A practical treatise on disease in children.

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

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    vical glands are sufficiently characteristic. In tonsillitis the uvula is not swollen, and the whitish exudation occupying the mouths of the crypts, and sometimes spotting the surface of the tonsils, is very different in ap- pearance from the consistent false membrane of diphtheria. It never forms a coherent layer, and never invades the nares or the larynx. Moreover, in quinsy, although the swoUen tonsils can be felt externally, the cervical glands are seldom appreciably enlarged. If, in diphtheria, the exudation is soft and pultaceous, instead of being coherent and tough, there is still enlargement of the superficial cervical glands, and the general symptoms indicate profound depression. Any huskiness or weakness of the voice implies extension of the inflammation to the larynx, and points unmistak- ably to diphtheria. The difficult cases to detect are those in which the throat affection is imperfectly developed, or is slow to appear. At first, nothing may be noticed but redness and swelling of the fauces, with some discomfort in swallowing. In such cases until the false membrane ap- pears, we cannot say that we have not to deal with an ordinary inflamma- tory sore throat; for although the weakness and pallor of the patient are usually out of proportion to the apparent mildness of the local affection, no positive inference can be drawn from this discrepancy, as some chil- dren are more depressed than others by a trifling ailment. If such a con- dition be met with at a time when diphtheria is known to be prevalent, we should regard the symptoms with much apprehension. Indeed, in any case of sore throat, if enlargement of the glands of the neck can be dis- covered, we should withhold a positive assurance that the complaint is one of little consequence. Sometimes the appearance of albumen in the urine comes opportunely to clear up a doubtful ease. Sometimes after the ter- mination of an ill-defined angina, the occurrence of paralysis throws a new light upon the past indisposition. Laryngeal diphtheria, or membranous croup, may be confounded with stridulous laryngitis, with abscess of or about the larynx, or with retro- pharyngeal suppuration. The distinctive points between these diseases will be referred to in the chapters treating of these affections. It is pos- sible that a foreign body in the air-passages may be mistaken for croup ; but the attack of dyspnoea produced by this means comes on quite sud- denly and follows at once upon an attempt to swallow. There is spas- modic cough but no hoarseness ; and the first paroxysm of suffocation and cough is usually succeeded by a period of quiet in which, for the time, the breathing is fairly easy and the child seems to be well. It is very important to be able to discriminate between cases in which tracheotomy may be expected to succeed, and those in which no perma- nent good can be anticipated from the operation. Dr. George Buchanan, of Glasgow, has pointed out that in cases where the air-passages below the point of obstruction are free, and the lungs are in a normal condition, there is great recession of all the soft parts of the chest. At each inspira- tion the intercostal spaces fall deeply in, and the epigastrium forms a deep hollow. If, on the contrary, the smaller bronchial tubes are full of mucus or diphtheritic exudation, the movements of the chest-wall are impeded, and the chest is puffed out so as to resemble the distended thorax of chronic emphysema. ( If the patient be seen for the first time when the paralytic symptoms have declared themselves, the history of the attack will declare the nature of the disease. Even if, as sometimes happens, the throat affection has been too slight to constitute a regular illness, we shall find, probably, that other members of the household have suffered from diphtheria, and that,