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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    and it may be years before the general glandular system becomes affected. When, however, the cachectic stage begins, the course is more acute. Still, the progress of the malady is always variable, and growth is more rapid at some times than at others. In the child the general disease rarely lasts longer than six or eight months. Death may result from asthe- nia or from some complication, as pneumonia, pleurisy, vomiting, or diar- rhoea. It may be preceded by convulsions. Sometimes the end is has- tened by the injurious effects of mechanical pressure upon the air-passages, the gullet, or the large veins of the abdomen. Diagnosis.—In the diagnosis of a case of lymphadenoma we have to search for evidence of general affection of the glandular system. So long as the disease remains limited to a few glands of the neck the nature of the swelling is not always easy to ascertain ; but even at this time it may be sometimes distinguished by the elasticity of the growth, for, ac- cording to Birch-Hirschfeld, even in the harder variety of lymphadenoma there is a certain elasticity as compared with the dense, boardlike hard- ness of the cheesy gland. Moreover, there is no inflammation set up round the mass, and caseous degeneration and softening are very rare. In a group of scrofulous glands some usually soften early and form an ab- scess. In such a case, too, the general signs of scrofula may be noticed. Sarcomatous glands present a greater likeness to lymphadenoma ; but when extension takes place in the former disease the tissues involved are not especially the lymphatic tissues ; indeed, the disease tends to spread rather to organs than to glands. In the cachectic stage lymphadenoma is usually easy of recognition. The irregular fever, the extreme pallor, the great drowsiness and unwill- ingness to speak, the general implication of lymphatic glands in all parts of the body, the character of the blood, which shows diminution in the number of red corpuscles with no or only slight increase in the proportion of leucocytes. These symptoms are sufficiently characteristic. Prognosis.—Although some cases of recovery from this disease have been recorded, the illness is so generally fatal that little hope of a favour- able issue can be entertained. In the cachectic stage speedy death may be anticipated. In the earlier period a prolonged course may be hoped for, especially if the enlargement is slow ; but it is unwise to sj>eak too favourably even of this prospect, for the disease may at any time suddenly assume an acuter character, and variations in the rapidity of its progress are not uncommon. Examination of the blood may be of some service in estimating the probabilities of a lengthened course. If the number of red corpuscles is greatly reduced, the child's prospects are very unfavourable. Treatment.—In every case the child should be put into as good sanitary conditions as possible, and every effort should be made to improve the general health. Cod-liver oil, iron, quinine, and tonics generally are use- ful in this respect, but none of these remedies have the power of delaying materially the progress of the disease after the affection of the lymphatic glands has become general. Arsenic, however, is highly spoken of for its value, even in this stage of the disease. The dose should be a large one ; and it must be remembered that most children have a special tolerance for this drug, being often able to take it in larger quantities than can be readily borne by the adult. For a child of eight years old ten drops of Fowler's solution may be given three times a day, freely diluted, directly after food, and every few days the dose can be increased by two drops. The effect of the medicine is to increase the softness and mobility of the glands. Soon pain begins to be complained of in the swellings, and this