A practical treatise on disease in children.

  • Smith, Eustace, 1835-1914.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on disease in children. 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.

    128/880 (page 98)
    Nasal diphtheria has been already referred to as constituting a symp- tom of the malignant type of the disease. A diphtheritic, coryza is, how- ever, sometimes seen as a complication of milder attacks. In these cases a thin discharge flows from the nostril, usually at first on one side only. It produces some excoriation of the margin of the nasal opening as well as of the upper lip, for these parts are often red and raw-looking. No doubt the presence of false membrane in the nasal passages is a sign of the ut- most gravity ; but I have known coryza with excoriation of the nostril to occur in cases of a comparatively mild nature without producing an unfa- vourable influence upon the course of the illness. Sometimes in epidemics of diphtheria more unusual manifestations of the disease are met with. The false membrane may form upon the con- junctiva, the external auditory meatus, the outlets of the vagina and rec- tum, upon the glans penis, and upon any wounds or abraided surfaces present on the skin. Often after tracheotomy the edges of the wound quickly become covered by the diphtheritic exudation. These exceptional seats of the false membrane may be the only local signs of the disease to be discovered, or may be accompanied by the usual affection of the throat. When a wound or abraided surface becomes attacked by the diphtheritic process, its borders become purple red and swollen, and the surface pours out a profuse, watery, fetid discharge. Soon a pellicle forms on the sore, and from this point the disease may spread over the skin. Thus the discharge irritates the neighbouring cutaneous surface ; little vesicles form, break, and become themselves converted into diphthe- ritic sores covered by the characteristic false membrane. In this way, ac- cording to Trousseau, the diphtheritic process may spread over a large ex- tent of surface ; and the layers of membrane, constantly moistened by the discharge, undergo rapid decomposition, and give out a most offenrive gangrenous stench. The general s3'mptoms in such cases are very severe, and the patient usually sinks rapidly from exhaustion. Inflammatory complications sometimes arise in the course of diphthe- ria. After the operation of tracheotomy for membranous croup, it is un- fortunately far from uncommon to find the temperature rise to 102° or 103°, and to discover, on examination of the chest, all the signs of acute consolidation of the lung. Sometimes, however, the pulmonary lesion is an early complication. In any case it greatly lessens the child's chances of recovery. Inflammation of the pericardium and endocardium are occasional corn- plications of the illness. Pericarditis occurring alone will probably be overlooked without a careful examination of the precordial region. Endo- carditis also may give rise to but few symptoms, and is often only dis- covered on examination of the body after death. We must, however, be on our guard, and avoid attributing to endocarditis the hamatomatous beading of the mitral valve described by Parrot. (See page 546.) When a thrombus forms in the heart, death may occur either suddenly at the moment of formation of the coagulum, or gradually after an interval of much anxiety and suffering. Usually the symptoms appear quite sud- denly, and at a time when the child seems to be going on favourably to con- valescence, or even after recovery is far advanced. If the formation of the clot does not bring the case to a sudden termination, marked dyspnoea is one of the earliest signs of the accident. Dysjmcea arising from want of blood in the pulmonary circulation is shown, as Dr. Iiichardson has pointed out, by symptoms very different in character from those due to an obstructed larynx. In the first case, al-