Lectures on the diseases of infancy and childhood / by Charles West.

  • West, Charles, 1816-1898.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the diseases of infancy and childhood / by Charles West. 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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    effects do not pass away so speedily, but leave a much more abiding depression. 2d. That the shock consequent on large losses of blood, shows itself, not merely by causing syncope, but also, not very seldom, by producing convulsions; and such convulsions are specially apt to be excited in cases where the previous disorder of the nervous system was consider- able, even though that disorder depended on congestion of the brain which called for depletion to relieve it. It seems as if in these cases, just as in some of comparatively slight disease of the heart, if the equilibrium of the circulation is suddenly disturbed it altogether fails to recover itself. A child of ten months old was brought to me many years ago with symptoms of cerebral congestion—a hot head, a raised fontanclle, a buuning skin, and twitching of the tendons of the arms and legs. I ordered leeches to the head, which drew freely: but the convulsions which it was hoped they would ward off, occurred while the bleeding was still going on, and the child sank at once into a state of coma, from which it never rallied completely, and died in the course of forty-eight hours. Now, in this case, the abstraction of blood was indicated, and the appearances discovered after death showed that the depletion had not been excessive. It had, however, been too sudden ; and probably, had I been present when the leeches were applied, I should have noticed some change in the child's condition which would have warned me to put a stop to further bleeding, and might thus have led to an entirely different result. In proportion, therefore, to the youth of our patient, must be our caution in ordering free depletion, and our care in watching its effects; and these must both be greater when marked disorder of the nervous system forms the indication for our treatment. 3d. Not only are very large losses of blood hazardous, and great shock by its too sudden abstraction also attended with danger in early infancy, but repeated bleedings are also inexpedient. The system rallies from them with proportionately far greater difficulty than in the adult, and that peculiar class of symptoms, by which exhaustion is apt to simulate congestion of the brain, is specially likely to be in- duced. It may be added that, to a considerable degree, the same cau- tion holds good with reference to all other antiphlogistic remedies ; that free purgation, spare diet, and depressing measures of all kinds, though often requisite, yet require most heedful watching, and generally need to be soon discontinued. Changes in medical opinion, such as have taken place within the past twenty years, influence one's conduct by slow and almost imper- ceptible degrees, and I find that my practice now differs much from what it was a quarter of a century ago; that I deplete less than I did, that I have less faith in mercury, that I employ antimony more rarely, that I have more confidence in nature's powers, less reliance on my own resources. And yet I am unwilling to believe that all my former observations were erroneous and that my old faith was entirely mis- placed ; but unhappily I have no longer the leisure to test the value of these changes as I could wish ; while the peculiarities of consultation practice in a large city, though they may sharpen one's perception, and