Front matter
•YAiLE-^MipnEissinnf-
Gift of the
School of Medicine
Preface
It was not without misgivings that the author acceded to the request of the J. B. Lippincott Company to prepare a work limited to six hundred pages comprising all the medical diseases of infancy and childhood. For want of space case records and temperature charts are omitted, while discussions and opinions upon mooted subjects are necessarily restricted. The reader's indulgence is asked for the flavor of dogmatism, from which deductions drawn largely from personal experiences are rarely free.
The need of a more thorough preparation for the study of clinical pasdiatrics than is afforded by a general knowledge of the Anatomy and Physiology of adult life is so evident that considerable space is devoted to these subjects with reference to the developing period.
Part I is practically a revision of the author's previously published Lessons on Anatomy, Physiology, and Hygiene of Infancy and Childhood.
The subject of Infant Feeding, always of paramount importance, is treated broadly in the hope of stimulating a genuine interest in principles rather than a blind following of dogmatic formulae.
The author desires to acknowledge the unfailing courtesy and patience of the Publishers and to return thanks to the following gentlemen for reading manuscript and for valuable suggestions: Dr. John Edwin Rhodes, diseases of the Respiratory System; Dr. Theodore Tieken, disorders of the Blood and Glands; Dr. G. W. Hall, diseases of the Nervous System ; Dr. W. J. Butler, Heart Disease and Eruptive Fevers ; Dr. J. W. Vanderslice, Infant Feeding ; Dr. J. A. Patton, diseases of the Genito Urinary Tract ; Dr. Cassius D. Wescott, for practically rewriting diseases of the Eye. To Drs. John Ridlon and "Wallace Blanchard for illustrative cuts; Dr. F. W. Allin for reading page proof and arranging index; Hon. Win. H. Collins for corrections in phraseology. He also acknowledges with thanks the privilege of reproducing from Johnson Symington's "Anatomy of the Child " a few illustrations embodied in this work.
Especial acknowledgment is due to Dr. Julia D. Merrill for valuable assistance and advice in every stage of the work.
Chicago, January, 1900.
Chapter I Page
ANATOMT OF THE NEW-BORN
The Skin — Skull — Ear — Face — Neck — Vertebral Column — Long Bones — Thorax — Larynx — Trachea — Lungs — Heart — Thymus Gland — Thyroid Gland — Liver — Spleen — Pancreas — Kidneys — Suprarenals — Bladder — Urethra — Testicles— Ovaries — Uterus — Mammary Glands — Brain — Spinal Cord 17
Chapter II
Length — Weight — Bones of Head and Face — Nasopharynx — Dentition — Vertebral Column — Thorax — Lungs — Heart — Blood-Vessels — Thyroid — Thymus — Alimentary Tract — Stomach — Intestines — Liver — Spleen — Kidneys — Bladder — — Uterus — Inguinal Canal — Nervous System 42
Chapter III
Circulation of the Blood — Respiration — Temperature — Alimentary Canal — Urine — Skin — Sebaceous Glands — Sweat Glands — Lachrymal Glands — Nervous System — Sight — Hearing — Smell — Taste — Touch — Care of the New-Born. ... 61
Chapter XII. Artificial Feeding Concluded
Home Modification of Milk — Methods of — Tables and Rules for — Difficulties of Artificial Feeding — Constituents of Cow's Milk — Objections to Cow's Milk — Efforts at Correction — Other Infant Foods — Principles to be Observed in Artificial Feeding 118-132
Chapter XVI
Caput Succedaneum — Cephalhematoma — Meningocele, Encephalocele — Hydrencephalocele — Hernia Cerebri — Congenital Hydrocephalus — Microcephalus — Spina Bifida — Malformations of the Spinal Cord — Congenital Deformities of Extremities — Malformations of the Eye — Malformations of the Ear — Hematoma of Sternomastoid (Caput Obstipum) — Cleft Palate (Harelip)— Branchial Fistula1 — Facial Defects — Malformation of the Digestive Tract — Congenital Dilatation of the Colon and Stomach — Umbilical Defects — Diastasis of the Recti Muscles — Diaphragmatic Hernia — Exstrophy of the Bladder (Ectopia Vesica?) — Congenital Atresia of Urethra, Vulva, and Vagina — Epispadias (Hypospadias) — Nsevi (Birth-Marks; Port-Wine Stains) — Congenital Bony Defects (Osteogenesis Imperfecta) — Achondroplasia (Chondrodystrophia Fetalis) — Cleidocranial Dysastosis 149
CONTENTS ix
Chapter I Diseases Of The New-bobn Page
Examination of Children — Asphyxia — Inspiration Pneumonia of the Newly Born — Cyanosis Infantum — Atelectasis — Inanition Fever — Anuria — Sclerema Neonatorum — Paralysis 166
Chapter II Infectious And Hemorrhagic Diseases Of The New-born
Susceptibility — Mastitis Neonatorum — Icterus Neonatorum — Grave Icterus — Pemphigus Neonatorum — Omphalitis — Tetanus — Erysipelas — Acute Fatty Degeneration (Buhl's Disease) — Epidemic Hemoglobinuria (Winckel's Disease)— Hemorrhages — Helena — Vaginal Hemorrhages 176
Chapter III
Marasmus — Infantile Atrophy; Pedatrophy; Athrepsia; Simple Wasting — Rhachitis — Scorbutus (Infantile Scurvy) — Adipositas — Osteomalacia — Osteopsathyrosis 182
Chapter IV
The Lips, Tongue, and Mouth — Perleche (Licking Disease of the Lips) — Macroglossia (Hypertrophy of the Tongue) — Acute Glossitis — Lingua Geographica (Desquamative Glossitis; Pityriasis Linguae) — Ulcer of the Tongue — Riga's Disease — Ranula — Tongue-Tie (Elongatio Frenuli) — Difficult Dentition — Catarrhal Stomatitis (Stomatitis Catarrhalis) — Stomatitis Aphthosa (Stomatitis Herpetica; Vesicular Stomatitis; Follicular Stomatitis; Canker Sore Mouth) — Bednar's Aphtha- (Aphthae of the Palate) — Stomatitis Mycosa (Mycetogenic Stomatitis; Parasitic Stomatitis; Thrush; Muguet; Sprue; Soor) — Stomatitis Ulcerosa (Ulcerative Stomatitis: Putrid Sore Mouth) — Stomatitis Gangrenosa (Noma of the Face; Cancrum Oris) — Stomatitis Membranosa — Gonorrheal Stomatitis 201
Chapter V Disorders Of The Digestive System — Continued
Diseases of the Throat, Pharynx, and (Esophagus— Acute Tonsillitis— Suppurative Tonsillitis (Phlegmonous Tonsillitis; Quinsy) — Follicular Tonsillitis (Lacunar Tonsillitis) — Chronic Tonsillitis (Hypertrophy of the Tonsils) — Vincent's Angina ( Ulcero-Membranous Tonsillitis) — Acute Uvulitis — Pharyngitis — Acute Pharyngitis — Chronic Pharyngitis — Adenoid Vegetations—Retropharyngeal Abscess — Diseases of the (Esophagus — Retroesophageal Abscess 215 x CONTENTS
Chapter VI Diseases Of The Gastroenteric Tract Page
Vomiting — Congenital Hypertrophic Stenosis of the Pylorus; Pyloric Spasm — Acute Gastritis (Acute Gastric Catarrh; Acute Gastric Adenitis) — Gastric Ulcer and Hemorrhage — Intestinal Colic (Enteralgia; Neuralgia Enterica) — Acute Dyspepsia (Acute Indigestion) — Acute Enteritis (Summer Diarrhoea)— Cholera Infantum — Chronic Gastritis (Chronic Gastric Catarrh; Chronic Dyspepsia) — Amoebic Dysentery — Incontinence of Faeces — Constipation— Mucous Disease (Chronic Intestinal Catarrh; Gastro-Duodenal Catarrh; Chronic Mucocolitis; Intestinal Indigestion; Tubular Diarrhoea; Myxoneurosis Coli; Colica Mucosa) — Intestinal Parasites (Worms) — Intussusception— Volvulus — Appendicitis — Proctitis and Rectal Ulceration— Prolapse of the Rectum and Anus — Fissure of the Anus — Rectal Polypi — Hemorrhoids 237
Chapter VII
DISEASES OF TIIF. LIVER AND PANCREAS
Congestion of the Liver — Acute Infectious Liver — Suppurative Hepatitis (Abscess of the Liver) — Cirrhosis of the Liver — Acute Yellow Atrophy of the Liver — Fatty Liver — Amyloid Degeneration of Liver, Kidney, Spleen, etc. — Hydatids of the Liver — Tumors of the Liver — Syphilitic Pancreatitis 283
Chapter VIII Diseases Of The Heart And Pericardium
Congenital Diseases of the Heart — Functional Heart Disease — Acute Endocarditis— Chronic Endocarditis (Chronic Valvular Disease) — Myocarditis — Adherent Pericardium ( Chronic Pericarditis) 289
Chapter IX
Rhinitis, Acute and Chronic (Coryza; Acute Nasal Catarrh; Cold in the Head)
— Membranous Rhinitis — Syphilitic Rhinitis — Nasal Polypi — Epistaxis (Nose-bleed) — Congenital Laryngeal Stridor — Acute Laryngitis — Chronic
Laryngitis — Syphilitic Laryngitis — Tuberculous Laryngitis — Pseudomembranous Laryngitis (Membranous Croup; True Croup) — Oedema of the Glottis — Tumors of the Larynx — Foreign Bodies in the Larynx and Trachea — Tracheitis — Acute Bronchitis — Chronic Bronchitis — Fibrinous Bronchitis
— Bronchiectasis — Asthma - — Fibrinous Pneumonia ( Lobar Pneumonia ; Croupous Pneumonia; Pneumonitis) — Bronchopneumonia (Catarrhal Pneumonia; Lobular Pneumonia; Capillary Bronchitis) — Chronic Interstitial Pneumonia (Peribronchitis; Pulmonary Fibrosis; Fibroid Phthisis; Cirrhosis or Induration of the Lung) — Hypostatic Pneumonia — Abscess of the Lung and Pulmonary Gangrene — Atelectasis (Collapse of the Lung) — Pulmonary Emphysema — Pleuritis (Pleurisy) 3H
Chapter X Diseases Of The Kidneys, Bladder, And Genital Organs
Anuria and Oliguria — Hematuria — Ha?moglobinuria — Intermittent Albuminuria (Orthostatic, Postural, Cyclic, Functional, Physiological Albuminuria) — Kidneys (Malformations and Congenital Anomalies) — Acute Nephritis — Chronic Nephritis — Uric Acid — Calculi — Pyelitis (Pyelonephritis; Pyo-
CONTENTS xi
PAGE
nephrosis ) — Cystitis — Perinephritis ( Paranephritis ; Epinephritis ) — Hydronephrosis—Balanitis, Posthitis, and Urethritis in Male Children — Simple Vulvovaginitis— Specific Vulvovaginitis— Phimosis and Adherent Prepuce — Eneuresis (Incontinence of Urine) — Cryptorchidism (Undescended Testicla) — Hydrocele — Hydrocele in Girls 366
Chapter XI Diseases Of The Nebvous System
Convulsions (Eclampsia; Spasms) — Epilepsy — Tetany (Tetanilla) — Laryngismus Stridulus ( Laryngospasm ; Cerebral Croup) — Thomsen's Disease — Myotonia Congenita — Hysteria — Catalepsy — Chorea — Habit Spasm (Tic Convulsif; Habit Chorea; Facial Tic) — Imperative Movements — Spasmus Nutans (Head-nodding; Nystagmus) — Athetosis — Pavor Nocturnus (Night Terrors ) — Speech Defects — Echolalia and Coprolalia — Aphasia — Masturbation— Reflexes — Rellex Disorders of Dentition — Headache — Meningitis — Tuberculous Meningitis — Cerebro Spinal Meningitis — Simple Basic Meningitis (Infantile Basilar Meningitis of Non-Tuberculous Origin) Posterior Basic Meningitis — Encephalitis (Cerebritis) — Insolution (Sunstroke; Heat Prostration; Thermic Fever) — Thrombosis of the Cranial Sinuses — Tumors of the Brain — Abscess of the Brain — Hydrocephalus (Hydrops Cerebri; Water on the Brain) — Infantile Cerebral Palsies (Spastic Hemiplegia; Diplegia; Paraplegia) — Progressive Bulbar Paralysis (Labioglossolaryngeal Paralysis) — Idiocy (Imbecility and Feeble-mindedness) — Mongolian Imbecility— Amaurotic Family Idiocy — aretic Dementia — Insanity — Transverse Myelitis — Acute Anterior Poliomyelitis (Infantile Spinal Paralysis) — Tumors of the Spinal Cord — Syringomyelia (Myelosyringosis) — Hereditary Spinal Ataxia (Friedreich's Disease) — Landry's Paralysis (Acute Ascending Paralysis) — Hereditary Spastic Paralysis (Cerebrospinal Paralysis — Locomotor Ataxia (Tabes Dorsalis) — Multiple Sclerosis (Disseminated Sclerosis; Insular Sclerosis) — Progressive Muscular Atrophy (Hand Type of Aran and Duchenne) ; Leg Type of Charcot-Marie-Tooth (Peroneal Form) ; Muscular Atrophy with Pseudohypertrophy; Juvenile Form (Erb's Type) ; Facioscapulohumeral (Landouzy-Dejerine Type) — Multiple Neuritis 394
Chapter XII Diseases Of Tiie Glands, Blood, Bones, And Joints
Lymphatism — Simple Acute Adenitis — Chronic Adenitis — Hodgkin's Disease (Pseudoleukemia; Lymphatic Anaemia; Adenia; Lymphadenoma ) — Disorders of the Spleen — Disorders of the Adrenals — Disorders of the Thymus — Disorders of the Thyroid — Cretinism — Exophthalmic Goitre (Graves's Disease; Basedow's Disease) — Anaemia — Chlorosis — Pernicious Anaemia — Leukaemia — Haemophilia — Purpura — Spinal Caries (Pott's Disease; Spondylitis)— Hip Disease (Morbus Coxarius) ; Coxitis — Knee-joint Disease (White Swelling) — Dactylitis (Chronic Osteomyelitis; Spina Ventosa; Spina Pedarthroeace) — Chronic Polyarthritis, with Splenic and Glandular Enlargement — Acute Epiphysitis — Chronic Osteoperiostitis — Acute Osteomyelitis— Osteochondritis — Arthritis Deformans 479
Chapter XIII Diseases Of The Eye 'and Ear
Affections of the Lids: Blepharitis — Hordeolum, or Stye — Chalazion — Trichiasis— Distichiasis — Entropion — Ectropion — Ptosis. Injuries of the Eyelids : Ecchymosis — Insect-bites — Burns — Blepharospasm — Conjunctivitis— xii CONTENTS
PAGE
Trachoma — Interstitial Keratitis — Iritis — Cataract — Refraction of the Eye — Paralysis — Strabismus — Nystagmus — Exophthalmos. Diseases of the Ear : Importance of Otitis Media — Ear Tumors — Internal Ear 523
Chapter XIV
Exanthemata — Scarlet Fever (Scarlatina) — Measles (Rubeola Morbilli) — Atypical Measles (Complications and Sequelae) — Rubella (Rotheln, German Measles) — Variola (Smallpox) — Vaccinia (Cow-pox) — Varioloid (Modified Smallpox) — Varicella (Chicken-pox) — Tubulated Differentiation of Exanthemata 540
Chapter XV The Specific Infectious Diseases — Continued
Pertussis ( Whooping-Cough ; Tussis Convulsiva) — Influenza (La Grippe; Catarrhal Fever) — Epidemic Parotitis (Mumps) — Diphtheria — Diphtheroid
(Pseudodiphtheria) —Intubation of the Larynx — Typhoid Fever (Enteric Fever) — Peculiarities of the Infantile Form of Typhoid Fever — Malaria
(Intermittent Fever; Paludism) — Hereditary Syphilis — Tuberculosis — Glandular Tuberculosis — Abdominal Tuberculosis — Peritoneal Tuberculosis — General Treatment for Tuberculosis 560
Chapter XVI
Prevalence in Childhood — Erythema Simplex (Redness of Skin) — Seborrhoea — Eczema — Miliaria — Urticaria (Nettle-Rash; Hives) — Impetigo Contagiosa — Herpes — Tinea Trichophytina ( Ringworm ) — Favus ( Tinea Favosa ; Crusted Ringworm; Honeycombed Ringworm) — Scabies (Itch) — Pediculosis— Furunculosis — Psoriasis — Ichthyosis — Scleroderma ( Dermatosclerosis ; Cutis Tensa Chronica ) — Verruca ( Warts ) — (Edemata 603
CHAPTER XVII Diabetes Mellitus — Diabetes Insipidus — Rheumatism 624
SICK-ROOM HYGIENE
Contagious Diseases — Therapeutic Suggestions — Massage — Lumbar Puncture — Hydrotherapy — Hot Pack — Cold Pack — Sponge Bath — Tub Bath — Hot Mustard Bath— Vapor Bath — Bran Bath — Shower Bath — Internal Use of Water — Nasal Irrigation — Lavage — Gavage — Irrigation of the Vagina — Enema — Colonic Flushing. Dietary: Barley- Water or Gruel — Rice-Water — E<*g- Water — Clam-Broth — Chicken-Broth — Beef-Broth — Mutton-Broth — Oyster- Broth — Scraped or Pulped Raw Meat — Raw-Meat Juice — Whey — Junket (Sweet Curd for Older Children) — Egg- Junket — Lime-Water — Cream-of- Tartar Lemonade 632
FORMULARY
Disinfecting Solutions— Mouth-Wash and Spray— Astringents— A Gargle to prepare the Throat for Tonsillotomy — Anodyne Sprays used in Tubercular Laryngitis— Infant Correctives — For Relief of Asthma— Rubefacients 644
Illustrations
FIGS. PAGE
1. New-born — side, reclining (plate) 18
2. New-born — front, reclining (plate) 18
3. New-born - back (plate) 18
4. New-born — fists doubled (plate) lit
5. New-born — front, sitting (plate) 19
6. New-born — side, sitting (plate) 19
7. Pericranial hemorrhage in new-born 19
8 to 13. Skull of new-born (plate) 20
14. Anencephalus 21
15. Branchial clefts 22
16. Skeletons of new-born (plate) 21
17. Skiagram of new-born (plate) 25
18. Skiagram of new-born (plate) 25
19. Lower end of femur, showing centres of ossification 26
20. Spina bifida (dissection) 27
21. Lungs, heart, thymus and thyroid of still-born infant 30
22. Fetal circulation 31
23. Stomachs of new-born ( plate) 34
24. Folds of infant rectum 36
25. Liver in the new-born 37
26. Spleen with a supernumerary and pancreas 38
27. Lobulated kidney of the new-born 38
28. Mesial section of four months infant, showing distended bladder 39
29. Genito-ui inary organs at birth (plate) 40
30. Weight chart 43
31. Weight chart 43
32. Linea albicantes after typhoid 44
33. Boas table 45
34. Coronal section of head through the auditory meati 47
35. Coronal section of head through the orbits 48
36. Vertical mesial section of head and trunk (plate) 48
37. Dissection showing teeth at sixth year 50
38. Inferior maxilla1 (plate) 50
39. Horizontal section at third dorsal vertebra (plate) 51
40. Horizontal section at clavicle (plate) 52
41. Von Starck's types of cardiac dulness 53
42. Horizontal section at the eleventh vertebra 57
43. Mesial section of pelvis at fifteen months 58
44. Infant's garments (plate) 58
45. Infant's garments (plate) - 59
46. Infant's outer garments 65
47. Infant's undergarments 66
48. Rubber bath-tub 79
xiii xiv ILLUSTRATIONS
PAGE FIGS.
49. Bath thermometer
50. Scales 80
51. Correct position for nursing
52. Holt's creamometer
53. Feser's lactoseope
54. Marchand's tube
55. Babcock test tube 102
56. Babcock centrifuge
57. Leffman and Beam's test bottle 103
58. Office centrifuge 103
59. Lactometer lu*
60. Freeman's pasteurizer
61. Arnold's sterilizer H'
62. Ladd's table for milk modification H9
63. Ladd's table for milk modification H9
64. Gurler's table for milk modification 120
65. Westcott's chart for milk modification i22
66. Materna 122
67. Chapin's milk dipper l22
68. Connor's table for milk modification 123
69. Position for bottle feeding I25
70. Nasal syringe l33
71. Oil atomizer I33
72. Foot and orthopaedic shoe 134
73. Foot and orthopaedic shoe 135
74. Skiagram of lower extremities ( plate ) 134
75. Skiagram showing effects of large, wadded diaper (plate) 135
76. Pelvis at birth, showing cartilage 136
77. Skiagram showing pelvis constricted by tight diaper (plate) 136
78. Skiagram showing effect of tight bands on thorax (plate) 136
79. Saddle-shaped palate 138
80. Krohn's diagram of fatigue periods 142
81. Premature infant 146
82. Incubator • 147
83. Feeding tube 148
84. Aneneephalus 150
85. Spina bifida 153
86. Amputations of extremities in utero 155
87. Congenital dislocation of hips, front view 155
88. Skiagram of intra uterine malformations of fingers 156
89. Congenital dislocation of hips and back (plate) 158
90. Congenital dislocation of hip (dissection) (plate) 15S
91. Congenital talipes (plate) 158
92. Double cleft palate, front view (plate) 159
93. Single cleft palate, side view (plate ) 159
94. Cleft palate, front view (plate) 159
95. Cleft palate, after operation (plate) 159
96. Meckel's diverticulum 159
97. Atresia ani (plate) 160
98. Atresia recti (plate) 160
ILLUSTKATIONS xv
tigs. PAGE
99. Atresia of both anus and rectum (plate) 160
100. Common cloaca (plate) 160
101. Congenital dilated stomach (plate) 161
102. Congenital exompholos (plate) 161
103. Exstrophy of bladder ■ 162
104. Achondroplasia, front view (plate) 164
105. Achondroplasia, side view (plate) 164
106. Achondroplasia, back view (plate) 164
107. Achondroplasia, dissection (plate) 165
108. Skiagram of femur of achondroplasic (plate) 165
109. Examination of cheat I"7
110. Infantile atrophy 184
111. Fetal rickets 187
112. Rhachitic femur 187
l °iQ
113. Rhachitic curvature of spine
i on
114. Rhachitic curvature of spme loa
115. Rhachitic deformity 190
1Q0 110. Rhachitic family
117. Rhachitic deformity 191
119. Skiagram of genu valgum
120. Skiagram of genu varum
121. Rhachitic deformities
122. Same after correction . . '.
123. Rhachitic bow-legs
124. Same after correction '
125. Rhachitic knock-knees
126. Same after correction
127. Adenoid facies
128. Mouth breather 22g
129. High-arched palate ' ^
130. Digital exploration for adenoids ^
131. Effects of thumb sucking '
132. Characteristic attitude in retropharyngeal abscess ^
133. Skiagram of foreign body in oesophagus (plate) ^
134. Emaciation due to stricture of oesophagus ^
135. Stricture of oesophagus ^
136. Ulceration of Peyer's patch (plate) 2T.i
137. Intussusception 2^
138. Palpating the appendix ,21$
139. Direction of anal outlet 2gg
140. Malformation at aortic orifice 2W
141. Congenital malformation of heart '.291
142. Congenital malformation of heart 300
143. Chronic valvular heart disease 314
144. Nasal irrigation • ' ; ' \" " " o.jo
145. Diphtheritic membrane from trachea and bronchi (plate) ■ ■ ■■ •■ —
146. Exploratory aspiration of chest .370
147. Rudimentary kidney 371
148. Cystic tumors of kidney xvi ILLUSTRATIONS
Paoi
149. Tetany 4Ul
150a. Athetosis .- 413
152. Gun-hammer position
154. General purpuric eruption. Death on the 12th. day of continuous
convulsions
154a. Hydrocephalus
155. Congenital enlargement of thyroid gland 443
156. Brain hemorrhage after forceps 44°
157. Birth palsy. Microcephalic idiot 449
158. Cerebral palsy 449
159. Prenatal cerebral palsy. Diplegic idiot 45°
100. Spastic contracture 4^'
161. Diplegia 452
102. Section of medulla in bulbar paralysis 454
103. Progressive bulbar paralysis 454
164. Mongolian imbecility ( plate) 4&8
165. Mongolian imbecility, profile (plate) 459
166. Tongue in Mongolian imbecility (plate) 459
167. Mongolian imbecility (plate ) 459
168. Slight degree of Mongol ianisrn (plate) 459
169. Amaurotic family idiocy, before development of symptoms 459
171. Eyeground in amaurotic family idiocy (colored plate) 460
174. Amaurotic family iodicy, convulsions in 462
175. Cupped foot 472
176. Pseudohypertrophic paralysis 477
177. Progressive muscular dystrophy 477
178 to 185. Pseudohypertrophic muscular paralysis, eight characteristic postures assumed in rising from the floor (plates) 478
186. Acute cervical adenitis 483
187. Hodgkin's disease 486
188. Hodgkin's disease with enlarged liver and spleen 487
189. Palpating the spleen 488
190. Splenic anaemia 489
191. Cretin, untreated 493
192. Cretin, untreated 494
193. Cretin, after treatment, 495
194. Cretin, after treatment (plate) 506
195. Cretin, before treatment (plate) 50ti
196. Cretin, after treatment (plate) 5yy
197. Post-diphtheritic purpura 508
198. Peliosis rheumatica 509
199. Spinal caries, (dissection) 510
200. Spinal caries, psoas abscess 512
201. Dorsal caries, infrascapular abscess 513
202. Spinal caries, psoas abscess 513
ILLUSTRATIONS xvii
FIG3. PAGE
203. Characteristic posture of spinal caries 51-1
204. Hip disease 510
205. Tuberculous knee and elbow - 517
20G. Tuberculous sinuses of ankle 519
207. Tuberculous dactylitis 519
208. Koplik's spots ( colored plate ) 550
208a. Chicken-pox 558
209. Conjunctival ecchymosis in pertussis 562
212. Rupture of tuberculous gland in trachea 593
213. Rupture of tuberculous gland in tpsophagus 594
214. Pulmonary tuberculosis with large liver 597
215. Mesenteric and pulmonary tuberculosis 600
216. Tuberculous peritonitis with ascites 601
217. Tuberculous peitonitis with ascites, side view 601
218. Lumbar puncture 637
219. Nasal feeding 640
220. Colonic flushing , 642
PART I
Anatomy, Physiology, and Hygiene
of the Developing Period
Chapter I Anatomy Of The New-born The Skin
The infant's integument at birth is usually more or less covered with a thick whitish substance, the vernix caseosa, which is most abundant in the flexures and depressions, and upon the scalp. It consists of a mixture of cast-off epithelium, lanugo, and the product of the sebaceous glands.
Usually upon delivery the color is dusky blue, owing to venous stasis from the long pressure. After a few full inspirations this color changes to the " boiled lobster" hue. About the third day exfoliation begins and continues for a week or ten days. During this time the hyperaemia is marked ; this gradually subsiding, the skin assumes an icteroid tint.
The texture of the skin is very delicate, and the downy growth, lanugo, which was more abundant in the sixth and seventh months of intrauterine life, still covers the body.
The margin of the nails projects far over the ball of the fingers. It was formed at an early period and is much thinner than the part resting on the bed of the nail. This margin breaks readily and becomes detached soon after birth.
At first view the large head, small chest, enormous abdomen, and insignificant extremities of a new-born infant seem out of all proportion (Figs. 1 to 6). Not until the student has gained a knowledge of development and growth up to this period can he adjust his ideas to accept these as normal.
Upon comparing the records of many hospitals in this and other countries, the average weight at birth for boys is found to be 3280 grammes and for girls 3130 grammes (about seven and one-fifth and seven pounds). The average length is forty-six to fifty centimetres (eighteen to twenty inches).
Many observations have shown a constant proportional relationship between the different members of the normal infant at birth. Any marked variation in these proportions is considered an abnormality of development. The following simple rule will aid the student in remembering this relationship. The circumference of the thorax in centimetres should equal one-half of the length plus ten. If estimated in inches, add four to half the length. The circumference of the head should equal that of the thorax plus two. The abdomen is usually one to two centimetres larger in circumference than the head, for example :
Centimetres. Inches.
Length 40 18
Circumference of thorax 33 13
Circumference of head 35 13|
Circumference of abdomen 36 Hi
From the abundant deposition of subcutaneous fat, the contour of the body and limbs is well rounded, the location of the articulations being marked by dimples. A marking never absent from a normal, plump infant after the first month is a deep sulcus extending around the inner aspect of the thigh.
Recent investigators have questioned the correctness of the statement that the bones of infants contain more animal matter than do those of adults, — viz., one-third. Their analyses go to prove that equal weights of bone contain, at all ages, and in all bones, nearly the same relative proportions of animal and earthy matter. A particle of bone is a definite, not a variable compound. Hardness and compactness depend upon the quantity of bone condensed in a given space. The softness and elasticity of the bones of infancy are due to their vascularity, the sponginess of their texture, and to the layers of cartilage and membrane not yet ossified. Equal weights of corresponding sections of adult and infant bones would certainly yield different percentages of earthy and animal matter. The error lies in regarding the sections as containing equal amounts of bone. A peculiarity of infant bones is seen in the composition of the red marrow which is found in all the long bones. It consists of seventy-five per cent, water, the twenty-five per cent, solids containing only one per cent, fat, while the yellow marrow of adult bones contains ninety-six per cent. fat.
The centres of ossification do not all appear at once, some not until after birth, but all in regular succession and at stated periods. The early ossification corresponds directly with the functional importance of the particular bone, — e.g., that of the lower jaw and ribs, which renders possible respiration and suction from birth.
THE SKULL.
The head, being plastic, shows the pressure effects of recent parturition, sometimes presenting a great elongation. Not infrequently the contour is still further modified by the caput succedaneum. By the end of the first week the head has resumed its normal shape.
The integument covering the head is thicker than that of any other part of the body and is closely adherent to the aponeurosis of the occipito-
Hk
MP^*
Infant at birlh.
Fig. 6.
THE SKULL 19
frontalis muscle. The extreme mobility of the scalp in infancy is due to, the loose attachment of the above-mentioned tissues to the pericranium, — points to be remembered in considering extravasations in this region (Fig. 7). The pericranium may be regarded as the remains of the outer layer of the developing membrane which surrounded the bones in fetal life. It is very slightly attached, except at the sutures where it blends with the dura mater.
The skull at birth presents marked peculiarities not only in its entirety, but also as to its individual bones, and further in the persistence of some of its chondral portions.
Considered as a whole the large size of the head compared with that of the body, and the predominance of cranial over facial proportions, are marked features ; the proportion of face to cranium has been put as
Fig. 7.— Pericranial hemorrhage in new-born. (Dr. P. Bassoe. )
1 : 8 (Figs. 5, 6, 8) , while in later life it is as 1 : 2. The parietal eminences are large and conspicuous. Adjacent margins of the bones of the vault are separated by fibrous tissue continuous with the dura mater internally and the pericranium externally. The bones of the vault consist of a single layer without diploe. At the angles of the parietal bones are membranous spaces, called fontanelles. The largest and most important of these is the anterior median, which is situated at the junction of the frontal, sagittal, and coronal sutures (Fig. 9). It is quadrilateral, from two to four centimetres long and one to two centimetres wide, and immediately after birth it is slightly depressed. In this space there is a regular pulsation corresponding in frequency with the action of the heart. The posterior median fontanelle is smaller and triangular in. shape. The remaining four lateral spaces are found at the inferior angles of the parietal bones and are irregular in outline (Pigs. 10 to 12). Supernumerary (Wormian) bones are frequently found in the line of sutures or at the fontanelles.
At the base of the skull the most striking points are, first, the absence of the mastoid processes, and, second, the large angle which the pterygoid plates form with the skull base. (In the adult the angle is almost a right one.) The base is relatively short, and the lower border of the mental symphysis is on a level with the occipital condyles. The facial skeleton is relatively small in consequence of the small size of the nasal fossa? and the undeveloped condition of both jaws (Fig. 13). The external auditory meatus is found anterior to the middle of a straight line connecting the symphysis mentis and the occipital condyle. In the adult it is decidedly posterior to the centre of this line. Embryology shows that the vault of the skull is formed in membrane and the base in cartilage. Although in fetal life ossification begins first in the vault, at birth it is always more advanced at the base. Pathology often makes this distinction more manifest. Among the more common of the gross malformations is that which shows an entire absence of all parts of the cranium formed in membrane, while the base is more or less perfectly developed, as in the anencephalus (Fig. 14).
The occipital bone consists of four distinct plates : the s.quamo-, the basi-, and two ex-occipitals united by strips of cartilage. The first named portion, which is formed in membrane and belongs to the vault, is often separated from the ex-occipitals by a wide fissure (Fig. 11). These fissures are of interest for they have been mistaken for fractures. The fact is, it is difficult to fracture the skull of a young infant, as the bones are soft and yielding and a blow indents without fracturing. Another membranous space extends from the squamo-occipital portion to the foramen magnum. It is here that a hernia of the membranes or brain occurs. There is no jugular process and the grooves of the lateral sinuses are absent or but rudimentary.
The sphenoid consists of three pieces, the median, containing the basisphenoid, and the two lateral, which are made up of the greater wings and internal pterygoid plates. The dorsum ephippii is cartilaginous ; there are no air-sinuses and the optic foramina are large and triangular (Pig. 13).
The temporal is also made up of parts which are easily separable, — viz., squamous, petrosal, and mastoid. The mastoid process is not developed, and the jugular fossa is only a shallow depression.
The antrum is relatively large and resembles the tympanic cavity in having a very thin roof separating it from the cranial cavity, but it approaches much nearer the outer surface of the skull than does the tympanum. The mastoid cells are not present at birth, and it is of interest in this connection to know that they are not present in twenty per cent, of adult mastoids. The petrosal is of loose and open texture, resembling unglazed porcelain, thus offering a striking contrast to the dense and ivory-like petrosal of adult life.
Fig. 8.— Skull of new-born. Frontal bone depressed by desiccation. (Dr. J. L>. Merrill.)
Fig 9.— Skull at birth. Vertex. (Dr. J. D. Merrill )
Fig. 10. — Skull at birth, showing tympanic membrane and notch of Revinus.
Fig. 11.— skull sit birth. Base. (Dr. J. D. Merrill.)
Fig. 12.— Skull at birth. Base. Teeth exposed by dissection. (Dr. J. D. Merrill.)
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You’ve reached the end of The medical diseases of infancy and childhood : with points on the anatomy, physiology, and hygiene peculiar to the developing period.