A practical treatise on disease in children

Front matter

\ A v x ,

A

PRACTICAL TREATISE

Preface

It was not without hesitation that the author consented to the proposal made to him by Messrs. Wood & Company, of New York, that he should write for them a complete Treatise on the Diseases of Infancy and Childhood. The length of time which would be required for the completion of a task so considerable, and, especially, the knowledge that many manuals of varying merit were already in the field, indisposed him to attempt a work which must necessarily prove not only long but laborious. Encouraged, however, by the reflection that his opportunities for studying these complaints had been abundant ; that in the course of more than twenty years he had acquired a mass of valuable material, and that of existing books few dealt with more than a part of the subject, he thought himself justified in believing that a treatise which undertook to discuss the whole subject of disease in early life, and to deal with the matter purely from a clinical stand-point, might not be without its uses.

The constitutional peculiarities of childhood, and the weakness due to immaturity, so shape the course and symptoms of disease that there are few complaints which do not assume special features when present in the young. Consequently the author has not hesitated to admit into his pages descriptions of every form of illness which is capable of being influenced in its manifestations by the early age of the patient. Those only have been purposely omitted which, like diabetes, present exactly the same characters in the child that they do in the adult.

Each subject has been treated as fully as the space would allow, but many faults of omission may, no doubt, be discovered. The author, however, has striven to satisfy all clinical requirements, and where much must be left out, that the book may be kept within reasonable limits, has been anxious to omit nothing of real value to the practitioner.

In the composition of the work the use of statistics has been generally avoided, for unless dealing with enormous numbers little that is

VI PEEFACE.

trustworthy can be obtained from this method of inquiry. In fact, there can be little doubt that very erroneous impressions have been sometimes derived from statistical calculation based upon an insufficient number of cases.

In order to increase the usefulness of the book, much care has been bestowed upon the sections relating to diagnosis and treatment. 'No attempt, however, has been made to include in the directions for treatment an enumeration of all the remedies which have been suggested for the cure of the several forms of illness. Such excess of detail not only fills the page with information often of doubtful value, but tends rather to confuse the reader than to instruct him. Moreover, it gives to this branch of therapeutics an importance which, in the case of children, it does not always possess. In the case of a young patient, judgment in feeding and care in sanitary arrangements not seldom constitute the sole necessary treatment of the illness. Quiet, rest, appropriate food, and plenty of fresh air will often restore the health without the aid of physic ; or if physic seem called for, the remedies needed are simple and few. But whatever be the nature of the malady, and however elaborate may be the medication required, the details of nursing should always take precedence of those of drug-giving. Keeping this truth in view, the author has been careful to give due prominence to the subjects of diet and hygiene ; and in the matter of drugs has confined himself, for the most part, to recommending those only which experience has taught him to value, and upon which, therefore, he has himself been accustomed to rely.

For purposes of illustration a number of concisely narrated cases have been introduced into the text. Most of these have been selected from the author's case-books, but a few are taken from the practice of his hospital colleagues. To these colleagues, for their kindness in placing their cases at his disposal, the author desires to express his deep obligations.

George Street, Hanover Square, June, 1884.

Table Of Contents

PAGE

Introductoky Chapter 1

Physiological peculiarities of early life, 1 ; causes of sudden death, 5 ; convalescence, 5 ; definition of infancy and early childhood, 5 ; clinical examination of infants, 6 ; inspection of the face, 6 ; attitude, 8 ; cry, 8 ; absence of cry, 9 ; the pulse, 9 ; the respirations, 10 ; the temperature, 10 ; pyrexia from rapid growth, 11 ; movements of the chest and belly in breathing, 12 ; inspection of the mouth and throat, 13 ; treatment, 14 ; forced feeding, 14 ; reducing temperature, 15 ; baths, 16 ; internal remedies, 18 ; abuse of aperients, 19.

CHAPTER I. Measles 21

The contagious principle, 21 ; morbid anatomy, 22 ; symptoms, 22 ; pre-eruptive period, 22 ; the rash, 23 ; catarrh, 23 ; asthenic measles, 24 ; relapses, 24 ; complications, 25 ; sequelae, 26 ; diagnosis, 26 ; prognosis, 27 ; treatment, 28.

Chapter II

Epidemic Roseola „ „ . . . . . . „ .„, B 30

Symptoms, 30 ; diagnosis, 31 ; treatment, 31.

CHAPTER HL Scarlet Fever , 32

Causation, 32 ; morbid anatomy, 33 ; symptoms, 33 ; invasion, 34 ; eruptive stage, 34 ; the rash, 34 ; temperature, 35 ; the desquamative stage, 36 ; malignant scarlet fever, 36 ; complications and sequelae, 37 ; scarlatinous rheumatism, 38 ; albuminuria and uraemic symptoms, 39 ; latent scarlet fever, 40 ; diagnosis, 41 ; prognosis, 42 ; illustrative case, 42 ; treatment,

CHAPTER VII. Mumps 65

Morbid anatomy, 65 ; symptoms, 65 ; incubation, 65 ; temperature, 65 ; metastasis, 66 ; deafness, 66 ; diagnosis, 67 ; treatment, 67.

CHAPTER VHI.

Cerebro-spinal Fever 68

Causation, 68 ; morbid anatomy, 68 ; symptoms, 69 ; rash, 69 ; nervous symptoms, 69 ; temperature, 70 ; paralysis, 70 ; convulsions, 70 ; varieties, 71 ; form in infancy, 71 ; diagnosis, 72 ; prognosis, 73 ; treatment, 73.

CHAPTER IX. Enteric Fever

Causation, 74 ; morbid anatomy, 75 ; symptoms, 76 ; first week, 76 ; second week, 77 ; third week, 77 ; digestive organs, 78 ; the urine, 78 ; special senses, 79 ; temperature, 79 ; duration, 80 ; case, 80 ; mode of death, 81 ; relapses, 82 ; secondary pyrexia, 82 ; convalescence, 82 ; diagnosis, 83 ; prognosis, 84 ; treatment, 85.

CHAPTER X. Diphtheria

Diphtheria and croup, 88 ; causation, 90 ; morbid anatomy, 91 ; symptoms, 93 ; mild form, 93 ; severe form, 94 ; albuminuria, 95 ; laryngeal diphtheria, 95 ; dyspnoea, 96 ; malignant form, 97 ; case, 97 ; secondary diphtheria, 97 ; complications, 97 ; nasal diphtheria, 98 ; cutaneous diphtheria, 98 ; inflammatory complications, 98 ; thrombosis of heart, 98 ; cardiac dyspnoea, 98 ; apncea from laryngeal obstruction, 99 ; sudden death, 99 ; paralysis, 99 ; diagnosis, 100 ; prognosis, 102 ; treatment, general, 103 ; local, 104 ; tracheotomy, 105.

Chapter XI. Erysipela8 109

Causation, 109 ; morbid anatomy, 110 ; symptoms, 111 ; rash, 111 ; fever, 111 ; complications, 111 ; diagnosis, 112 ; prognosis, 112 ; treatment, 113.

CHAPTER XII. Whooping-cough , f , . . . 114

Causation, 114 ; duration of infection, 114 ; pathology, 114 ; nature of the disease, 115 ; symptoms, 115 ; the cough, 116 ; the whoop, 116 ; haemorrhages, 116; complications, 117; ulceration of tongue, 117; bleeding from ears, etc., 118; digestive troubles, 118; nervous accidents, 118; pulmonary lesions, 119 ; sequelae, 120 ; diagnosis, 122 ; prognosis, 123 ; treatment, 124; of complications, 127.

CONTENTS. IX

Jkrt 2.

GEJSTEEAL DISEASES NOT INFECTIOUS.

CHAPTER I. p AGE

Rickets . 129

Causation, 129; bad feeding, 129 ; bad air, 130; relation to syphilis, 131 ; relation to tuberculosis, 131 ; nature, 131 ; morbid anatomy, 132 ; ossification of bone, 132 ; softening of bones, 133 ; changes in internal organs, 133 ; the urine, 134; effects of bone changes, 134 ; on the contents of the chest cavity, 134; relation to osteo-malacia, 135; "congenital rickets," 135 ; symptoms, 136 ; distortion of bones, 137 ; chest, 139 ; spine, 139 ; long bones, 140 ; general nutrition, 140 ; complications, 142 ; diagnosis, 143 ; prognosis, 143 ; treatment, 144.

CHAPTER II.

Ague 147

Causation, 147 ; morbid anatomy, 147 ; symptoms, 148 ; the cold stage, 14S ; the hot stage, 148 ; the sweating stage, 148 ; stages often ill developed, 148 ; temperature, 149 ; urine, 149 ; malignant form, 149 ; anaemia, 149 ; hematuria, 149 ; diagnosis, 149 ; prognosis, 150 ; treatment, 151 ; hypodermic injection of quinine, 151.

CHAPTER III.

Acute Rheumatism 153

Frequency in children, 153 ; causation, 153 ; morbid anatomy, 154 ; symptoms, 154 ; inflammation of joints, 155 ; pericarditis, 155 ; fewness of its symptoms, 155 ; illustrative case, 155 ; occasional severity of symptoms, 155 ; pericardial friction, 156 ; effusion, 156 ; elevation of heart's apex,

157 ; illustrative case, 157 ; suppurative pericarditis, 157 ; endocarditis,

158 ; ulcerative endocarditis, 158 ; pleurisy, 158 ; illustrative case, 158 ; pneumonia, 159 ; hyper-pyrexia, 159 ; rheumatism of abdominal wall,

159 ; fibroid nodules, 160 ; duration, 160 ; relapses, 160 ; chronic rheumatic pains, 161 ; diagnosis, 161 ; of pericarditis, 161 ; endocarditis, 162 ; ulcerative endocarditis, 162 ; prognosis, 162 ; occasional disappearance of cardiac murmurs, 163 ; treatment, 163 ; salicylate of soda, 164 ; importance of rest, 165.

CHAPTER IV.

Spontaneous Gangrene 166

Pathology, 166 ; morbid anatomy, 167 ; symptoms, 167 ; disseminated form, 168 ; illustrative cases, 168 ; gangrene of extremities, 169 ; dry and moist varieties, 169 ; of vulva, 170 ; diagnosis, 170 ; prognosis, 171 ; treatment, 171.

JJort 3.

THE DIATHETIC DISEASES.

CHAPTER I. Scrofula 173

Causation, 173 ; hereditary tendency, 173 ; exciting causes, 174 ; morbid anatomy, 174 ; caseation of glands, 175 ; symptoms, 175 ; variety of the lesions, 176 ; cutaneous abscesses, 177 ; disease of bones and joints, 178 ; of the spine, 178 ; caseation of glands, 179 ; of cervical glands, 179 ; of bronchial glands, 180; its consequences, 181 ; asthmatic attacks, 182; alteration in physical signs, 182 ; of mesenteric glands, 183 ; its consequences, 184 ; diagnosis, 185 ; prognosis, 186 ; treatment, 187.

X * CONTENTS.

CHAPTER II. page

Acute Tuberculosis 190

Three forms, 190 ; causation, 190 ; hereditary tendency, 190 ; acute specific diseases, 191 ; the tubercle bacillus, 191 ; morbid anatomy, 191 ; the gray granulation, 192 ; the giant cell, 192 ; lung changes, 193 ; lesions of intestines, 193 ; of the spleen, 193 ; of the bladder, 193 ; nature of cheesy matter, 194 ; symptoms, 194 ; gradual onset, 194 ; temperature, 195 ; oedema of legs, 195 ; local symptoms, 195 ; in brain, 195 ; in lung, 196 ; illustrative case, 196 ; in bladder, 197 ; in other organs, 197 ; duration, 198 ; diagnosis, 198 ; from gastric catarrh, 198 ; from infantile atrophy, 199 ; of pulmonary complication, 199 ; of tubercle of bladder, 199 ; prognosis, 200 ; treatment, 200.

CHAPTER III. Infantile Syphilis 202

Causation, 202; influence of the father and mother, 202; Colles's law, 202 ; acquired syphilis, 203 ; morbid anatomy, 203 ; affection of mucous membranes, 204 ; of solid organs, 204 ; of bones, 206 ; two varieties, 206 ; Parrot's views, 206 ; dactylitis, 207 ; affection of bones of skull, 207 ; cranio-tabes, 208 ; symptoms, 208 ; snuffling, 209 ; rash, 209 ; complexion, 209 ; affection of hair and nails, 210 ; the cry, 210 ; thickening of the bones, 210 ; pseudo-paralysis, 210 ; true paralysis, 210 ; general nutrition, 210; relapses, 211 ; sequelae, 211; diagnosis, 211 ; prognosis, 213 ; treatment, 213.

flart 4.

DISEASES OF THE DUCTLESS GLANDS AND BLOOD.

CHAPTER I. ' Leucocythemia .' 216

Causation, 216 ; morbid anatomy, 216 ; symptoms, 217 ; enlargement of spleen, 217; anaemia, 217; temperature, 218; hemorrhages, 218; enlargement of glands, 218 ; diagnosis, 218 ; from enteric fever, 218 ; from lymphadenoma, 219 ; prognosis, 219 ; treatment, 219.

CHAPTER II. Lymphadenoma 220

Causation, 220 ; morbid anatomy, 220 ; changes in lymphatic glands, 221 ; in spleen, 221 ; in liver, 222 ; kidneys, 222 ; adenoid new growtbs, 222 ; blood, 222 ; symptoms, 222 ; regular, 223 ; illustrative case, 223 ; glandular swellings, 224 ; temperature, 224 ; cachectic stage, 224 ; anaemia, 224 ; early local symptoms, 225 ; illustrative case, 225 ; accidental symptoms, 226 ; pressure signs, 226 ; paralysis, 226 ; illustrative case, 226 ; diagnosis, 227 ; prognosis, 227 ; treatment, 227.

CHAPTER III. Anaemia 229

Frequency of impoverishment of the blood in children, 229 ; reasons for this, 229 ; use of the blood in nutrition, 230 ; causation, 230 ; two classes, 230 ; morbid anatomy, 231 ; idiopathic anaemia, 232 ; symptoms, 232 ; complexion, 232 ; breatlilessness, 232 ; anaemic murmurs, 233 ; epistaxis, 233 ; headache, 233 ; symptoms of idiopathic anaemia, 233 ; diagnosis, 233 ; prognosis, 234 ; treatment, 234 ; diet, 234 ; attention to general hygiene, 234 ; iron, 235 ; arsenic, 235 ; cold-water packing and massage, 236.

CONTENTS. XI

Chapter IV. Pagb

Enlargement op the Spleen 237

Causation of splenic enlargement, 237 ; simple hyperplasia, 238 ; morbid anatomy, 238 ; symptoms, 238 ; anaemia, 238 ; oedema, 238 ; the blood, 239 ; cases, 239 ; gastro-intestinal troubles, 239 ; diagnosis, 240 ; prognosis, 240 ; treatment, 240 ; abuse of mercurial frictions, 241.

CHAPTER V. Hemophilia 242

Causation, 242 ; morbid anatomy, 242 ; symptoms, 243 ; three grades, 243 ; haemorrhages, 243 ; joint auction, 244 ; .diagnosis, 245 ; prognosis, 245 ; treatment, 245.

CHAPTER VL

Purpura 247

Two varieties, 247; causation, 247; morbid anatomy, 247; pathology, 248; symptoms, 248 ; eruption, 248 ; illustrative case, 249 ; pains in limbs, 249 ; haemorrhagic purpura, 249 ; various haemorrhages, 249 ; purpura rheumatica, 249 ; anaemia, 250 ; temperature, 250 ; illustrative case, 250 ; oedema, 250 ; cerebral haemorrhage, 251 ; convulsions, 251 ; course, 251 ; diagnosis, 251 ; prognosis, 251 ; treatment, 251.

CHAPTER VII. Scurvy 258

Causation, 253 ; morbid anatomy, 254 ; periosteal extravasation, 254 ; pathology, 255 ; symptoms, 255 ; tenderness, 256 ; swelling, 256 ; petechiae, 256 ; separation of epiphyses, 256 ; the gums, 256 ; cachexia, 256 ; temperature, 257 ; course, 257 ; diagnosis, 257 ; prognosis, 258 ; treatment, 258.

JJart 5.

DISEASES OF THE NEKYOUS SYSTEM.

CHAPTER I. General -Considerations 260

Excitability of the nervous system in early life, 260 ; value of various symptoms, 261 ; squint, 261 ; nystagmus, 261 ; state of the pupils, 261 ; delirium, 262 ; drowsiness, 262 ; loss of consciousness, 262 ; changes of temper, 262 ; tremours, 263 ; spasms, 263 ; paralysis, 263 ; aphasia, 263 ; rigidity, 264 ; retraction of head, 264 ; vomiting, 264 ; the breathing, 264 ; the pulse, 265 ; cerebral flush, 265 ; the urine, 265 ; hysterical symptoms, 265.

CHAPTER II. Laryngismus Stridulus 267

Causation, 267 ; association with rickets, 267 ; pathology, 268 ; exciting causes,

268 ; illustrative case, 268 ; symptoms, 269 ; description of the seizure,

269 ; duration of attacks, 269 ; illustrative case, 269 ; spasm limited to glottis, 270 ; characters of the spasm in new-born infants, 270 ; mode of death, 270 ; incarceration of epiglottis, 271 ; diagnosis, 271 ; prognosis, 272 ; treatment, 272 ; ammonia, 272 ; cold bathing, 272 ; fresh air, 272 ; antispasmodics, 273 ; tonics, 273.

Xll CONTENTS.

Chapter III. Page

Tonic Contraction of the Extremities 274

Usually associated with laryngismus stridulus and reflex convulsions, 274 ; not uncommon in the subjects of rickets, 274 ; symptoms, 274 ; pain, 274 ; contraction of muscle, 274 ; usual seat, 274 ; influence of manipulation, 275 ; is usually bilateral, 275 ; if severe, persists during sleep. 275 ; sensation unaffected, 275 ; diagnosis, 275 ; prognosis, 276 ; treatment, 276.

CHAPTER IV. Convulsions a . 277

Common during the first two years of life, 277 ; causation, 278 ; symptoms 279 ; description of a paroxysm, 279 ; drowsiness, 280 ; temporary paral ysis, 280 ; congestion of brain, 280 ; illustrative case, 280 ; diagnosis, 281 from cerebral convulsions, 281 ; from epilepsy, 282 ; prognosis, 283 ; in fluence on brain development, 283 ; treatment, 284 ; warm bath, 284 chloral r 284 ; nitrite of amyl, 285 ; stimulants, 285 ; tonics, 285.

CHAPTER V. Epilepsy . . „ 286

Causation, 286 ; hereditary tendency, 286 ; injuries, 286 ; a fit of convulsions, 286 ; illustrative case, 286 ; pathology, 287 ; symptoms, 288 ; epilepsia gravior, 288 ; epilepsia mitior, 288 ; a fit of epileptic vertigo, 288 ; illustrative case, 289 ; frequency of attacks, 289 ; association with chorea, 290 ; diagnosis, 290 ; from syncope, 290 ; from hysterical fits, 290 ; prognosis, 291 ; treatment, 291 ; general attention to health, 291 ; diet, 292 ; the bromides, 292 ; strychnia, 292 ; nitrite of amyl, 293.

CHAPTER VI. Megrim 294

Causation, 294 ; pathology, 294 ; symptoms, 295 ; headache, 295 ; impairment of sight, 295 ; of other senses, 295 ; illustrative case, 296 ; pains in limbs, 296 ; illustrative case, 296 ; diagnosis, 296 ; treatment, 297 ; strychnia and ergot, 297.

CHAPTER VII. Chorea 299

Causation, 299 ; association with rheumatism, 299 ; pathology, 300 ; various theories, 300 ; symptoms, 301 ; disordered movements, 301 ; inco-ordination of voluntary movement, 302 ; sleeplessness, 302 ; sensory disturbances, 302 ; hemichorea, 302 ; the urine, 303 ; mental state, 303 ; temperature, 303 ; weakness of muscle, 303 ; heart murmurs, 304 ; course and duration, 304 ; diagnosis, 304 ; prognosis, 304 ; treatment, 305 ; hygiene, 305 ; moral treatment, 305 ; drugs, 305 ; massage, 306.

CHAPTER VIII. Idiopathic Tetanus ; 308

In infants, rare in England, 308 ; causation, 308 ; influence of general unsanitary conditions, 309 ; morbid anatomy, 309 ; symptoms, 310 ; difficulty of swallowing, 310 ; stiffness of jaws, 310 ; temperature, 310 ; attacks of spasm, 310; tonic rigidity, 310; illustrative case, 310; duration, 311; tetanus in older children, 311 ; illustrative case, 311 ; diagnosis, 312 ; from strychnia poisoning, 312; prognosis, 312; treatment, 313; forced feeding, 313 ; Calabar bean, 313 ; chloral, 313 ; illustrative case, 314.

CONTENTS. Xlll

Chapter IX. Pagb

Congestion of the Brain 316

Circulation of blood in the brain, 316 ; causation, 316 ; two forms, 316 ; relation to dentition, 316 ; and convulsions, 317 ; minute embolisms, 317 ; morbid anatomy, 317 ; symptoms, 318 ; irritative stage not clinically recognisable, 318 ; the common form, 318 ; illustrative case, 318 ; thrombosis of cerebral sinuses, 319 ; diagnosis, 319 ; prognosis, 320 ; treatment, 321.

CHAPTER X. Cerebral Haemorrhage. 322

Only common in still-born children, 322 ; causation, 322 ; sometimes the result of aneurism of a cerebral artery, 322 ; morbid anatomy, 322 ; meningeal haemorrhage, 323 ; cerebral haemorrhage, 323 ; cause of aneurism, 323 ; symptoms, 324 ; of meningeal haemorrhage, 324 ; low temperature, 324 ; stupor and convulsions, 324 ; resemblance to simple meningitis, 325 ; illustrative case, 325 ; cerebral haemorrhage, 326 ; illustrative case, 326 ; haemorrhage from rupture of aneurism, 327 ; illustrative case, 327 ; diagnosis, 328 ; prognosis, 329 ; treatment, 329.

CHAPTER XL

Cerebral Tumour , „ . . „ 330

Cerebral growth usually tubercular, 330 ; morbid anatomy, 330 ; varieties of growths, 331 ; symptoms, 331 ; headache, 332 ; convulsions, 332 ; loss of special sense, 332 ; ophthalmoscopic appearances, 332 ; illustrative case, 333 ; gliomatous tumour, 333 ; tubercular growth, 335 ; illustrative case, 335 ; two stages often seen, 336 ; illustrative case, 336 ; cerebellar tumour, 337 ; characteristic symptoms, 337 ; other seats, 337 ; diagnosis, 337 ; prognosis, 339 ; treatment, 339.

CHAPTER XII. Chronic Hydrocephalus 340

Causation, 340 ; morbid anatomy, 341 ; effect of pressure on the brain and skull, 341 ; symptoms, 342 ; distention of skull, 342 ; imperfect nutrition, 343 ; intelligence, 343 ; nervous symptoms, 343 ; illustrative case, 343 ; the acquired form, 344 ; spontaneous evacuation of fluid, 344; diagnosis, 345 ; prognosis, 345 ; treatment, 345.

CHAPTER XIII. Otitis and its Consequences 346

Extension of inflammation from the tympanum to the skull cavity, 346 ; causation, 346 ; morbid anatomy, 347 ; symptoms, 348 ; extension of inflammation to the meninges, 348 ; purulent meningitis, 349 ; temperature, 349 ; convulsions, 349 ; illustrative case, 349 ; phrenitic form, 350 ; delirium, 350 ; temperature, 350 ; thrombosis of the cerebral sinuses, 351 ; encephalitis, 351 ; convulsions, 351 ; stupor, 351 ; paralysis, 351 ; illustrative case, 352; diagnosis, 352; prognosis, 354; treatment, 354.

CHAPTER xiy.

Tubercular Meningitis 355

Common at all ages of childhood, 355 ; causation, 355 ; morbid anatomy. 356; symptoms, 357 ; premonitory, 357 ; two forms, 357 ; primary meningitis, 357 ; three stages, 358 ; first stage, 358 ; second stage, 359 ; third stage, 360 ; duration of illness, 361 ; secondary meningitis, 361 ; common in infants, 362 ; anomalous cases, 362 ; diagnosis, 362 ; illustrative case, 363 ; prognosis, 365 ; treatment, 365.

Xiv CONTENTS.

Chapter XV. Page

Paralysis of the Portio Dura 367

Course of the facial nerve in the Fallopian canal, 367 ; causation of the paralysis, 367 ; symptoms, 368 ; illustrative case, 368 ; diagnosis and prognosis, 369 ; treatment, 370.

CHAPTER XVI. Acute Infantile Spinal Paralysis 371

Causation, 371 ; morbid anatomy, 372 ; symptoms, 373 ; onset, 373 ; completeness of the paralysis, 374 ; rapid limitation of the paralyzed area, 374 ; wasting of muscles, 375 ; stage of contraction, 375 ; mechanism of the deformities, 375 ; diagnosis, 377 ; prognosis, 377 ; treatment, 378.

CHAPTER XVII. Spasmodic Spinal Paralysis 380

Morbid anatomy, 380 ; symptoms, 380 ; rigidity of joints, 381 ; diagnosis, 382 ; prognosis, 382 ; treatment, 382.

CHAPTER XVIII. Pseudo-hypertrophic Paralysis 384

Causation, 384 ; morbid anatomy, 384 ; symptoms, 385 ; enlargement of muscles, 385 ; progressive weakness, 385 ; occasional atrophy of muscle, 386 ; contractions, 386 ; course, 387 ; diagnosis, 387 ; prognosis, 388 ; treatment, 388.

CHAPTER XIX. Idiocy 2

Causation, 389 ; morbid anatomy, 390 ; classification, 391 ; symptoms, 391 ; cretinism, 392 ; illustrative cases, 393 ; degrees of mental development,

394 ; diagnosis, 395 ; development of the senses in the healthy infant,

395 ; prognosis, 396 ; treatment, 397.

Jkvt 6.

DISEASES OF THE OKGANS OF KESPIEATIOK

CHAPTER I. Examination of the Chest 399

Position of the patient during examination, 399 ; inspection, 399 ; shape of the chest, 400 ; movements in respiration, 400 ; retraction of the chest, 400 ; enlargement, 401 ; palpation. 401 ; vocal fremitus, 401 ; friction fremitus, 401 ; site of apex-beat of heart, 401 ; causes of its displacement, 402 ; level of the liver and spleen, 402 ; percussion, 402 ; degree of resistance, 403 ; auscultation, 403 ; conduction of sounds, 4C4.

CHAPTER II. Laryngitis 406

Simple laryngitis, 406 ; causation, 406 ; morbid anatomy, 406 ; mild form, 407 ; severe form, 407 ; illustrative case, 408 ; chronic laryngitis, 408 ; diagnosis, 408 ; case of hysterical aphonia, 409 ; prognosis, 410 ; treatment, 410 ; stridulous laryngitis, 411 ; causation, 411 ; morbid anatomy,

411 ; symptoms, 412 ; dyspnoea, 412 ; croupy cough, 412 ; temperature,

412 ; illustrative case, 412 ; carpo-pedal contractions, 413 ; diagnosis, 413 ; prognosis, 414 ; treatment, 414 ; tubercular laryngitis, 415 ; causation, 415 ; symptoms, 416 ; illustrative case, 416 ; diagnosis, 417 ; case of warty growths on larynx, 417 ; prognosis, 418 ; treatment, 418.

CONTENTS. XV

Chapter III. Page

Suppuration about the Larynx 419

Causation, 419 ; morbid anatomy, 419 ; symptoms, 419 ; ortliopnoea, 419 ; suppressed voice, 420 ; diagnosis, 420 ; prognosis, 421 ; treatment, 421.

CHAPTER IV. Croupous Pneumonia , 422

Causation, 422 ; nature of the disease, 422 ; sometimes secondary, 423 ; morbid anatomy, 423 ; symptoms, 424 ; onset, 424 ; temperature, 424 ; cough, 424 ; muscular weakness, 425 ; nervous symptoms, 425 ; illustrative case, 426 ; breathing, 426 ; pulse-respiration ratio, 426 ; digestive organs, 426 ; urine, 426 ; pyrexia, 426 ; occasional dyspnoea, 427 ; physical signs, 427 ; their seat, 428 ; terminations, 428 ; resolution. 428 ; abscess of the lung,

429 ; latent form of pneumonia, 429 ; complications, 430 ; plastic pleurisy,

430 ; pericarditis, 43l> ; jaundice, 430 ; diagnosis, 430 ; prognosis, 431 ; treatment, 432 ; diet, 432 ; reduction of pyrexia, 432 ; tepid bathing, 432 ; quinine, 432 ; value of bleeding, 433 ; stimulants, 433.

CHAPTER V. Catarrhal Pneumonia 434

Causation, 434 ; morbid anatomy, 434 ; symptoms, 436 ; always secondary to pulmonary catarrh, 436 ; temperature, 436 ; pulse-respiration ratio, 437 ; breathing, 437 ; cough, 437 ; physical signs, 437 ; terminations, 438 ; subacute course, 438 ; complications, 439 ; diagnosis, 439 ; from croupous pneumonia, 440 ; exclusion of tuberculosis, 440 ; acute dilatation of bronchi, 441 ; prognosis, 441 ; treatment, 441 ; tepid bathing, 441 ; counter-irritation of chest, 442 ; stimulants, 442 ; diet, 442 ; emetics, 442 ; iron, 443.

CHAPTER VI. Pleurisy 444

Causation, 444 ; morbid anatomy, 444 ; characters of effusion, 445 ; symptoms, 445 ; onset, 445 ; pyrexia, 446 ; pain, 446 ; complexion, 446 ; empyema, 447 ; physical signs, 447 ; inspection, 447 ; percussion, 448 ; auscultation, 449 ; friction-sound, 449 ; occasional symptoms, 449 ; spontaneous evacuation, 450 ; perforation of bronchus, 450 ; illustrative case. 451 ; varieties, 451 ; plastic pleurisy, 452 ; loculated form, 452 ; tuberculous form, 452 ; complications, 453 ; diagnosis, 453 ; from croupous pneumonia, 453 ; from catarrhal pneumonia, 454 ; from collapse of lung, 454 ; of empyema, 455 ; of hydrothorax, 455 ; prognosis, 455 ; treatment, 456 ; iodide of potassium, 456 ; aspiration, 457 ; illustrative case, 457 ; causes of sudden death, 458 ; use of the drainage-tube, 459 ; resection of rib, 460 ; diet, 460.

CHAPTER YIL

Collapse of the Lung 461

Two varieties, 461 ; congenital atelectasis, 461 ; morbid anatomy, 461 ; symptoms. 462 ; prostration, 462 ; lividity, 462 ; temperature, 462 ; feeble respiration, 462 ; trifling physical signs, 462 ; drowsiness, 462 ; signs of recovery sometimes deceptive, 463 ; diagnosis, 463 ; prognosis, 463 ; treatment, 463 ; artificial respiration, 464 ; hot bath, 464 ; counter-irritation, 464 ; stimulants, 464 ; post-natal atelectasis, 465 ; causation, 465 ; morbid anatomy, 466 ; symptoms, 467 ; lividity, 467 ; feeble, rapid breathing, 467 ; temperature, subnormal, 467 ; perverted pulse-respiration ratio, 467 ; physical signs, 467 ; symptoms during second year, 468 ; illustrative case, 469 ; diagnosis, 469 ; prognosis, 471 ; treatment, 471 ; warmth, 471 ; emetics, 471 ; stimulants, 471.

Xvi CONTENTS.

Chapter VIII. Page

Fibroid Induration of the Lung 473

Pathology, 473 ; morbid anatomy, 474 ; amyloid degenerations, 475 ; symptoms, 475 ; early stage, 475 ; physical signs oi established disease, 476 ; symptoms, 476 ; cough, 476 ; offensive sputum, 477 ; nutrition, 477 ; temperature, 477 ; hypertrophy of right ventricle of heart, 477 ; contraction of side, 477 ; fibroid phthisis, 477 ; diagnosis, 478 ; from pleurisy with retraction, 478 ; from phthisis, 478 ; prognosis, 479 ; treatment, 479 ; diet, 479 ; tonics, 480.

CHAPTER IX. Bronchitis 481

Causation, 481 ; morbid anatomy, 482 ; symptoms, 482 ; of bronchial catarrh, 483 ; the mild form, 483 ; the severe form, 483 ; capillary bronchitis, 483 ; temperature, 483 ; dyspnoea, 483 ; pulse, 484 ; physical signs. 484 ; signs of asphyxia, 484 ; chronic bronchitis, 484 ; symptoms, 485 ; illustrative case, 485 ; diagnosis, 485 ; prognosis, 486 ; treatment, 486 ; counter-irritation, 486 ; diaphoretics, 487 ; stimulant expectorants injurious at the first, 487 ; after-treatment, 488 ; treatment of chronic bronchitis, 489.

CHAPTER X. Emphysema : 491

Causation, 491 ; morbid anatomy, 492 ; two varieties, 492 ; inter-lobular and vesicular, 493 ; symptoms, only present in the vesicular form, 493 ; physical signs, 493 ; illustrative cases, 494 ; diagnosis, 494 ; prognosis, 494 ; treatment, 495.

CHAPTER XI. Gangrene op the Lung 496

Rarity in childhood, 496 ; causation, 496 ; morbid anatomy, 497 ; symptoms, 497 ; onset, gradual or sudden, 498 ; prostration and restlessness, 498 ; pulse, 498 ; respiration, 498 ; temperature, 498 ; fetid breath and expectoration, 498 ; dyspnoea, 498 ; haemoptysis, 499 ; physical signs, 499 ; illustrative case, 499 ; diagnosis, 499 ; prognosis, 500 ; treatment, 500 ; antiseptic inhalations, 500 ; stimulants, 501 ; diet, 501.

CHAPTER XII. Pulmonary Phthisis 502

Varieties, 502 ; causation, 502 ; communicability of the disease, 503 ; morbid anatomy, 504 ; acute phthisis, 505 ; symptoms, 505 ; dyspnoea, 506 ; temperature, 506 ; physical signs, 506 ; illustrative case, 506 ; mode of death, 507 ; duration, 507 ; prognosis, 507 ; chronic pneumonic phthisis, 508 ; mode of beginning, 509 ; stage of softening, 509 ; cough, 509 ; haemoptysis, 510 ; temperature, 510 ; physical signs, 510 ; ulceration of bowels,

510 ; secondary catarrhal pneumonia, 510 ; mode of death, 511 ; chronic tubercular phthisis, 511 ; wasting, 511 ; temperature. 511 ; physical signs,

511 ; advantages of removing diseased bone, 512 ; illustrative case, 512 ; occasional obscurity of physical signs, 513 ; diagnosis, 513 ; of dilated bronchi, 514 ; from empyema, 514 ; prognosis, 515 ; treatment, 516 ; preventive treatment, 516 ; treatment of acute phthisis, 516 ; reduction of temperature, 516 ; regular feeding, 517 ; treatment of chronic phthisis, 517 ; diet, 517 ; change of air, 517 ; antiseptic inhalations, 518 ; sedatives and expectorants, 518 ; necessity of attention to the digestive organs, 518.

CONTENTS. XV11

CHAPTER XIII. p AGE

Paroxysmal Dyspncea 519

Definition of dyspnoea, 519 ; causes which produce it, 519 ; obstruction of wind-pipe, 519 ; of pulmonary artery, 519 ; disease of heart, 519 ; external pressure upon lung, 519 ; by fluid in pleura, 519 ; by the atmosphere in rickets, 519 ; disease of lung, 519 ; causes of paroxysmal dyspnoea, 520 ; bronchial asthma, 520 ; its causes, 520 ; its symptoms, 521 ; its physical signs, 521 ; diagnosis, 521 ; of enlarged bronchial glands, 522 ; of foreign body in the air tubes, 523 ; of bronchial asthma, 523 ; prognosis, 524 ; treatment, 524.