Diseases of children; designed for the use of students and practitioners of medicine

Front matter

Class _SJ_4£ Book_^_S_44_

TO

COP/RIGHT DSPOSI&

Preface

This volume is the consummation of the author's experience in the field of pediatrics for nearly thirty years. It embodies the latest knowledge of the theory and practice of the diseases of infancy and childhood and is designed to meet the needs especially of the general practitioner and medical student.

The book is conveniently divided into fourteen sections, the classification of the diseases varying somewhat from that of older textbooks, so as to correspond to the modern conception of the causation of the diseases in question.

Infant feeding is based upon the most recent studies of the digestibility of proteins, fats and carbohydrates and upon the author's practical experience. The fads and fetichisms of the erratic reformer and senile reactionary are eliminated. Breast feeding is recommended in preference to bottle feeding, yet the author believes that hosts of perfectly healthy babies can be reared on cow's milk, if good judgment is applied in the selection of suitable milk mixtures. A mixed diet is advocated for infants over nine months of age and well tried formulas and diet lists are appended for infants and older children. A special dietary is also provided for mentally deficient children.

The author hopes that the chapter on examination of the patient and semeiology of disease will greatly aid especially the beginner to surmount the difficulties of diagnosis in infants and older children. The normal anatomy and physiology are contrasted with the abnormal. Prominent symptoms which several diseases have in common are analyzed in relation to their pathogenesis and the different methods of physical diagnosis are amply elucidated and illustrated. The article on the clinical significance of the large abdomen may prove of special interest to the reader.

The time for "snap diagnoses" is past. Every obscure fever can no longer be dubbed malaria, and every cold bronchitis, for the very good reason that up-to-date laymen are sufficiently educated to demand a more exact and scientific diagnosis. To meet this requirement, a careful survey is presented of the most modern methods of laboratory diagnosis, such as the Schick test, the complement-fixation reaction of tuberculosis, the tuberculin tests, the Wassermann reaction of syphilis, the Widal reaction of typhoid fever and the Weil-Felix reaction of typhus fever. The therapeutic value and the indications for the use of serums and vaccines

8 PREFACE

are fully discussed and the prophylactic efficiency of diphtheria-toxin-antitoxin-immunization is dwelt upon at length.

A mere glance at the chapter on materia medica will assure the reader that the author is not a therapeutic nihilist, but on the contrary, a firm believer in the efficiency of some drugs. One of the principal reasons for the survival of many, often utterly useless, proprietaries is the fact that medical students receive but perfunctory instruction in pharmacology and prescription writing, and often do not even appreciate the inertness and incompatibilities of the drugs contained in the concoctions. The author hopes that the young beginner will profit by memorizing his article on select and palatable medication and by making use of some of the numerous prescriptions distributed throughout the book. Attention is also directed to the. instruction given in hydrotherapy, (which includes hypodermoclysis, saline, intravenous, intraperitoneal and intrasinus injections) massage, electricity, climatology and organotherapy.

To obviate the great loss of life that still prevails among the newborn, their diseases, and more especially those of septic nature, are gone into minutely. It has often occurred to the author that a certain number of cases of dislocation of the hip in infants instead of being congenital in character are in reality acquired as a result of sepsis, and he hopes that the reader will henceforth scrutinize these cases with greater care and possibly confirm the author's observations. Under the head of "Feeble Vitality" are grouped the diverse diseased conditions in which feeble vitality forms the predominating feature. Herein are included also the premature babies which need the special care chiefly to overcome their feeble vitality.

A separate chapter is also reserved for the numerous congenital malformations which are frequently amenable to treatment if taken in hand early and treated skillfully. This refers especialty to congenital pyloric stenosis which is fully discussed from a medical as well as surgical point of view. A great many illustrations accompany the text and should prove helpful early to detect the divers abnormalities.

In the description of acute gastroenteric affections the classification of Finkelstein is followed with but slight modifications. As the great majority of these cases are the result of milk infection, stress is put chiefly upon the care in handling the milk and the dietetic changes that are indicated in individual cases. The active treatment is presented briefly and clearly and is based upon the author's personal experience. Faulty metabolism is treated in another section of the book, in which are grouped rachitis, scorbutus, acidosis, exudative diathesis, glycosuria and the allied affections. Intussusception and appendicitis are discussed as strictly surgical diseases.

PREFACE y

The section on respiratory diseases includes those of the nose, throat, and ears. The importance of diseased tonsils and adenoids as the immediate cause of widespread systemic infections is given due prominence. Enucleation of the tonsils is advocated in preference to tonsillotomy, which latter generally fails to eradicate the source of the trouble. On the other hand, it cannot be denied that tonsillectomy is a rather serious operation. All the necessary precautions against untoward results are amply emphasized when speaking of the dangers of the operation. The diagnosis of deafness is elaborated with greater detail than in other textbooks on pediatrics ; the different tests will prove useful to the family physician who is often consulted about the listlessness and inattentiveness of some of his little patients. In the description of the diverse inflammations of the lungs and pleura, the author has endeavored to embody the very latest advances in serology which offer the only hope for the ultimate discovery of a specific against pneumonia. Influenza pneumonia is described in connection with influenza. The newest views on the etiology of asthma are given due consideration, but the author is inclined to the belief that the symptoms arising from protein sensitiveness, anaphylactic manifestations, etc., are entirely distinct from those of genuine asthma, and transient in character, irrespective of the therapeutic measures employed.

With introduction of school inspection in a number of states the fact has been disclosed that heart disease in children is by far more common than was generally supposed. How much of it may be congenital in character is difficult to judge from the reports at hand. In the section of heart disease, both the congenital and acquired forms of heart disease are fully elucidated. Rest and digitalis are still urged as the only reliable therapeutic means at our command in heart disease, more especially in the noncompensating variety. Unfortunately few children can accommodate themselves to a regime of everlasting rest. The benefits derived from graduated exercises in heart disease of children which are fully delineated in this chapter are as yet an unknown quantity, yet worthy of trial. The author has failed to find any signal diagnostic help from the use of the sphygmomanometer, sphygmo graph, cardiograph, and similar apparatus, hence has omitted their description.

Except for the recent advances in the study of blood coagulation practically no progress has been made in the knowledge of the diverse blood affection. No attempt therefore has been made to disrupt the generally accepted classification and methods of treatment. For the want of a better term hemorrhea is used instead of hemophilia — which latter is an utterly inappropriate designation for spontaneous hemorrhage. Transfusion is recommended as the most reliable remedy to control this kind

10 PREFACE

of bleeding. The author has refrained from going into a minute description of the pathology of blood diseases, since excepting Von Jaksch's anemia, which is peculiar to childhood, they are fully discussed in text-books on general medicine.

To a great extent the same holds true of kidney diseases, except pyelitis, which is of very frequent occurrence in children, and hence is receiving careful attention. A great deal is yet to be learned about the management of pyelitis. Like the urinary antiseptics the use of vaccines and kidney flushing have thus far failed in the majority of recalcitrant cases. The importance of early diagnosis and prompt treatment of cervicitis and vulvovaginitis is strongly emphasized and should receive due consideration on the part of the general practitioner who has ample opportunities to observe them.

The rather frequent association of acidosis with pyelitis is deserving of consideration from an etiologic, as well as therapeutic, point of view.

In recent years the profession has learned to appreciate the vital role the ductless glands are playing in the human economy, and the need for further scientific investigation. This subject therefore is treated broadly, laying particular stress upon the diseases of the thyroid, thymus and pituitary glands. The correlation of the disturbed functions of these glands to mental deficiencies is emphasized in another section of the book, when discussing the mental affections of infants and older children. A separate chapter is devoted to this greatly neglected subject. The diseases of the lymphatics, the skin and bones are dwelt upon at length. Attention may here be directed to the article on malignant disease in children which is often overlooked in the early stages. Several vivid photographs and roentgenograms illuminate the text.

The author hopes that the chapter on nervous diseases will be found especially instructive. The brain and cord have ceased to be organs best let alone, and the progressive surgeon does not at all hesitate to operate on the brain as occasions arise. Emphasis is put upon the advisability of operating upon suitable cases of cerebral hemorrhage in the newborn, spastic cerebral paralysis, epilepsy, etc. Spasmophilia and hysteria are elaborated with great care. In order to facilitate their study in connection with diseases of the brain as a whole, meningitis, poliomyelitis and encephalitis are incorporated in this chapter, although from an etiologic point of view they belong in the section of contagious diseases. Of the greatest importance, of course, to the general practitioner is a thorough acquaintance with the communicable diseases of childhood which are ever rampant and creating an overabundance of misery to mankind. This subject is treated exhaustively, and includes a large number

PREFACE 11

of tropical diseases which have recently invaded our shores. A special article is allotted to pertussis in the newborn infant. Epidemic influenza in all its phases is described in detail, more especially its pathogenesis and serum treatment. The same applies to poliomyelitis already spoken of which is clarified by a large number of original illustrations. The exanthemata are discussed from a modern point of view. In the article on tuberculosis are included the tuberculous affections of the brain, glands, skin and bones. Syphilis, in all its forms, is receiving explicit consideration. As already stated, the diphtheria-toxin-antitoxin-immunization and the diverse laboratory diagnostic tests are discussed in the chapter on the prevention and control of disease.

In closing the author wishes to extend his gratitude to the authors and publishers whose literature and illustrations have aided him in the preparation of the book; and he is particularly grateful to his publishers for their liberal suggestions and good will.

H. B. S.

New York City.

Contents

CHAPTEE I

Inherent Strength, 25 ; Power of Resistance and Susceptibility, 26 ; Nutrition, 26; The Digestibility of the Proteins of Milk and Their Role in Infant Nutrition, 26; Physiology and Pathology of the Digestion of the Carbohydrates in Infancy, 32; Fat Metabolism, 37; Fat Retention and Excretion in Relation to Diet, 38 ; Fat in the Stools of Breast Fed Infants, 38 ; Fat in the Stools of Infants Fed on Modifications of Cow 's Milk, 39 ; Fat in the Stools of Children on a Mixed Diet, 39 ; The Digestion of Some Vegetable Fats by Children on a Mixed Diet, 41; Woman's Milk Feeding, 42 ; Artificial Feeding, 48 ; Cow 's Milk Feeding; 48 ; Laboratory and Home Modification of Cow's Milk, 51; Indications of Faulty Assimilation of the Food, 55; Cow's Milk Substitutes, 56; Weaning the Baby and Its Feeding Thereafter, 59 ; Hygiene and Sanitation, 64 ; General Care of the Newborn and Older Children, 64; Immunization — Acquired Immunity. Biologic Diagnosis and Therapeutics, 71 ; Variola Vaccine, 72; Vaccination, 72; Antidiphtheritic Serum, 75; Diphtheria Toxin- Antitoxin Immunization, 75 ; The Local and Constitutional Reaction, 76 ; The Immunization Response in Susceptible Children, 76 ; The Immunizing Results, 76; Antitetanic Serum, 77; Antimeningitis Serum (Flexner), 78 ; Bacterial Vaccines, 81 ; Tuberculin Tests and Tuberculins, 82 ; Complement-Fixation Reaction in Tuberculosis, 84; Serum Diagnosis of Syphilis (Wasserniann), 85; Serum Diagnosis of Typhoid, 86; Weil-Felix Reaction of Typhus Fever, 87; Allergy or Food Idiosyncrasy-Test, 87; Materia Medica and Therapeutics, 88; Hydrotherapy, 88; The Internal Use of Water, 92; Electricity, 96; Massage, 99; Climatotherapy, 100; Select Medication in Children, 101; Digestants, 103; Tonics, 103; Mineral Acids, 105; Alteratives, 105; Antipyretics and Antirheumatics, 106; Hypnotics, Anodynes and Antispasmodics, 107; Stimulants, 108; Heart Sedatives, 109; Emetics, 109; Expectorants, 110; Diuretics and Diaphoretics, 110; Laxatives and Purgatives, 111; Intestinal Astringents, 112; Gastric Sedatives, 112; Organotherapy, 113; Vitamines, 114.

CHAPTER II Examination of the Patient and Semeiology of Disease 115

The Head, 116; The Face, 118; The Eyes, 120: The Ears, 122; The Nose, 122; The Lips, 123; The Oral Cavity, 123; The Neck, 129; The Thorax, and its Contents, 129; Auscultation and Percussion, 129; The Thorax, 132; The Lungs, 133; Cough, 138; Sputum, Expectoration, 138; The Heart, 139; The Abdomen and Its Contents, 146; The Diagnostic Significance of Chronic Abdominal Enlargement, 151; Infants' Stools, 158; Principal Abnormalities of Urine, 159; The Genitalia, 164; The Rectum, 165; The Vertebral Column, 165; The Extremities, 166; Weight and Length of Normal Children, 171.

Chapter III

Congenital Malformations of the Head, 174; Cephalocele (Hernia of the Brain), Meningocele, Encephaloeele, Encephalocystocele or Hydrocephalocele, 174; Congenital Malformations of the Face, Including those of the Palate, Mouth, Eyes, Nose and Ears, 175; Clefts of the Face and Lips, 175; Cleft Palate (Palatum Fissum, Palatoschisis), 176; Defects of the Mouth and Tongue, 177; Malformations of the Eyes, 177; Malformations of the Nose, 179; Malformations of the Ears, 179; Malformations of Larynx and Trachea, 180 ; Malformations of the Neck, 180 ; Malformations of the Thorax, 182; Malformations of the Alimentary Tract, 183; Congenital Stenoses and Atresia? of the Intestines, 183; Congenital Hypertrophy and Dilatation of the Colon (Megacolon Congenitum, Hirschsprung's Disease), 184; Atresia of the Rectum and Anus, 186; Defects of the Abdominal Parietes, 187; Congenital Umbilical Hernia, 188; Persistence of the Ductus Omphalomesentericus, 190; Urachus' Fistula, 191; Malformations of the Genitourinary Organs, Congenital Abnormalities of the Kidneys, 192 ; Malformations of the Ureters, 192 ; Malformations of the Bladder, 192 ; Malformations of the Urethra, Prepuce, Testicles, and Vagina, 193 ; Congenital Phimosis, 193 ; Cryptorchidism, 195 ; Hydrocele, 195 ; Congenital Malformations of the Vertebral Column, 197; Spina Bifida or Hernia of the Cord, 197; Congenital Sacral Tumors, 200; Malformations of the Extremities and Hip, 201 ; Luxatio CoxaB Congenita, 201 ; Talipes, 202; Congenital Affections of the Muscles and Bones, 204; Amyatonia Congenita, 204; Myotonia Congenita, 205; Osteogenesis Imperfecta, 205.

Chapter IV

Birth Injuries, 207; Superficial Structures, 207; Caput Succedaneum, 207; Cephalhematoma, 207; Hematoma Sternocleidomastoidei, 208; Deep Structures, 208; Central Birth Paralysis, 208; Cerebral Hemorrhage Apoplexia Neonatorum, 208; Peripheral Birth Paralysis, 210; Facial Palsy, 210; Brachial Paralysis — Obstetrical Paralysis — Duchenne-Erb Paralysis, 211; Diseases of the Newborn, 213; Feeble Vitality of the Newborn, 213; Asphyxia Neonatorum, 213; Atelectasis Neonatorum, 213; Vitia Cordis, 214; Syphilis Embryonalis s. Fetalis, 214; Premature Birth, 214; Management of "Feeble Vitality of the Newborn" with Special Reference to the Premature Baby, 216; Sclerema Neonatorum, 218; Scleredema Neonatorum, 218; Sepsis Neonatorum, 219; Local Sepsis, 219; Omphalitis (Inflammation of the Navel), 219; Omphalorrhagia (Bleeding from the Navel — Idiopathic Umbilical Hemorrhage), 222; Umbilical Granuloma (Excrescence, Fungus, Sarcomphalos, 222; Ophthalmoblennorrhea Neonatorum (Gonorrheal or Purulent Ophthalmia, 222; Pemphigus Neonatorum, 224; Dermatitis Exfoliativa Neonatorum, 225; General Sepsis, 226; Tetanus (Trismus) Neonatorum, 226; Arteritis and Phlebitis Umbilicalis, 228; Erysipelas Neonatorum, 229; Helena Neonatorum, 229; Epidemic Hemoglobinuria with Icterus in the Newborn, 229; Acute Fatty Degeneration of the Newborn (Buhl's Disease), 230; Functional Disorders of the Newborn, 231; Uric Acid Infarct, 231; Icterus Neonatorum Catarrhalis, 231; Mastitis Neonatorum, 232.

Chapter V

Diseases of the Mouth, 233; Stomatitis, 233; Dentitio Difficilis, 236; Diseases of the Salivary Glands, 237; Salivation, 237; Ranula, 237; Secondary Parotitis, 238; Diseases of the Tongue, 238; Glossitis, 238; Diseases of the Esophagus, 239; Esophagitis, 239; Diseases of the Stomach and Intestines, 211 ; General Etiology, 211 ; Stenosis Pylori Congenita, 212 ; Acute Gastroenteritis, 248; Classification, 218; Cholera Infantum, 250; Subacute and Chronic Gastroenterocolitis, 253 ; Dysentery, Enterocolitis, Ileocolitis, 257; Acidosis, 257; Proctitis, 257; Colica Infantum, Gastralgia, Enteralgia, Neuralgia Enterica, 257; Chronic Constipation, 259; Prolapsus Ani, Prolapsus Recti, 263; Intussusception, 261; Appendicitis, Typhlitis, Perityphlitis, 269; Peritonitis Acuta, 275; Intestinal Worms, 276; Ankylostomiasis, Uncinariasis, 280 ; Diseases of the Liver, 283 ; Icterus Catarrhalis, 283; Diseases of the Parenchyma of the Liver, 283; Cirrhosis of the Liver, 281; Acute Yellow Atrophy, 285; Fatty Liver, 285; Amyloid Liver, 285 ; Abscess of the Liver, 285 ; Tumors of the Liver, 286.

CHAPTER XI

General Remarks, 287; Diseases of the Nose and Throat and Ear, 288; Rhinitis Acuta, 288; Rhinitis Chronica, 289; Epistaxis, 289; Tumors and Foreign Bodies in the Nose, 290 ; Sinusitis, 291 ; Pharyngitis Acuta, 292 ; Pharyngitis Chronica, 292; Angina, 293; Tonsillitis Acuta, Amygdalitis, Quinsy, 293; Hypertrophy of the Tonsils, 296; Adenoid Vegetations, 297; Dangers and Accidents Attending Adenoid and Tonsil Operations, 300; Retropharyngeal Abscess, 301; Otitis Media, 303; Deafness, 306; Interpretation of Tests for Hearing, 307; Indications of Labyrinth or Auditory Nerve Deafness, 308; Laryngitis Acuta, 308; Laryngitis Chronica, 311; Edema Glottidis, 313; Laryngeal Tumors, 313; Foreign Bodies in the Larynx, 314; Diseases of the Bronchial Tubes, Lungs and Pleura, 311; Bronchitis Acuta, 314 ; Bronchitis Chronica, 316 ; Broncho or Lobular Pneumonia, 316; Lobar Pneumonia, 320; Pleuritis, 327; Dry Pleurisy, 327; Pleurisy with Effusion, 328 ; Serous or Serofibrinous Pleurisy, 330 ; Hemorrhagic and Tuberculous Pleurisies, 330; Purulent Pleurisy (Empyema, Pyothorax), 331; Chylous Pleuritis (Chylothorax), 333; Asthma, 337; Emphysema Pulmonum, 339 ; Bronchiectasis, 310 ; Pulmonary Gangrene, 341; Pneumothorax, Hemopneumothorax, Pyopneumothorax, 343; Pneuniohypoderma, 344.

CHAPTER VII Specific Communicable Disease 345

Influenza, 345; Vaccine from Influenza Bacillus as a Prophylactic, 354; Vaccines from Streptococcus and Other Organisms, 356; The Polyvalent Vaccine of Rosenow, 357; Rubeola, 358; Rubella, 363; Diphtheria, 365; Differential Diagnosis, 374; Intubation in Laryngeal Diphtheria, 376; Tracheotomy, 381; Scarlatina, 382; The Fourth Disease, 394; Varicella, 394; Variola Vera. Varioloid, 395; Typhus Abdominalis, 399; Typhus Exanthematicus, 404; Typhus Recurrens, 404; Glandular Fever, 405; Malaria, 405; Intermittent Fever, 406; Remittent (Estivo-autumnal) Fever, 407; Chronic Malarial Cachexia, 408; Dengue, 410; Rocky Mountain Fever, 410 ; Pestis Americana, 411 ; Ileocolitis Epidemica, 412 ; Rheumatismus Acutus, 414; Differential Diagnosis, 418; Rheumatoid Arthritis, 420; Still's Disease, 422; Rheumatisms Nodosus Infantilis, 422; Erythema Nodosum, 424; Peliosis (Purpura) Rheumatica, 424; Myositis, 425; Polymyositis, 425 ; Myositis, Ossificans, 426 ; Multiple Exostoses, 426; Meningitis Cerebrospinalis, 427; Poliomyelitis Anterior, 427; Encephalitis Lethargica, 427; Parotitis Epidemica, 427; Pertussis, 429; Whooping Cough in the Newborn, 434; Tuberculosis, 437; Introductory Remarks, 437 ; Miliary Tuberculosis, 442 ; Phthisis Pulmonum, 444 ; Tuberculosis of the Brain, 452 ; Tuberculosis of the ' Abdominal Organs, 453 ; Tuberculous Peritonitis, 453; Intestinal Tuberculosis, 456; Tuberculosis of the Genitourinary Tract, 456 ; Serof ulosis, 458 ; Tuberculosis of the Bones and Joints, 461 ; Tubercular Osteomyelitis and Arthritis, 461 ; Tuberculosis of the Vertebral Column, 462; Morbus Coxarius, 466; Knee- Joint Disease, 470; Spina Ventosa, 472; Nontuberculous Osteomyelitis, 473; Osteosarcoma, 476; Scoliosis, 479; Syphilis Hereditaria s. Congenita, 482; Syphilis Embryonalis, s. Fetalis, 482; Syphilis Neonatorum, 483; Syphilis Hereditaria Tarda s. Lata, 490; Acquired Syphilis, 494; Franibesia, 496; Leprosy, 497; Pestis Bubonica, 499.

Chapter VIII

Marasmus, Athrepsia, Infantile Atrophy, 501; Rachitis, 503; Achondroplasia, 512; Scorbutus Infantum, 514; Beriberi, 517; Pellagra, 517; Diabetes Mellitus, 518; Diabetes Insipidus, 520; Adipositas, 520; Exudative Diathesis, 521; Acidosis, 522.

CHAPTER IN

Diseases of the CirculatopvY System 525

Congenital Heart Disease, 525; Persistence of the Foramen Ovale, 526; Persistence of the Ductus Arteriosus Botalli, 526; Defects in the Septum Ventriculorum, 527; Congenital Stenosis of the Pulmonary Artery, 527; Congenital Stenosis of the Tricuspid Valve, 528 ; Congenital Stenosis of the Ostium Atrioventriculare Sinistrum, 528; Dextrocardia, 529; Acquired Heart Disease, 529; Myocarditis, 529; Pericarditis, 530; Endocarditis

Acuta, 533; Endocarditis Chronica, 536; Differential Diagnosis, 539; Stage of Compensation, 540; Formal Gymnastics — Cardiac Cases, 542; State of Failing Compensation, 544.

Chapter X

Diseases of the Blood, 546; Anemia Simplex/ Chlorosis, 547; Pseudoleukemia Infantum, Splenica, 549; Pseudoleukemia Lymphatiea, 550; Leukemia, 550; Pernicious Anemia, 551; Hemorrhea Congenita, 552; Hemorrhea Acquista, 553; Differential Diagnosis, 555; Morbus Addisonii, 556; Diseases of the Spleen, 556; Movable Spleen, 556; Acute Splenitis, 557; Chronic Inflammation of the Spleen, 557; Banti's Disease, 557; Primary Family Splenomegaly (Gaucher), 558; Adenitis and Lymphadenitis, 559; Diseases of the Thyroid Gland, 561; Thyroiditis, 561; Goiter, 561; Exophthalmic Goiter, 563; Cretinism, 563; Diseases of the Thymus Gland, 564; Acute Thymitis, 566; Chronic Thymitis, 567; Disease of the Pituitary Gland, or Hypophysis Cerebri, 571

CHAPTEE XI

Diseases of the Kidneys, Bladder, etc 572

Nephritis Acuta, 572; Nephritis Chronica, 577; Nephrolithiasis, 578; Pyelitis, Pyelonephritis, Pyelonephrosis, 580; Hemoglobinuria, 581; Orthotic, Lordotic, Cyclic or Functional Albuminuria, 582 ; Tumors of the Kidney, 582; Cystitis, Colicystitis, 584; Vesical Calculi, 586; Spasmus Vesicae, Dysuria, Ischuria, 586; Enuresis, 587; Vulvovaginitis, 589; Masturbation, 593; Menstruatio Precox, 594; Gangrene of the Genitalia, -594.

CHAPTEE XII

Organic Diseases, 596; Hydrocephalus, Congenital and Acquired, 596; Anemia of the Brain, 600; Hyperemia of the Brain, 601; General Eemarks on Cerebral or Central Paralysis and Brain Localization, 601 ; Intracranial Hemorrhage, 603; Embolism of the Brain Arteries, 604; Sinus Thrombosis, 604; Meningitis Acuta, 605; Meningitis Cerebrospinalis, 605; Meningococcic, Pneumococcic, Tuberculous, Streptococcic, etc., Meningitis, 605 ; Differential Diagnosis, 613 ; Diplegia Spastica Infantilis, 615 ; Hemiplegia Spastica Infantilis, 618; Encephalitis, 620; Brain Abscess, 621; Lethargic or Epidemic Encephalitis, 624; Poliomyelitis Anterior, 627; Tumors of the Brain, 645 ; Epilepsia, 649 ; Migraine, Hemicrania, 653 ; Pavor Nocturnus, 654 ; Syringomyelia, 654 ; Spinal Hemorrhage, 655 ; Spinal Meningitis, 655; Myelitis, 656; Ataxia Hereditaria (Friedreich), Heredoatoxie Cerebelleuse (Marie), 657; Disseminated Sclerosis, 657; Hereditary Progressive Muscular Atrophies, 658; Spinal Progressive Muscular Atrophy, 658; Neural Progressive Muscular Atrophy, 658; Myogenic Progressive Muscular Atrophy, 659 ; Lipodystrophia Progressiva, 661; Tumors of the Cord and Membranes, 662; Peripheral Facial Paralysis, 663; Hemiatrophia Faciei, 665; Polyneuritis, 665; Functional Diseases, 668; Spasmophilia, 668; Eclampsia Infantum, 669; Tetanism, 671; Tetany, 673; Pseudotetanus (Eschericli), 676; Spasmus Glottidis, 677; Chorea Vera, 678; Habit Spasm, 681; Spasmus Nutans, 682; Hysteria, 682; Dystonia Musculorum Deformans, 688.

CHAPTER XIII

Idiocy and the Allied Mental Deficiencies, 690 ; In Infancy and Childhood, 690; Stigmata of Degeneration, 697; Normal Intelligence, 698; The Abnormal Baby, 701 ; Mental Tests, 705 ; Classification, 706 ; Microcephalus, 707; Hydrocephalus, 710; Paralytic Amentia, 712; Amaurotic Family Idiocy, 716; Mongolism, 718; Cretinism, Myxidiocy, 721; Infantilism, 726; Moramentia, 728; Prophylaxis, 732; Active Treatment, 737; Hygiene, 737; "Incentive" Training and Physical Therapeutic Measures, 739 ; Medicinal Treatment, 746 ; Surgical Treatment, 719 ; Prognosis, 750 ; Amentia in Older Children, 751 ; Epileptic Idiocy, 751 ; Imbecility, 752 ; Mental Affections in Older Children, 757; Dementia, 757; Dementia Precox, Katatonia, Hebephrenia, 757 ; Dementia Paralytica, 759 ; Melancholia, 759; Mania, 759.

CHAPTER XIV

Eczema, 761; Urticaria, 764; Intertrigo, 765; Psoriasis, 766; Herpes zoster, 767; Miliaria, Lichen Strophulus, 768; Ecthyma, 768; Impetigo Contagiosa, 769; Pediculosis Capitis, 770; Pediculosis Corporis, 771; Pediculosis Pubis, 771; Scabies, 771; Tinea Trichophytina Capitis, 774; Tinea Trichophytina Corporis, 776; Molluscum Contagiosum, 776; Telangiectases, Xevi and Angiomas, 777; Combustio, 778; Congela.tio, 779.

COLOR PLATES

PLATE PAGE

I. The normal stool of the breast-fed infant 42

II. Formed alkaline stools . 54

III. Stomatitis aphthosa (advanced stage) 234

IV. The green, acid stool of dyspepsia 250

V. Angina follicularis. Angina herpetiformis, after vesicles burst. Angina

ulcerosa (Vineentii) 292

VI. Buccal exanthema in measles (Koplik's spots) 360

VII. Tonsillar diphtheria 366

VIII. Angina scarlatinosa and "strawberry tongue" 384

IX. Life-cycle of Plasmodium vivax 406

1. Microscopic appearances of woman's milk 42

2. Breast pumps 44

3. Holt 's milk testing apparatus 45

4. Chapin's dipper for removal of " top-milk " 50

5. Stages in Widal reaction of typhoid. 86

6. Hydrocephalus 117

7. Fontanels 118

8. Diagram of the visual tract 121

9. Temporary and permanent teeth 125

10. Ulcerative stomatitis involving also the lips and adjacent structures . . . 127

11. The thoracic and abdominal regions 130

12. The regions of the back 131

13. Diagnostic lines of the thorax 135

14. Anterior boundaries of the lungs 135

15. Posterior boundaries of the lungs 135

16. Normal heart of a child three years old 140

17. Normal heart of a child eight years old 141

18. The relative and absolute heart dulness up to four years 142

19. The relative and absolute heart dulness up to eight years 142

20. The relative and absolute heart dulness up to twelve years ...... 142

21. Topography of cardiac valves 144

22. The thoracic and abdominal regions 146

23. Dissection of still-born child 148

24. Topography of the liver and spleen 149

25. Topography of kidneys, spleen, and liver ............ 150

26. Sarcoma of the left kidney 153

27. High degree of rachitis. Abdominal enlargement chiefly in epigastric region 154

28. Tuberculous peritonitis. Abdominal enlargement most marked in hypo-

gastric region 155

29. Buffalo scale 172

30. Normal infant's weight chart 172

31. Harelip 176

32. Bilateral congenital anophthalmia 178

33. Large asymmetrical cervical ribs; neuritis and vascular disturbances in the

right arm 182

34. Moderate degree of megacolon congenitum or Hirschsprung's disease, in a

child three years old 184

35. Congenital absence of anus and rectum and of scrotum and its contents . 1S5

36. Stomach and intestines of case shown in Fig. 35, showing ending of colon

in a blind pouch filled with meconium 186

37. Diastasis recti abdominis in an amaurotic idiot 187

38. Congenital umbilical hernia 188

39. Congenital femoral hernia 189

40. Ectopia viscerivm 189

41. Thoracoabdominopagus with prolapse of intestines 189

42. Skiagram of thoracoabdominopagus. (Same as Fig. 41.) 190

43. Congenital hydrocele communicans : 196

44. Myelocystocele 198

45. Spina bifida occulta in a boy eight years old. This condition was associated

with incontinence of urine 199

46. Bilateral club feet in father and three children 202

47. Same case as Fig. 44 showing also congenital club foot 203

48. Osteogenesis Imperfecta . 205

49. Method of insertion of trocar through the anterior fontanel to reach the

ventricles 209

50. Obstetric facial paralysis in boy fifteen months old, which failed to yield

to treatment 210

51. Bilateral obstetric brachial paralysis, the so-called " Duchenne-Erb Par-

alysis" 211

52. Obstetric brachial palsy: Erb's "upper arm type;" failed to respond to

treatment 212

53 Incubator room for newly born babies with feeble vitality . „ . . . . 216

54. Breck's feeder 217

55. Absorption of left head of femur and consequent dislocation of the hip in

a child two years old as a direct result of sepsis neonatorum which began with an infection in the navel 220

56. High degree of "tetanism" greatly resembling tetanus neonatorum. Note

Fig. 59, showing same case during partial relaxation of the spasm . 227

57. Penny in esophagus of an infant readily extracted under the guidance of

the roentgen ray 239

58. Pylorus stenosis in a boy three months old 243

59. Chronic gastroenteritis in an infant ten weeks old 254

60. Prolapsus recti 263

61. Stick pin in transverse colon giving rise to symptoms of intussusception

requiring operation 266

62. Oxyuris vermicularis. Female and male 277

63. Ascaris lumbricoides 277

64. Tenia saginata 277

.65. Tenia solium 278

66. Bothriocephalus latus 278

67. Ankylostomum duodenale 281

68. Uncinaria Americana 281

69. Toy ring in antral cavity giving rise to empyema of the antrum of High-

more in a child three years old 291

70. Adenoids in a boy eleven years old. Note characteristic dull, facial features

and contracted chest 297

71. Spinal curvature (stooping) secondary to adenoids 298

72. Retropharyngeal abscess in a ten-month-old infant. Note characteristic

attitude of mouth, head and neck 302

7.*>. Fever curve of typical lobar pneumonia in a child fourteen months old, ending- by crisis 322

74. Fever curve of a fatal case of apex pneumonia with marked cerebral symp-

toms in a child two years old 322

75. Grocco's sign of pleurisy with effusion (paravertebral triangle of dulness

on the side opposite to that of the effusion — G) 329

76. Extensive right empyema in a child four years old 332

77. Same case as Fig. 76 three weeks after resection of second and third ribs.

Note clearing of right lung 335

78. Same case as Fig. 76 two months later. Eight lung field almost clear.

Note retraction of chest wall and secondary scoliosis 336

79. Pneumothorax (posterior view). Note compression of lungs and disloca-

tion of heart 341

80. Pneumohypoderma (emphysema, cutis) in a girl five years old complicating

measles with pneumonia 342

81. Same case as Fig. 80 six weeks later 343

82. Section of lung of epidemic influenza in a young infant showing congestion

of the blood vessels in the pleura and hemorrhages just beneath the pleural surface 346

83. Section of lung of epidemic influenza in a young infant showing suppurative

bronchitis and areas of pneumonia about the bronchi 348

84. Fever curve of atypical influenza in a baby fourteen months old . . . 350

85. Paralysis of N. abducens, with convergent strabismus and facial paralysis

following postinfluenzal encephalitis. Her mentality remained greatly

affected 351

86. Fever curve of measles . 359

87. Fever curve of German measles 363

88. Instruments for intubation 378

89. Mode of feeding after intubation 379

90. Tracheotomy tube 382

91. Fever curve of a case of scarlet fever 385

92. Fever curve of typhoid fever in child four years old 400

93. Eheumatic torticollis of several weeks' duration in a child six years old