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ON THE GENERAL PATHOLOGY OF INFANCY.

SECTION I.

GENERAL CONSIDERATIONS ON THE DISEASES ON THE FIRST

STAGE OF INFANCY AND ON THE MEANS OF

THEIR DIAGNOSIS.

It is impossible to account for the phenomena which accompany disease in the first stage of infancy, without a knowledge of the principles and laws which govern the affections of that tender age; and this ■ knowledge is more especially requisite for the due appreciation of the difference existing between the affections of infancy and the same

^", affections developed in the adult. Nothing is to be compared io the influence of age on the character of disease, without it is the influence which climate exerts on the strength and form of plants and the large animals. When we observe the puny specimens of ricinus of our own 'country, and then compare them to the superb and gigantic ricini of inter-tropical countries—when we see the pale cacti of our hothouses in juxta position with the brilliant and celebrated cacti of '„ fhe New World—when we compare animals of the same species born in different latitudes, the Polar bear, for instance, with the

. bear of the Pyrenees—the lion of the desert with the lion of the forests of Brazil—we shall then comprehend the whole extent of the modifications produced in the development of individuals of the same species according to their place of birth, and consequently be struck with the difference which exists between the disease of a growing infant and the same disease in a well formed man in all the vigour of life.

• ,,_, In this chapter I will consider the general conditions by reason of which the diseases of infants differ from those of adults. I will then point out the most suitable methods for the diagnosis of these diseases; and will treat of the physiognomy of children, of their gestures, attitudes, cry, stature, and of all those external signs furnished by the examination of the respiration, of the circulation, Ac.—signs of so much the more importance to understand in proportion as the children are younger, and consequently less capable of describing their sensations.

GENERAL CHARACTERS OF INFANTILE DISEASES.

On Diseases Of Children At The Breast.

| The new-born infant is an imperfect being, whose organization, as yet unfinished, requires to develop itself. As Hufeland observes, we may designate the period which elapses immediately after birth and during the first year, the sequel of a creation, one-half of which 4 is accomplished within, and the other without, the womb of the mother. Certain organs, hitherto inactive, commence their functions; they ... ___ develop and modify themselves; others disappear; the infant passes ttf-rffTvf v* into entirely new spheres of existence, first into extra uterine life, A 'J then into that of the senses, and, lastly, into the sphere of ^h^HJL-tiUU- /<intellectual world.) The life of an infant is not, then, a normal Jj state, but a succession of efforts to achieve this; and in this light it^*^(f^LLl^ *should engage the consideration of the physician. That which, under fjlfl is other circumstances, we should take for a disease, is here the effect' ~ . and the symptoms of the work of nature, occupied in creation axAJ-LUtf*^t^x' development. jfy / }{j JI

The infant at first weighs from six to eight pounds (French); at' the end of a year, it weighs twenty pounds; of two years, twenty-four _ ,

pounds; of three years, twenty-six and a half pounda; of four years, frlA-X '' thirty and a half pounds; of five years, thirty-four pounds; of six years, thirty-seven pounds; of seven years, forty-one pounds. The stature changes with equal rapidity: from eight to ten inches in f7T"/.. length at the time of birth, it increases to twenty-six or twenty-eight V"*^**-*^^ at the end of the ninth month; thirty to thirty-one at the end of the second year; thirty-one to thirty-three in the third; thirty-five in the fourth; and so on up to the age of seven years, when it is from thirty-nine to forty-one inches.. At the commencement of life the .-^ UA/.tXu.'h t". functional activity is truly remarkable: nutrition, circulation, and ^rr-' 'j the elaboration of fluids are effected with great rapidity. But if this acceleration of organic movements is necessary for the growth of Aw>^''P*"" the subjects, it determines—thus to express it—a fatal susceptibility j, tjf^,,//, / in these organs which disposes them to diseases. (^On this account there is more sickness during infancy than at any other epoch in life?)/ This morbid disposition is, moreover, indicated by facts of the highest Cc /H4t«*i <- importance—I allude to the mortality of new-born infants. ..

The first day is the most terrible to surmount: one-tenth of all fyji \JM new-born children perish; and we know that in France out of a million ( ^.

U, ("tiT-t ¥ of births per annum, 250,000—that is, the fourth part—are cat off h i&(* *i , by death before the end of the first year.

The infant receives with life a sort of existence which constitutes

its physiological individuality or idiosyncrasy, which depends at tbe

'same time upon the climate, the age and constitution of its parents,

I CtXUJM jb«Mheir moral disposition, their diseases, <fec.: it controls from the cradle

j,\ . certain unknown predisposing causes which may induce, at a later

'period, a great number of diseases, such as syphilis, scrofula, gout,

■'it £l*W^ epilepsy, mania, <fec. By virtue of this puerile idiosyncrasy it can

'-i /' / prevent some of these diseases up to the age of twenty, thirty, or

* forty years. There are others which it cannot keep in the latent state

'i,,,,1 . longer than five or six years; these are scrofula and epilepsy. But

there is one—syphilis—which, in its hereditary form, appears, at the

,1-U -'»t^ latest, six weeks or two months after birth.

''■a Lh There are some diseases peculiar to infancy; and others which

j are common to this age, and to every other period of life. The former,

such as ophthalmia, convulsions, croup, certain diseases of the intes

- f r.'' tines, have their own special characters, which must be individually

studied if we wish not to mistake them; the others, which appear at

• '■• the same time in the infant and adult, present on comparison a

specially modified form which establishes a marked difference between

them. This modification principally relates to the lesions and the degree

of reaction which they determine, that is to say, to the symptoms;

■• : • (t.' so that in a great number of cases, the knowledge of the diseases

of the adult would be of no avail in regard to the same diseases in

', .,4,„ infants, if a comparative study of them had been made. Thus, to cite

one example only, nothing is more easy to recognize than confirmed

pulmonary phthisis in the adult; whilst in the infant there is nothing

t- t v,. i. which presents more difficulty. This is also the case with a great

t , many other diseases.

The most frequent affections amongst children at the breast are

diseases of the digestive and respiratory organs; then follow skin

/ ^ . ,t4,//-i diseases and affections of the nervous system. However, nothing very

precise can be stated on this point, for that which would hold good for

the first period of lactation, would not do so entirely for the second

• i t't period. In fact, if we mentally divide the life of the child at the breast

into two parts, the one comprised between the moment of birth

'{'■[: ^l ,and the epoch of dentition, and the other extending from dentition

to the ordinary term of suckling—that is, up to eighteen or'twenty

[i'i •^'A'u-U)months, we shall find in this second period some diseases which

'assuredly are very rare in the first; diseases of the mouth for instance,

aptlue, pseudo-membranous angina, and other affections, are far more

frequent than in the first months which follow the birth.

;/•*"..-' AH infantile diseases are but impressions transformed, and result

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Sect. I.] GENERAL CONSIDERATIONS ON DISEASES OP INFANCY. 87 Clx*. hut*^.

from the reaction which follows a morbid impression. Impression ,/ua^k^) and reaction constitute, in fact, the most exact etiological expression for j /

all diseases. Only here, as regards the infant, the impression is easily ^*"

made, it is more profound and more serious than in the adult; the (1^ ^

reactions also are more intense and more dangerous. There are some"'

organs more susceptible than others; such are the brain, the lungs,

the bronchi, and the intestines; therefore, we ordinarily perceive that

morbid manifestations select these tissues and these viscera. i aJL' UH"*'

In a general manner it may be stated, without fear of deceiving A^, At*jt ourselves, that the anatomical lesions of the diseases occuring during .

the first stage of infancy are less purely inflammatory than the ILUiiluJi diseases of the second stage of infancy, and those of the adult; they fr^u* £ti» are more destructive it is true, but death is less frequently _ the 0 «. . result of the material disorders which they produce than of the ^*^ blow given to a weak organization by a too considerable dynamic U~ *"«■*■ reaction. Xvtu~t

In fact, if we carefully examine the anatomical lesions in a case of pneumonia, and compare them with those of acute pneumonia in the adult, and seek in each case for the material element of that which we are accustomed to call phlegmcuia, we shall be unable to establish any relation between them. Inflammation is feeble at this -* tender age — it is less plastic; it is, if we may thus express it, feeble like the patient in whom it develops itself: suppuration very rarely follows it; the material which it amasses in the cells of an . organ remain there, for the absorbent powers are lessened and Cj^ttU-U. incapable of effecting their removal. If the infant does not sink, ,

the disease often passes, into the chronic state. ,(lAlJuU-4

The subacute or chronic form is, in my opinion, one of the most important characteristics of these diseases: it is the one which assimi- Jaim d lates them, up to a certain point, to the diseases of aged people. _ Thus, pneumonia much more often assumes the chronic form at these t-S^jL*' &**• two extreme periods of existence than at the adult age. The same *. .J is the case with pleurisy and entero-colitis, the latter is especially '"■*' remarkable from its tendency to put on the chronic form. ,'.. ^

The anatomical alterations are not the only indications capable of revealing to the physician the difference which exists between inflammations in children at the breast and in adults; other signs, not less important, derived from the study of their symptoms, duration, and termination, tend to confirm this assertion. In fact, what a»<-yw*-**u difference we find in the symptoms according to the disease!/ Is tj .. . it not to the narrowness of the glottis in infants we must refer symptoms of dyspnoea and asphyxia which come on so suddenly in , /

some affections of the respiratory organs ?J [la it not to the excessive "**y*' sensibility of the nervous system we must attribute the spasmodic * and convulsive phenomena which indicate the commencement of acute febrile diseases, or the unfortunate termination of some chronic malady? it't l-etuj Lastly, are there not in the febrile reaction evident differential ^ • Clu^ characteristics of the highest importance? J

, In the infant, as in the aged, the febrile reaction bears no exact

relation to the material lesion: in the former it is very intense, and

k I/mama would seem to indicate an unimportant disorder; in the latter, it is

T -tj n* weak, sometimes wanting, notwithstanding the presence of very serious

_ y , anatomical lesions; it is only in the adult where the balance maintains

LfK . lUu*J m gome respects its equilibrium, and where one can judge of material

f\i . injuries from the amount of reaction taking place.

The disparity existing between the amount of reaction and of lesion,

j* titMf \s one 0f the most curious phenomena of infantile pathology, and

U, )il*aij possesses, in my opinion, an important medical signification. Thus,

, .-, for example, the exaltation of the power which is observed to be so

rapid and so varied in infantile pneumonia, in the pneumonia of adults

■n and of the aged, attests once more, at least, the truth of this principle—

that the lesions sustained being the same, each according to age, or

other circumstances, has a manner of suffering them which constitutes

his idiosyncrasy.

'.';' iiuiU-f In young children, the reaction is made up of the whole of the

general phenomena, such as affections of the general sensibility and

motive faculty, disorder of the cutaneous calorification, and, lastly,

a,/., by the state of the arterial pulsations. The pulse, it is true, only

gives a proximate and exaggerated idea of the extent of the local

* changes, and of the dynamic resistance of the subjects; but nevertheless,

,. i',7., ;/' it is a very useful indication and must not be neglected. "Weak or

strong, it is generally very varied in its acceleration, and daily presents

one or two remissions. It rarely intermits, and this takes place in

advanced disease of the cerebro spinal system. In infancy the febrile

, , reaction is not continually the same; very rapid one moment, it

* '-'becomes considerably diminished and then remounts to a very high

",w ,'■ degree. These alternations are especially remarkable at the end of

some days of continued inflammation, either of the lungs or large

'-'• ' i LuLi ^testnie; *ney become very apparent when these diseases pass into

, < , a chronic form.

The affections of early infancy differ, then, from those of the adult

,• i in many respects; the ready action of exciting causes, the often

exaggerated rapid reaction which quickly becomes lowered, the feeble

^ (■ * plasticity of the inflammation which gives to the organic lesions a

special character; a febrile state often accompanied with remissions,

i the rapid progress of symptoms, the precipitate terminations of the

'^ '-'-J:! u same, whether a cure is effected, whether death or a chronic state

,,' , supervene; everything, however, permits us to state that the diseases

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