ... 88

Softening ... . 88

Thickening of flat bones . . . . .88

Mechanical deformities . . . 88

Bones of skull and face 89

Distinction between rickety and hydrocephalic skull 90

Cranio-tabes ........ 90

Dentition .91

Spine. . . 91

Deformities of long bones and of pelvis . 95

Arrest of growth of bones .97

Articulations 98

Relaxation of ligaments . . . . 99

Other symptoms ... 99

Enlargement of liver and spleen . . 101

Intellect . 101

General behaviour of a rickety child . . .101

Complications . . ..... 102

Catarrh and bronchitis 102

Diarrhoea ... . . 103

Laryngismus stridulus ... . 104

Convulsions .... .104

Chronic hydrocephalus .... . 1 05

Death from intensity of the general disease . . . 105

Pathology 106

Rickets a general disease . 106

Anatomical characters of bone changes . . . .107

Kblliker's views . . ... 108

Virchow's views ......... 108 xii CONTENTS.

PAGE

Reconsolidation of rickety bone

Analysis of rickety bone

Emphysema and collapse . ....

Alterations in lymphatic glands ....

In liver ... ...

In spleen ...

In other organs

Urine . ...

Diagnosis . ....

Prognosis . . ...

Importance of complications

Causes ......

Rickets not a diathetic disease .

Bad feeding and hygiene

Connection between rickets and syphilis

Prevention ... . ■

Treatment . . .

Dry bracing air . . , .

Attention to digestive organs

Value of mechanical supports ....

Treatment of complications .....

Diarrhcea

Convulsions . .....

Laryngismus stridulus

CHAPTER V. Congenital Syphilis

Appearance of first symptoms

Before birth

At birth .

Afterbirth .

Snuffling

Necrosis of nasal bones Eruptions Seat .

Varieties

Ecthymatous pustules Mucous patches Cracks and fissures Complexion .

CONTENTS.

PAGE

. 135

Openness of fontanelle . . . .

. 136

Influence of the disease on general nutrition

. 136

Affections of internal organs ....

. 136

Local peritonitis ... . .

. 137

Spleen ....

. 137

Delayed symptoms . . .

. 138

Syphilitic teeth .... . .

. 139

Diagnosis ..... ...

. 139

By general sj'mptoms ... . .

By history

. 140

By examination of other children of the same family

. 140

Signs of past disease in child ....

. 140

Transmission of taint from father

. 141

Transmission of taint from mother ....

. 141

Mother seldom escapes if father affected

. 141

Colles' law

Other modes of infection . . . .

. 142

. 143

From observation of parents

. 143

From observation of child ......

. 144

Importance of considering the intensity of the gen jral

Importance of certain special symptoms

Prevention .....

. 145

Treatment . .

. 145

Treatment to be begun early .

. 146

Remarks on the non-mercurial treatment .

. 146

Different preparations

. 148

Ointment . . . . •

. 149

Mercurial baths

. 149

To improve general nutrition.

. 150

Diet

. 150

Peculiarities of milk in syphilitic mothers

Cod's liver oil

Warmth

Cleanliness . . •

CONTENTS.

PAGE Treatment of vomiting and diarrhoea . . 153

Local applications ... ... 154

CHAPTER VI. Worms

Varieties ....

Description ....

Oxyuris vermicularis .

Ascaris lumbricoides Tricocephalus dispar , Taenia solium ...

Taenia medio-canellata Botnrioeephalus latus ....

Development and mode of obtaining admission into human

body

Symptoms . ...

Due principally to accompanying derangement of stomach and bowels .......

Mucous flux

Very common in scrofulous children and in pertussis

Appearance of the tongue

Emaciation . . ....

Pain

Disturbance of nervous system Convulsions ......

Symptoms when digestive derangement is triiliug .

Migrations of worms

Special symptoms with each variety of worm . Diagnosis ......

From tuberculosis .

From tubercular meningitis Treatment ....

Two objects ...

To expel wormsj ...

Remedies required for each variety

Thread worms

Long worms ......

Large thread worms ....

Tape worms ......

To restore healthy condition of alimentary canal

Diet

Alkalies .

160 161

CONTEXTS.

Alum Tannin

Aloes ....

Iron . . . .

Treatment of prolapsus ani

PAGE

175 175 176 176 177

CHAPTER VII. Chronic Tuberculosis

A diathetic disease attacking the organs generally May be acute or chronic .....

Yellow infiltrated tubercle of Laennec not true tubercle Two forms of tubercle . . ...

Grey granulations . .

Yellow granulations ...

May co-exist in the same organ

Differences between them Changes in tubercle .....

The tuberculous and scrofulous types

Distinct, but not antagonistic Symptoms ....

Shape of chest ,

Fever ...

Wasting . . ....

Temperature .

Diagnosis .

In infants

Value of the thermometer .

In older children . .

Causes . . ...

The result of a constitutional tendency . Exciting causes ...

Inoculation of tubercle .

Prevention ....

Climate . ■ •

Exercise

Fresh air .

Diet

Attention to digestive organs

Astringents ....

Alkalies

Cod's liver oil

CONTEXTS.

CHAPTEE VIII.

Chronic Pulmonary Phthisis.

Comprehends several distinct pathological processes .

Infrequency of extensive pulmonary disintegration in young children .... ....

Symptoms .

Cough ...

Sputa usually swallowed

Haemoptysis rare .

Rapidity of breathing

Chest pains ....

Diarrhoea .

Physical signs

Percussion .

Its value . . . • ■

Auscultation ... • ■

Importance of using stethoscope

Value of stethoscopic signs . . ■ •

Bronchial breathing ..... ...

Its value as evidence of pulmonary consolidation and excavation ... . . .

Disseminated miliary tubercles Physical signs Anatomical characters ... . •

Grey and yellow granulations

Two varieties of pneumonia . . .

Pneumonic consolidation

Softening and excavation . . .

Cavities ...

Cicatrization of cavities . . . . .

Fibroid phthisis ... . .

Diagnosis ....

Of tubercle ....

Of scrofulous pneumonia

Its complication with grey tubercle

Of fibroid phthisis .... . .

Of cavities .....

From dilated bronchi . . . .

From effusion into pleura ......

Fragments of elastic tissue in sputum as evidence of ulceration of lung ... . . . .

Prognosis ... . .

Causes ..... .

Of scrofulous pneumonia

PAGE

222 222 224

CONTENTS. xvii

PAGE

General . 225

Exercise , . 226

Fresh air . . . 226

Cleanliness . . . 226

Cold baths bad . . 226

Climate . . . . 227

Attention to Digestive organs . . 227

Special . . . 227

Use of expectorants . 227

Use of opium .... . 227

Method of prescribing expectorants . 229

Alkalies . . 229

Treatment of unabsorbed pneumonic deposits . . 229

Counter-irritation . 229