The diseases of children

Front matter

Class Book.

'0

Copyright^0

Preface

In the preparation of this work the aim of the author has been to make it represent the most modern views upon each subject discussed, and to present these views in such a way that they may be immediately available to the busy practitioner as well as easily intelligible to the medical student.

The treatment of each disease is given in full, and the physician engaged in general practice will find herein the precise management of a typical case of any disease which he is called upon to treat. In addition, the clinical examination of the sick child is carefully considered, and its anatomy and physiology are discussed in detail.

In the consideration of each subject a special effort has been made to make the book thoroughly up to date, and to each chapter has been allotted the amount of space its importance appeared to warrant, only a few of the rarest diseases having been omitted. As, however, the book has been written from the practical, and not from the theoretical standpoint, recent and unconfirmed suggestions and theories have not, as a rule, been considered.

Sufficient space has been devoted to pathology, and a larger amount, proportionately, to symptoms, diagnosis, and treatment. The illustrations and .r-ray plates are all from the author's private and hospital cases, except where credit has been given to others.

From long experience in teaching both students and practitioners, it has seemed to the author most important that the processes of normal digestion be thoroughly understood before any attempt be made to study the various disturbances and diseases of the gastro-intestinal tract, hence the subject of normal digestion has been considered in a special chapter.

The subject of infant feeding has received particular attention; the construction of milk mixtures, usually a vague subject to both the general practitioner and the student, is carefully explained, and the calculation of caloric and percentage feeding has been illustrated by formulas reduced to ounces.

vi PREFACE

Diseases of the gastrointestinal tract have been presented in full, and some of the most advanced ideas concerning diagnosis and treatment have been incorporated. Food injuries, chronic constipation, pylorospasm, and pyloric stenosis have received special consideration, a careful differentiation being made between the two latter affections.

Special features of the book to which the author desires to call the attention of the reader are the chapters on Infant Mortality, Heredity and Environment, Puberty, Fresh Air, and Diseases of the Liver, Spleen, and Thymus Gland. To each of these subjects is allotted a special chapter in view of their ever-increasing importance to the practising physician.

The Diseases of the Nervous System have been discussed in eighty pages. A careful consideration of these diseases belongs in a book on Pediatrics, and the physician interested in children will find here a broad field for study. To Infantile Paralysis the author has devoted ten of these pages.

A special chapter has been devoted to Dentition, for the author regards this as a normal and physiological process in the course of normal development. Particular attention is also called to the articles on Diphtheria, Influenza, Pertussis, Poliomyelitis, and Enlargement of the Thymus Gland.

The author here acknowledges his indebtedness to the following physicians connected with the Pediatric Department at Jefferson Medical College: Dr. Julius Blechschmidt, Dr. R. L. Engle, Dr. Joseph Fleitas, and Dr. W. H. Johnston.

I wish to express my appreciation to my publishers, Messrs. Lea & Febiger, for their earnest cooperation during the entire period of the book's preparation.

E. E. G.

Philadelphia, 1916.

CHAPTER I. The Normal Infant at Birth

General Appearance 17

Circulatory System 18

Digestive System 19

Respiratory System 20

Ductless Glands 20

Genito-urinary System 20

Nervous System 21

Mammary Glands 21

Temperature 21

Bathing 21

Clothing 22

Sleep 23

Exercise 24

Fresh Air 25

Vaccination 27

CHAPTER II. Normal Development of the Child

Height 30

Weight 30

Head 34

Neck 35

Spine 35

Thymus Gland 35

Thorax 36

Fetal Circulation 37

Pulse 39

Respiration 39

Temperature 40

Muscular Development 41

Nervous System 42

Special Senses 43

Stomach 44

Intestine 45 vin CONTENTS

CHAPTER VI. Congenital Malformations

Brain and Spinal Cord 72

Meningocele 72

Encephalocele 74

Hydrencephalocele 74

Acute Hydrocephalus 75

Chronic External Hydrocephalus 75

Chronic Internal Hydrocephalus 75

Caput Succedaneum 78

Cephalhematoma 78

Anencephalia 80

Hare-lip and Cleft Palate 82

Hare-lip 82

Cleft Palate 84

Congenital Malformations of the Tongue 85

Tongue-tie 85

Macroglossia 86

Congenital Diseases of the Neck 86

Fistulse of the Neck 86

Congenital Cystic Lymphangioma of the Neck 87

Congenital Torticollis 87

Congenital Malformations of the Esophagus 88

Meckel's Diverticulum 88

Hernia of the Umbilical Cord . 90

Umbilical Hernia 90

CONTEXTS IX

Congenital Dilatation of the Colon 92

Atresia of the Bowel 93

Malposition of the Bowel 95

Exstrophy of the Bladder 96

Undescended Testes; Cryptorchidism 97

Hydrocele 98

Congenital Hydrocele 98

Hydrocele of the Tunica Vaginalis 98

Encysted Hydrocele of the Cord 98

Obliteration of the Bile Ducts 99

Spina Bifida 100

Spinal Meningocele 100

Myelomeningocele 101

Myelocystocele 101

Spina Bifida Occulta « 101

Atresia of the Vagina, Labia, and Urethra 103

Hypospadias and Epispadias 104

CHAPTER VII. Diseases of the Newborn

Prenatal Paralysis 105

Xatal paralysis 106

Birth Palsies 108

Erb's Palsy (Obstetric Paralysis) 10S

Klumpke's Palsy 110

Facial Palsy Ill

Albuminuria and Uric Acid Infarction Ill

Bone Injuries 112

Asphyxia of the Newborn 112

Asphyxia Cyanotica 113

Asphyxia Pallida 113

Atelectasis 115

Mastitis 117

Icterus Neonatorum 118

Acute Septic Infection of the Newborn 120

Diseases of the Umbilicus 124

Omphalitis 124

Gangrene of the Cord 125

Gangrene of the Umbilicus 125

Umbilical Hemorrhage 125

Hemorrhage in the Newborn 126

Hemorrhagic Disease of the Newborn 126

Acute Fatty Degeneration of the Newborn (Buhl's Disease) .... 12S

Epidemic Hemoglobinuria (Winckel's Disease) 12S

Melena Neonatorum 129

Erysipelas 131

Tetanus (Trismus Neonatorum) 133

Sclerema 135

Sclero-edema 136

Achondroplasia (Chondrodystrophy — Microlelia) 138

CONTENTS

CHAPTER VIII. Infant Feeding

Cow's Milk 141

Bacteria in Milk 142

The Souring of Milk 143

The Preservation of Milk 143

Sterilization 144

Pasteurization 145

Concerning the Feeding of Sterilized, Pasteurized, or Raw Milk . . 146

Peptonization 148

Diluents 149

Water 149

Cereal Diluents 149

Alkaline Diluents 150

Condensed Milk 150

The Food Materials Used in Infant Feeding .151

Water 153

Protein 154

Fats 155

Mineral Salts 157

[Mammary Gland 159

Frequency of Breast Feeding 160

Human Milk 161

Advantages of Breast Feeding 161

Wet Nurse 165

Alexins 166

Percentage Feeding 167

Modification of Milk 167

Calculation of Percentages 172

Amount of Cream in Milk 173

Albumin Milk: Eweissmilch: Protein Milk 173

Buttermilk 174

Whey 175

Proprietary Foods 176

Meat Preparations 177

Malt Soup 178

Artificial Feeding 178

Fats 178

Milk Sugar 179

Cane Sugar 179

Starch 179

Caloric Feeding 179

Home Modification of Milk 180

Laboratory Method of Modification of Milk 181

Feeding after the Weaning Period 183

Care of Bottles and Nipples 183

CONTENTS xi

CHAPTER IX. Normal Digestion

The Oral Cavity 184

Gastric Digestion 185

Anatomical and Physiological Peculiarities 186

Absorption in the Stomach 190

Anatomical and Physiological Peculiarities of the Intestines 190

Succus Entericus 192

Absorption in the Intestines 193

Bacteria 195

Fat Indigestion 199

Protein Indigestion 201

Disturbance of Balance 205

Dyspepsia 206

Alimentary Intoxication 207

Feces 209

Composition 211

CHAPTER XIII. Diseases of the Gastro-intestinal Tract

Diseases of the Lips 246

Herpes 246

Perleche . 247

Diseases of the Tongue 248

Geographical Tongue 248

Glossitis 248

Microglossia 249

Macroglossia 249 xii • CONTENTS

Diseases of the Mouth 249

Alveolar Abscess 249

Ulcer of the Frenum 250

Bednar's Aphthae ♦ . 250

Catarrhal Stomatitis 251

Aphthous Stomatitis (Herpetic Stomatitis) 252

Thrush^Sprue 253

Ulcerative Stomatitis 255

Gangrenous Stomatitis 257

s Pyorrhea Alveolaris 260

Uvulitis .260

Diseases of the Esophagus 261

Esophagitis 261

Retro-esophageal Abscess 262

Diseases of the Stomach and Intestines 263

Vomiting 263

In Early Infancy 263

Symptomatic Vomiting 263

Cyclic Vomiting 264

Gastralgia • 266

Fat Indigestion 267

Carbohydrate Indigestion 269

Protein Indigestion . 271

Feces 273

Acute Gastric Indigestion . . . . 274

Acute Gastritis 275

Gastroduodenitis 279

Acute Gastro-enteritis — Summer Diarrhea — Summer Complaint . 279

Acute Enterocolitis 287

Cholera Infantum . . 292

Chronic Gastritis 295

Dilatation of the Stomach 299

Pylorospasm 301

Hypertrophic Pyloric Stenosis 305

Pyloric Stenosis in Older Children 308

Enteralgia, or Colic 312

Hematemesis 314

Gastric Ulcer 314

Chronic Intestinal Indigestion . . .316

Chronic Ileocolitis 320

Intussusception 323

Chronic Constipation 326

Incontinence of Feces 330

Diarrhea ' . 331

Intestinal Bacteria 332

Mucous Colitis 333

Amyloid Disease of the Intestines 334

Intestinal Obstruction 334

Volvulus 335

Gangrenous Appendicitis 338

Chronic Appendicitis 339

CONTENTS xiii

Diseases of the Stomach and Intestines —

Int&stinal Worms 341

Cestodes 341

Taeniae, or Tapeworms 341

Taenia Solium, or Pork Tapeworm 342

Taenia Mediocanellata, or Beef Tapeworm 342

Bothriocephalus Latus, or Fish Tapeworm .... 342

Dwarf Tapeworm — Taenia Nana 342

Nematodes 344

Oxyuris Vermicularis — Threadworm 344

Ascaris Lumbricoides — Roundworm 346

• Trichocephalus Dispar 347

Ankylostomum Duodenale — Hookworm 348

Trichina 350

Diseases of the Peritoneum 351

Acute Peritonitis 351

Chronic Peritonitis 354

Ascites 356

Inguinal Hernia 358

Diseases of the Rectum and Anus 361

Proctitis 361

Prolapse of the Rectum (Procedentia Recti) 362

Rectal Polypi 364

Hemorrhoids 365

Fissure in Ano 365

Spasm of the Anus 366

AnalFistulae 366

Ischiorectal Abscess 367

Diseases of the Liver 36S

Size and Location of the Liver 368

Bile 369

Jaundice or Icterus 369

Obstructive Jaundice 369

Hematogenic Jaundice 371

Congestion of the Liver 372

Enlargement of the Liver 373

Congenital Acholuric Jaundice 373

Congenital Obliteration of the Bile Ducts 375

Stenosis of the Bile Ducts 376

Acute Yellow Atrophy of the Liver 376

Cholelithiasis 378

Abscess of the Liver 378

Subphrenic Abscess 379

Functional Disorders of the Liver 380

Cirrhosis of the Liver 381

Amyloid Liver 3S4

Fatty Liver 385

Tuberculosis of the Liver 386

Syphilis of the Liver 3S7

Tumors of the Liver 388

Cysts of the Liver 389

Diseases of the Pancreas 389

Acute Pancreatitis 3S9

Chronic Pancreatitis 390

Tuberculosis of the Pancreas 390 xiv CONTENTS

CHAPTER XIV. Diseases of the Respiratory Tract

Anomalies 391

Diseases of the Nasopharynx 391

Acute Rhinitis 391

Chronic Rhinitis 394

Atrophic Rhinitis «... 395

Purulent Rhinitis 395

Epistaxis 395

Adenoids 396

Diseases of the Larynx 400

Acute Laryngitis (False Croup — Spasmodic Croup) 400

Edema of the Larynx (Glottis) and the Submucous Membrane . . . 402

Serous Infiltration . 402

Inflammatory Edema 403

Laryngismus Stridulus (Child-crowing) . *. 404

Congenital Laryngeal Stridor 405

New Growths of the Larynx 406

Foreign Bodies in the Larynx, the Trachea, and the Bronchi . . . 407

Diseases of the Bronchi 408

Diseases of the Lungs 414

Lobar Pneumonia 414

Diseases of the Pleura 430

Pleurisy — Serous and Purulent 430

Reflex Cough . 438

Asthma 439

Abscesses of the Lung 442

Gangrene of the Lung 442

Acquired Atelectasis, or Pulmonary Collapse 443

Emphysema 444

CHAPTER XV. Diseases op the Heart

The Heart . • 445

The Pulse 446

The Apex Beat 446

Murmurs 447

1. Pulmonary Systolic Murmurs 448

2. Cardiopulmonary Murmurs 448

3. Intracardiac Murmurs 449

Congenital Diseases of the Heart 450

I. Abnormal Persistence of Fetal Conditions 452

II. Deformities of Valves 453

III. Abnormalities of Vessels and of the Cavities of the Heart . . 454

Physical Examination in Diseases of the Heart 454

Palpation 455

Percussion 455

Auscultation 456

CONTENTS XV

The General Symptoms of Heart Disease 456

Acute Endocarditis 457

Chronic Endocarditis, or Acquired Valvular Disease 461

Acute Pericarditis 465

Adherent Pericarditis 467

Myocarditis 469

CHAPTER XVI. Diseases of the Blood

The Blood in Infancy and Childhood 172

Physical Properties 472

Hemoglobin 472

Red Cells 472

Leukocytes 473

Blood Platelets 475

Blood Dust 475

Anemia 475

Secondary, orSimple, Anemia 475

The Primary Anemias 476

Chlorosis 476

Pernicious Anemia 478

Leukemia 479

Pseudoleukemia of Infants (von Jaksch) 481

Splenic Anemia (Banti's Disease) 483

Lymphatic Anemia (Pseudoleukemia: Hodgkin's Disease) 484

Hemophilia (Bleeder's Disease) 487

Purpura 489

Purpura Simplex 490

Purpura Hemorrhagica 491

Purpura Rheumatica 492

Henoch's Purpura 492

CHAPTER XVII. Diseases of the Ductless Glands

Splenitis ■ 493

Perisplenitis 494

Abscess of the Spleen 494

Wandering Spleen 494

Primary Splenomegaly 495

New Growths of the Spleen 495

Diseases of the Lymph Glands 495

Simple Acute Adenitis 495

Simple Chronic Adenitis 497

Tuberculous Adenitis 498

Diseases of the Thymus Gland 499

Atrophy of the Thymus 504

Enlargement of the Thymus 504

Status Lymphaticus 507 xvi CONTENTS

Diseases of the Thyroid Gland 508

Goitre 508

Exophthalmic Goitre (Graves's Disease) 509

Cretinism 510

Diseases of the Adrenal Glands 514

Addison's Disease 514

The Pineal Gland 516

The Pituitary Gland . 516

CHAPTER XVIII. Diseases of the Bones and Joints

Acute Infectious Osteomyelitis 517

Tuberculosis of Bones - ' . 518

Syphilis of Bones 519

Dactylitis 520

Craniotabes ' 521

Bossing of the Skull 522

Acute Arthritis of Infants 522

Tuberculosis of Joints > ■ . • • • • 523

CHAPTER XIX. Diseased op the Genito-tjrinary System

Diseases of the Kidney 525

Hematuria 526

Hemoglobinuria 527

Functional Albuminuria (Postural, Cyclic, and Orthotic Albuminuria) 527

Paroxysmal Albuminuria '. . 528

Lithuria 528

Acetonuria 529

Indicanuria 530

Glycosuria 530

Fehling's Test 531

Pyuria 531

Dysuria 532

Anuria 532

Retention of Urine ■ 533

Polyuria 534

Enuresis 534

Acute Congestion of the Kidneys 539

Nephritis in Infancy 539

Acute Diffuse Nephritis 541

Chronic Nephritis 547

Chronic Parenchymatous Nephritis 548

Perinephritis 551

Tuberculosis of the Kidney 553

Renal Calculi 554

Tumors of the Kidneys 555

Congenital Cystic Kidney 557

Hydronephrosis 561

Movable Kidney 562

CONTENTS xvn

Diseases of the Bladder 563

Pyelitis 503

Cystitis 567

Vesical Spasm 568

Vesical Calculi (Urethral Calculi) 569

Urethritis 570

Specific Urethritis 570

Diseases of the Reproductive Organs 571

Phimosis 571

Paraphimosis 572

Balanitis 572

Torsion of the Spermatic Cord 572

Acute Orchitis 573

Tuberculous Orchitis 573

Tumors of the Testicle 574

Simple Vulvovaginitis 575

Gonorrheal Vulvovaginitis 576

Gangrene of the Vulva 580

Vicarious Menstruation 581

Menstruation Precox 581

Masturbation 582