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is it not known, from the recent experiments on the nervous system, that the heat of a part is increased or lowered at will by acting on the a great sympathetic or on the nerves of organic life? In fact, if, as M. A. Bernard has indicated, in an animal the branch of the great sympathetic which unites in the neck the cervical ganglion with the inferior ganglion be divided, there then results on the whole side of the face and in the corresponding ear an elevation of six, eight, and even nine degrees in the temperature which, added to an active congestion, thus continues for several days and disappears. The same is the case after the puncture of the spinal cord at the origin of the pneumo-gastric nerves, as regards the temperature of the liver and of the kidneys, which is very decidedly increased. On the contrary, when we act on the nerves of animal life, and when a section of the nervous cord of a limb is performed, the temperature of this limb is always decidedly lowered.

It is then, in fact, to the previous influence of the general nervous system that the exercise of the caloricity and the production of the superficial and the deep-seated temperature should be referred. The feeble degree of development, or the imperfection of this system, leads to the algide condition, and its physiological power or its morbid exaltation determine, on the contrary, a quantity of heat necessary to the support of the health, or that pathological exaggeration which characterizes fever.

APHORISMS.

59. The diseases of the infant approach those of the adult by an analogy which is founded on the seat and on the denomination; but they differ considerably in form, evolution, reaction, and termination.

60. Age expresses the degree of the power which proceeds from impregnation, its force and its future, as the figure on the sundial expresses the dawn, the height, and the decline of day.

61. The newly-born infant, before arriving at an independent existence, undergoes, externally, the remainder of a creation; the first portion of which is accomplished in the mother's womb.

62. Newly-born infants possess but little resistance to external impressions, and a quarter of them die before the end of the first year.

63. The newly-born infant brings with it diseases which should not burst forth until the end of many weeks, months, or even years. These constitute the hereditary diseases.

64. Infants, and children at the breast, are possessed of special opportunity necessary to the development of several diseases, particularly ophthalmia, croup, eclampsia, diarrhoea, erruptive fevers, &c. 65. Diseases are only transformed impressions.

66. In the first stage of childhood, the material lesions are less

purely inflammatory than in the second stage; and the suppuration of the tissues is then less frequent, and of a less laudable quality. 67. The sub-acute and the chronic form of diseases are more frequent in the child than in the adult.

68. In the first stage of childhood there is no relation between the intensity of the symptoms and the extent of the material lesions. 69. The most intense fever, with restlessness, cries, and spasmodic movements, may disappear in twenty-four hours without leaving any traces.

70. The diseases of childhood usually betray themselves, externally, by a collection of characters sufficiently significant to be recognized by all physicians.

71. In the first stage of childhood, the yellow colour of the skin, of the sclerotic, and of the under surface of the tongue, always announces an affection of the liver.

72. The red, sudden, fugitive, and intermittent colour in the face, accompanied by fever, is a symptom of acute cerebral disease.

73. Apyretic cyanosis indicates a disease of the heart, or the patency of the foramen ovale.

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74. Cyanosis accompanied by fever is a sign of asphyxia from 7 Ex

croup.

75. The rapid decolouration of the face and of the lips, with excavation of the eyes, is a sign of intestinal disorder.

76. The alteration of the features by a progressive paralysis of the eyelids, nose, and muscles of the face, with or without strabismus, indicates an affection of the brain, or simply of the facial nerve. 77. The alteration of the features, by the enormous disproportion of the face and cranium, is a sign of chronic hydrocephalus.

78. A young child attacked with fever, who breathes rapidly through the nose and heaves its abdomen, is attacked with acute pneumonia.

79. The decrepitude of the face of a young child is the sign of a pulmonary tuberculous affection and of a chronic enteritis.

80. The strabismus which succeeds fever and convulsions is the symptom of an acute meningo-encephalitis.

81. The primary strabismus, in a child of good health, is a simple muscular paralysis.

82. Redness of the eyes and lachrymation, accompanied by fever, indicate the incubation of measles.

83. The child who is frightened or attracted by an imaginary object, who would avoid it or seize hold of it, is threatened with cerebral disease.

84. A young child who is continually putting its hands into its mouth, is suffering under laborious dentition.

85. A child of two years old, who cannot stand upright, whose superior fontanelle is open, is affected with rickets.

86. A child who has rapidly lost its plumpness, whose flesh is soft and flabby, has had, and is probably labouring under, diarrhoea.

87. The feeble cry of a newly-born child, indicates its deficiency of vital strength and its imminent death.

88. An acute cry, very strong and intermittent, is usually a sign of hydrochephalus.

89. The muffled, hoarse cry, indicates the last stage of croup. 90. A large-sized abdomen, very disproportionate, observed in a child from one to two years old, indicates rachitis or chronic enteritis. 91. Expiratory respiration, groaning and jerking when a child is calm, indicates acute pneumonia.

92. Respiration suddenly stopped at each effort, by a sort of convulsive spasm, is a sign of acute pleurisy.

93. Short, incomplete, and painful respiration, mixed with a long breathing at every eight or ten inspirations, is a sign of acute peritonitis. 94. Short, incomplete, and intermittent respiration, is the sign of simple or granular meningo-encephalitis.

95. The deep lateral constriction of the base of the thorax at each respiratory movement, accompanied by fever, is a sign of acute pneumonia. 96. Permanent lateral fluttering of the thorax is a sign of rachitis. 97. At no period of existence is the heart so impressionable and so varying as in infancy.

98. Moral impressions quicken the pulsations of the heart as much as the febrile state.

99. The frequency of the movements of the heart occasioned by fever is always accompanied by an increase of the deep-seated temperature of the body, and it is this which distinguishes it from the acceleration which is due to a moral cause.

100. Fever manifests itself by the acceleration of the pulse and the elevation of the deep-seated temperature of the body of children.

101. Fever, present or past, always leaves on the tongue of children a red dotting, which is due to the erection of the papillæ, and which remains as the last trace of this organic movement.

102. A child sad, depressed, and dull, weeping readily, seeking a place to be quiet and sleep, biting the lips, tossing about its head, agitating its limbs which are occasionally started by small jerks, is labouring under fever.

103. Rigors are extremely rare in children at the breast.

104. Pallor and a general cutaneous chilling replace rigor with trembling, in the fever of very young children.

105. Abundant perspiration is not observed in young children; it is entirely replaced by moisture.

106. Fever always presents considerable remissions in the acute diseases of young children.

107. In the chronic diseases of infancy, the fever is almost always intermittent.

108. A high fever acts upon the secretion of urine, diminishes its quantity, concentrates its elements in a small quantity of water, and soon renders it irritating to the excretory passages.

109. A violent fever dries up the secretion of tears.

110. The deep-seated temperature of the body, measured in the axilla, becomes raised from two to six degrees in the acute febrile diseases of children, under the exclusive influence of the fever and not of each disease in particular, precisely as observed in the adult.

111. Calorification is in relation with the force of the constitution of infants.

112. Calorification supported by the food and covering is so easily lost in feeble and attenuated infants, that death by cold is the consequence of it.

113. Calorification is always very much diminished in sclerema or induration of the cellular tissue of infants.

END OF PART II.

K

Part III.

SPECIAL PATHOLOGY OF INFANCY.

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BOOK I.

PHYSIOLOGICAL AND PATHOLOGICAL PHENOMENA
CONSECUTIVE TO BIRTH.

SEPARATION OF THE UMBILICAL CORD.

The detachment of the cord completely separates the newly-born infant from all connection with foetal existence. It is accompanied by phenomena and symptoms which it is useful to know.

This detachment takes place more or less quickly, according to the subjects, according to the nature of the cord, and also according to the particular constitution of the children. Thus large, soft, and fat cords shrivel slowly, and often suppurate at their base before separation; on the contrary, thin, small cords dry up early, become transparent like parchment, so that the dried vessels which they enclose can be distinguished, and are separated rather early without suppuration.

The cord shrivels from the first to the third day, and desiccation rapidly follows. It is only completed at the end of twenty-four hours, three, four, and five days. It is equally observed in the gelatinous matter of the cord, and stops at the level of the cutaneous swelling. Then the cord becomes detached with or without suppuration, leaving a complete cicatrix beneath it.

The most curious part of this phenomenon of desiccation is the fact that it is so evidently under the dependence of the phenomena of life. It is not observed in children who die during parturition; the cord, far from becoming dry and separating, becomes decomposed at the end of several days, the vessels remain permeable, and capable of receiving a penetrating injection, as Billard has informed us. the fact is important in a medico-legal point of view, when it is endeavoured to find out if a child has lived one, two, or three days.

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