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.

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    vein ; there is no expectoration of ropy mucus ; and the disease is not capable of being communicated to other children. When convulsions occur in a case of whoojjing-cough it is very impor- tant, with a view to prognosis, to ascertain their mode of origin. If the convulsion is symptomatic of the onset of an inflammatory complication, it is accompanied by a rise of temperature and followed by a diminution in the spasmodic symptoms and a modification of the physical signs in the chest. If it announces the occurrence of collapse of the lung, the charac- teristic symptoms which mark that lesion will be present. If the convulsion arises from exaggeration of the nervous disturbance which is one of the peculiarities of the disease, it will have been preceded by signs of unusual agitation in former fits of coughing. Such seizures are only seen in children known to be nervous, sensitive, and impressionable ; they follow immediately upon the cough, and between the attacks no signs of nervous disturbance remain. So also in the case of convulsions arising from partial asphyxia : the nervous attack is excited by extreme violence of spasm, but alter the fit has passed off no signs of cerebral lesion are left behind. If, after a fit, there is squinting, drowsiness, stupor, or other sign of nervous disturbance, we may fear that congestion of braimis present or that thrombosis of the cerebral sinuses has occurred, and should watch the case with grave apprehension. Prognosis.—Whatever be the age of the child, the prognosis is favour- able so long as the disease remains uncomplicated ; but if a complication arise the prospect is less hopeful, and in a very young child any addition to the normal course of the complaint is to be regarded with anxiety. Convulsions, bronchitis with collapse, and catarrhal pneumonia are the principal causes of an unfavourable issue to the disease. In the case of convulsions, if the attack can be connected with nervous agitation or the onset of an inflammatory complication, or if, after the fit, the child seem bright and well, there is still room for favourable anticipa- tion. If, however, the seizure is symptomatic of diffused pulmonary col- lapse ; if it occur in the course of an extensive pulmonary inflammation ; or if it be followed by drowsiness, squinting, or sign of cerebral lesion, there is little prospect of the child's recovery. Sometimes we can antici- pate the occurrence of convulsions. If we find the child to be nervous and impressionable, and we notice that he displays unusual agitation and ex- citement on the approach of the paroxysm, we may be prepared for an attack. So also if we find that the face becomes very blue during the cough, and that the spasm of the larynx is unusually prolonged, we may fear that an eclamptic attack may ensue. Laryngismus stridulus, as it supplies an additional obstacle to the aeration of the blood and tends to promote collapse of the lung, is an unfavourable sign. If it occur in combination with extensive lung mischief, the prospect is a very hope- less one. If the pulmonary catarrh becomes aggravated, the presence or absence of rickets is a very important matter. Softening of ribs is a great obstacle to efficient breathing ; and if the presence of thick mucus in the tubes pro- vides an additional impediment to the entrance of air, the occurrence of collapse is imminent. If, with this, the spasms are violent, and the child seem much exhausted at the end of the fit of coughing, collapse of the lung may be considered inevitable. In such a case the prognosis is a very gloomy one. If the catarrh pass to the small air-tubes and vesicles, and set up catar- rhal pneumonia, the state of the child is serious. Still, if the patient be