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/.' general accompanied by fever; its termination is nearly always favourable.

.■'•/.; In some circumstances, however, it presents all the characters of acute / entero-colitis, and depends upon inflammation of the mucous membrane. i'i-t,<i*J'£J The diarrhoea of dentition is, then, most frequently idiopathic; it is perhaps the result of a simple acceleration of the peristaltic move''z , tj, ment of the intestines, occasioned by the general nervous state of the _children. It is, probably, a nervous diarrhoea. In fact, if fear, cold, ''T>r some acute moral emotion can provoke diarrhoea, and this is incontestable, it is not impossible that the pain of dentitiou, and the nervous r agitation which is the consequence of it, may determine the same result Whatever may be the nature of this diarrhoea, it must be treated /" / Jj ky the appropriate means. First, it very much weakens the children; afterwards, it may persist in a permanent manner, and then it is evident 'that it is symptomatic of an intestinal alteration. Further in the , 't,','. chapter devoted to the study of diarrhoea, will be found the series of means by the aid of which we may remedy this disease.

APHORISMS.

220. The first teeth should appear from the lower jaw, between the sixth and eighth month.

221. The first teeth appear very late and very slowly in rickety children.

222. The median inferior incisors, then the median superior, then the superior lateral, and after the inferior lateral, appear successively by groups in their respective alveoli.

223. After the irruption of the incisor teeth, that of the first small molar teeth commences.

224. The canine teeth always appear after the first molar teeth.

225. After the irruption of the canine teeth, the process commences which should prepare the evolution of four new molars which complete the set of teeth of childhood.

226. A short period of arrest, a veritable period of repose, always exists between the appearance of each group of the teeth of early childhood.

227. The teeth of early childhood are twenty in number, and are called caducout, in consequence of their premature decay between the seventh and eighth year.

228. The caducous teeth are replaced, on their decay, by new permanent teeth.

229. A third dentition is observed, but it is an exceedingly rare phenomenon.

230. Good or bad teeth is an hereditary circumstance in families.

231. Short teeth, of a yellowish white colour, are the strongest, the most lasting, and indicate a good constitution.

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232. White and long teeth are soft and readily decay.

233. Teeth with a bluish tint indicate a feeble constitution, and arc frequently met with amongst phthisical subjects.

234. The irruption of the teeth very often engenders local symptoms of simple, ulcerous, or apthous stomatitis, and general sympathetic phenomena, developed on the skin, mucous membrane, and nervous system.

235. The ulcerous stomatitis caused by dentition should be carefully treated, in order to avoid the formation of glandular enlargements of the neck.

236. The diarrhoea of dentition should be arrested as soon as it becomes very abundant.

237. It is in the highest degree unreasonable to acquiesce in the popular adage, which, everywhere and always, accords immunity to the accidents of the first dentition.

CHAPTER IV.

ON PHARYNGITIS.

Inflammation of the pharynx is a very rare circumstance in infants and children at the breast. There are scarcely any examples of it in the various treatises on medicine. I have discovered a very curious one which appears worthy of mention here. It relates to the development of an abscess in the posterior wall of the pharynx, and it has been published by M. Besserer. This is the substance of it: the case will be afterwards given at full length. s, . ./

A child, four months old, was seized with fever, hoarse and frequent cough, obstruction to the respiration, and difficulty of deglutition. At fi' , , , the end of forty-eight hours the child was unable to drink, the anxiety was considerable, and the finger introduced into the back of the throat discovered a tumour projecting in front of the vertebral column. On the tenth day the tumour had acquired a considerable volume, but it could not be well examined, as every attempt at this kind brought on attacks of suffocation. It was thought to be croup; and the child died.

There was nothing wrong in the larynx, but there was, in front of the vertebral column, behind the posterior wall of the pharynx, an abscess as large as a hen's egg, enclosing half a cupful of pus, which a small incision would have easily liberated.

('use. Abscess of the posterior wall of the pharynx, in a child four months old. A child four months old, born of scrofulous parents, presented 21st November, 1840, the following symptoms: moderate fever; hot, dry skin; easy, moist, unfrequcnt J'/ / ((.£<£7fv/cough; mueoua rales, particularly in the larynx and trachea. The buccal cavity and the back of the throat were filled with filamentous and viscous mucosities. The ■IJ )I U posterior wall of the throat appeared to be covered with a false membrane. The base of the tongue was enlarged and covered with a white layer. The >'///, respiration was accelerated, deglutition manifestly difficult, the child took the • /v '''''■' ''■" breast but rarely. It was thought that a diphtheritis with laryngeal and tracheal catarrh existed, and an emetic was prescribed. On the 23rd, the symptoms, especially those which referred to the respiratory fuuctions, were more serious. Respiration was very difficult, sometimes with rather long intermissions, especially ,' . on dorsal decubitus; the cough was hoarse and frequent. The rales are very

.W , I (j loud, and there is much mucosity in the back of the throat. The finger introduced into the mouth, discovers the posterior wall of the pharynx projecting and swollen. The child is very much agitated and in a state of great anxiety; it 'would not take the breast, and allowed the small quantity of milk given it to

I !l i,u_i l drink to run from the mouth. A fresh emetic was administered and three leeches applied to the neck. After vomiting had taken place there was a little improvement; calomel was then given in the dose of half a grain every two hours, and the application of a blister prescribed. The symptoms remained stationary until the 1st of December; only the child grew weaker. They suddenly and violently 1 0 Illltlutfe*'VLTDe'^ m 'Qe n'8n' TM* *he nrs' *° tne second. A certain sound was, moreover, detected which appeared to be that of a membrane ruptured by the effort, after , having for a long time obstructed respiration. Every attempt to examine the larynx brought on attacks of suffocation. M. Besserer, believing it to be a case of croup, prescribed the sulphate of copper. In the evening the child was found with the head strongly thrown back, the face pale, covered with a cold sweat, „/l \i'«./' .and in a state of extreme agony. The finger introduced into the back of the (- i throat discovered a firm tumour which did not manifestly appear to narrow it. . t {. '< I'J"'-' This manoeuvre rendered the respiration more easy, as did also pressure on the sides of the larynx, carrying this organ forwards. Bleedings, emetics, etc, were '' .. »' .- followed by a slight amelioration; but the next day the attacks became more violent, and the child died in the night.

On the examination of the neck after death, it was discovered that the larynx, the epiglottis, and the trachea, were white, exsanguine, and covered by a viscid -^ mucus. The posterior wall of the pharynx which was not at all covered by false

membrane, as it was believed to have been observed to be during life, was white, swollen, and very thick ; it formed the anterior wall of an abscess as large as ft hen's egg. This abscess formed exclusively by the cellular tissue, rested on the bodies of the first, second, third, and fourth cervical vertebra;, and contained half a enpful of thick, flocculent, greenish yellow pus. The vertebne did not present any traces of disease.—(Gein. mid Westf. Corretpondenxbl. No. 22, 1844.)

[Abscess between the spine and the pharynx is occasionally observed, in which case surgical interference is as effectual as it appears to be essential from the symptoms, and not alone from the fact of certain fatal results from mechanical pressure on, and interference with, vital organs, but also from the situation of the abscess being particularly favourable to extensive diffusion. Dr. O'Ferrall has seen, in one case, a spontaneous opening occur: the abscess was high up, and matter passed through the nose. The abscess should be opened with a straight bistoury, with the cutting part short, as the density of the covering renders the plunges of a trochar unsafe.—P.H.B.]

Cynanchb Parotidea. I'\AAMM*V

[Cynanche parotidea, or mumps, consists of inflammation of the parotid, sub- . lingual, and submaxillary glands, occasionally associated with that of the tonsils. ^i/(^tvfiwll<^ It is more fequently met with as an epidemic, although it occasionally occurs as a sporadic affection. It usually commences with the ordinary symptoms of slight "., / f fever or catarrh, which are followed, in from twelve to twenty-four hours, by pain" l/sH->Z-"t-t and stiffness of the neck and the lower part of the jaw. Swelling is then t. . \, observed about the angle of the jaw; sometimes confined to one side, sometimes ■"^-*7 on both sides at once; but it is most commonly observed first on one side and ffl' then on the other. In consequence of this swelling the motion of the lower 1 LlA,Cu V jaw, for the purposes of speaking and mastication, is much impeded, and attended ,

with considerable suffering. The swelling is very tense, but the skin generally Jlr\l[lnjpt preserves its natural colour, except in some cases, in which the glands on both sides, being enlarged and pressing much upon the veins, the return of blood from the head . iT

is impeded, and the face assumes a flushed appearance. If the case be a severe "^* one, the child is feverish, and may be delirious; but the inflammatory condition Q j

almost always terminates in resolution after a few days. The disease reaches its \TUAAH'*--b height in about three or four days, and then begins to decline; its whole duration , may be averaged at eight or ten days. Evanson and Maunsell (On Diseases of ,:/•( t C t-v Children) state, that the swelling of mumps, at times but very rarely, will proceed" to suppuration, and may cause immediate death, by discharging its contents into the / . i j larynx, if it burst internally, or lead to great deformity when it opens externally. "-WT-*^-W^ West believes that suppuration is oftener met with in infants and young children t, (

than those who are approaching the period of puberty; but that, on the other hand,'''*-*t*/ metastatis of the disease from the parotid to the mamma, the testicle, or the brain, / Q «

of all of which instances are recorded by different writers, appears to be rare iMA^f p"' in proportion to the tender age of the patient. The treatment of this disease is very simple; mild antiphlogistic medicines, and the application of warmth, being /r\ fa/\Xb-i all that is required, local depletion being neither necessary nor useful.

M. Rilliet has published a very interesting account (Gazette Medicate, 1850) of v-LlAj fttOi*^ an epidemic visitation of mumps, which prevailed there from March, 1848, to May, , 1849. In the majority of cases there were no premonitory symptoms, those of rllM-A-f^" a local character being the first intimation of illness the patient received. The *_ f tumefaction of the parotidean and mastoidean regions continued increasing from *- w '' four to six days, and, after remaining stationary, then rapidly diminished, so as to (l have disappeared by from the seventh to the tenth day, the submaxillary gland Z.1; {. i f 'J, ' /., continuing hard and swollen, in several cases, long after the resolution of the parotidean tumour. The frequent cases were those in which the tumefaction was of I*' / »t" medium size only; but in some it was enormous, extending almost to the external -^ ,/- / / extremity of the clavicle. In such, and in subjects predisposed to neuralgia, the pain was severe and even violent, but in the other cases, moderate—it being usually JjJj /tt spontaneous, but also augmented by pressure and every movement of the jaw, which indeed was sometimes as immoveable as in tetanus. In some cases, when the tyO-LtUj '. mouth could be sufficiently opened to allow the tongue to pass, the patients were' unable to protrude it. In no case did Rilliet, or any of his colleagues, witness kCfUL L. t salivation, nor, when examination of the mouth and fauces was practicable, could ^ any exanthema be observed. The swelling was usually double, but rarely so at firet, £ (T~r commencing usually on the left side, and then proceeding, in a period varying from twelve hours to three or four days, to the opposite side, one gland being almost ci.il ' v always more swollen than the other.

The accompanying constitutional irritation was not prolonged beyond forty-eight } j / I hours, save in very bad cases. A feeling of great lassitude and debility accom- ^

CrUL^j. '■'■

T' K ■■ ■■

/ vi A*7,^-<'i*4]0 SPECIAL PATHOLOGY OF INFANCY. [Part III.

*4a 11 iatJUi/. P*n'e0- or f°ll°we<l the appearance of the swelling, several patients not recoverimj their ordinary strength for two or three weeks. The cure was always more prompt

I, r jTYtj. an(l complete in children. The duration of the disease, in slight eases and ui children, was but four or five days; but in other cases, usually eight or ten ; then six or seven, and lastly, seven to eight days. In some it continued even to the fifteenth day. No example of the termination of the disease in suppurativa occurred. The disease rarely attacked children under two years of age, and no example occurred under one. The maximum number occurred between five and

;'1 H.i 'J • fifteen. The two sexes were affected nearly alike.

Rilliet believes the disease to be analogous in its nature to eruptive fever, and to

i be contagious. The period of incubation was most frequently found to be from

twenty to twenty-two days, and then from fourteen to eighteen days. Still, in one of

the best marked cases, it did not exceed eight days. It prevailed equally in warm and

cold weather. The only complication frequently observed was orchitis, the youngest

person attacked being fourteen, but no case of metastasis, properly so called, was

i ,m noticed; but one case of tumefaction of the labium was met with.— P.H.B.1 t>ltl 11 •*

, /\liu<~ Cynanche Tonsillaris.

f> 11 \ *_ I ** * j [The term cynanche tonsillaris or quinsy is applied to inflammation of one or

both tonsils. It is accompanied by swelling of these parts which interferes with swallowing and breathing; on the inspection of the throat, more or less of inflammatory redness and swelling are observed on one or both of the tonsils. Sometimes both of them are affected at once; very often one only is first attacked, and the swelling commences in the other as it ceases in the first. The uvula

(ILL U J '8 enlarged, elongated, and of a bright red colour. Opaque whitish spots are observed on the inflamed tonsil at an early stage of the disease; these are merely . / exudations or the discharged contents of the mucous crypts, and must not be mistaken for specks of ulceration. Swallowing is difficult and painful, and the pain is almost solely felt during the act of deglutition; occasionally the inflammation extends along the Eustachian tube, giving rise to tinnitus annum and pain in the ears, or this may be simply caused by closure of its extremity in consequence of the swollen state of the parts about it. When in severe cases pain shoots from the throat to the ear along the course of the Eustachian tube, suppuration is to be feared. The voice becomes thick, guttural, and inarticulate from the

-i V <-l-J Cli' blocking up of the throat and the obstruction to the free play of the velum palati. Cynanche tonsillaris is usually attended with considerable febrile reaction, much '" ' ^ < < more indeed than might be expected, considering the limited extent of the local inflammation, but it is not followed by debity.

The inflammation usually terminates by resolution, but when it is violent, long continued, or occurs in persons who have a peculiar disposition to these attacks, it frequently leads to suppuration. j i With regard to the treatment, Watson (Lectures on the Principles and Practice of Phusic; vol. i, p. 786) believes that the disease may be cut short in its very outset by an emetic. When the inflammation is established the little patients should be kept in doors, warm applications and stimulating embrocations applied to the exterior of the throat; if the patient is old enough, gargles of warm water or warm milk and water should be used, and in a more advanced stage one containing a weak solution of chlorine. In the more chronic states, solutions of the nitrate of silver gallic acid of the tincture of iodine should be applied. .Professor Hess, of Copenhagen, uses compression by means of the index finger applied to the indurated tonsil with success, repeated three or four times a day;

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