Lectures on children's diseases : A handbook for practitioners and students.

  • Henoch, E. H. (Eduard Heinrich), 1820-1900.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on children's diseases : A handbook for practitioners and students. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    merely the laity but also many medical men have asserted. I have frequently endeavoured to press the enlarged tonsil out- wards with the finger introduced into the mouth, so as to make it possible to feel it from outside, but I have never succeeded, and in fact this is an anatomical impossibility on account of the number of structures which intervene (superior constrictor of the pharynx, bucco-pharyngeal fascia, platysma, parotid gland, skin). Therefore, what you do feel under these circumstances are either enlarged lymphatic glands or infiltration in the con- necting tissue, and not the tonsils. When a considerable hypertrophy of the tonsils takes place in very early childhood, a malformation of the thorax similar to that in rickets (the so-called pigeon-breast) may be produced owing to the interference with the free entrance of air into the lungs (Dupuytren, Shaw, &c). In this condition the external at- mospheric pressure exceeds the internal owing to the deficient filling of the lungs, and the yielding costal cartilages are pressed inward so that the thorax is flattened laterally and the sternum projects more than usual. Narrowing of the nostrils and arrested growth of the upper jaw with considerable concavity of the palate and crowding of the teeth have been observed in such children. Only in exceptional cases, however, has the interference with breathing reached such a degree that tracheotomy had to be re- sorted to. The only remedy to be recommended is excision, or at least partial resection of the enlarged tonsils. IV. Contagious Parotitis. (Cynanche Parotidea—Mumps.) In the region in front of the ear, and under the angle of the jaw, there occur in children various swellings which may be readily confounded with one another by the inexperienced. In this region you often find during the first dentition, but also much later, a diffuse swelling generally confined to one side; this is at first doughy in consistence and of a normal colour, gradually be- comes harder and red, and finally presents fluctuation, after which a large amount of pus is evacuated, either spontaneously or on incision. I should not have mentioned these common connec-