The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    are indefinite, and may be met with in almost any disease. There are dulness, headache, pains in the back, and the usual symptoms of malaise j there is rarely vomiting or diarrhoea. Drowsiness is a frequent symptom, and is regarded by tlie laity as characteristic. The exceptional cases in which the invasion is abrupt are puzzling. There may be a sudden accession of fever with vomiting, and even con- vulsions, as in a case lately under my observation. Not infrequent))', when the disease prevails epidemically, the invasion is sudden, with high fever and pulmonary symptoms which are so severe as to mask everything else until the rash makes its appearance, the cag.e up to that time being often regarded as one of primary piaeumonia or of influenza. The duration of the stage of invasion—i. e., from the beginning of the catarrh until the eruption—in 270 cases of which I have notes, was as follows: 6 davs 20 cases. 7 C 8 2 1 day or less 35 cases. 2 days 47 3 64 4 64 5 29 9 2 10 1 case. From this table it will be seen that the length of the period of invasion varies considerably,—more, I think, in infants and very young children (most of these were under three years old) than in those who are older. In the greater number of cases it lasts from two to four days. Eruption.—The rash usually appears on the third, fourth, or fifth day of the disease—in the largest number upon the fourth day. . As a rule, it is first seen behind the ears, on the neck, or at the roots of the hair over the forehead. It appears as small, dark-red spots, which are at first few, scattered, and not elevated, resembling fiea-bites. In twent3'-four hours the macules are much more numerous, and many of them have become papules. They frequently group themselves in crescentic forms. They are usually separated by areas of normal skin, but where the rash is intense they are frequently coalescent. From the time of its first appearance to the full development of the rash on the face, is usually about thirty-six hours, but may be from one to three days. With a full eruption there is considerable swelling of the face, especially about the eyes, and the features are sometimes scarcely recognisable. On the second day of the rash it begins to appear upon the neck beneath the chin, the upper part of the chest and back; on the third day the trunk is covered, and scattered spots are seen upon the extremities. The rash appears last upon the lower ex- tremities, and by the time it is fully out upon them it has usually begun to fade from the face. In mild cases it remains discrete, but in severe ones it is frequently confluent upon the face and upon the extensor surface of the extremities. As a rule, it covers the entire body, even the palms and soles. The eruption fades slowly in the order of its appearance, and there is