the examination of the respiration, of the circulation, &c.-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. hitherto inactive, commence their functions; they Certain organs, develop and modify themselves; others disappear; the infant passes efforty of into entirely new spheres of existence, first into extra uterine life, then into that of the senses, and, lastly, into the sphere of the alunte intellectual world.) The life of an infant is not, then, a normal state, but a succession of efforts to achieve this; and in this light it should engage the consideration of the physician. That which, under fire other circumstances, we should take for a disease, is here the effect and the symptoms of the work of nature, occupied in creation and Illuitate Aliase development. 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 pounds; of four years, 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 length at the time of birth, it increases to twenty-six or twenty-eight 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 uni functional activity is truly remarkable: nutrition, circulation, and arrivity. the elaboration of fluids are effected with great rapidity. But if this acceleration of organic movements is necessary for the growth of a the subjects, it determines thus to express it a fatal susceptibility!! 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 highestimportance I allude to the mortality of new-born infants. The first day is the most terrible to surmount: one-tenth of all que vien new-born children perish; and we know that in France out of a million Hate Qearraing to Chrussier de dubry porns 2 mchos Euch mouth is busting. of births per annum, 250,000—that is, the fourth part—are cut off 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 the same time upon the climate, the age and constitution of its parents, cirus their moral disposition, their diseases, &c.: it controls from the cradle life ideo= certain unknown predisposing causes which may induce, at a later period, a great number of diseases, such as syphilis, scrofula, gout, Cuts, epilepsy, mania, &c. By virtue of this puerile idiosyncrasy it can 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 longer than five or six years; these are scrofula and epilepsy. But there is one-syphilis-which, in its hereditary form, appears, at the de latest, six weeks or two months after birth. Card There are some diseases peculiar to infancy; and others which are common to this age, and to every other period of life. The former, inst such as ophthalmia, convulsions, croup, certain diseases of the intestines, 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; 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 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, which presents more difficulty. This is also the case with a great many other diseases. The most frequent affections amongst children at the breast are diseases of the digestive and respiratory organs; then follow skin 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 e, 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 and the epoch of dentition, and the other extending from dentition to the ordinary term of suckling-that is, up to eighteen or twenty the months, we shall find in this second period some diseases which ́assuredly are very rare in the first; diseases of the mouth for instance, apthæ, pseudo-membranous angina, and other affections, are far more frequent than in the first months which follow the birth. All infantile diseases are but impressions transformed, and result Constitulo Sect. I.] GENERAL CONSIDERATIONS ON DISEASES OF INFANCY. 87 An most from the reaction which follows a morbid impression. Impression marked. and reaction constitute, in fact, the most exact etiological expression for all diseases. Only here, as regards the infant, the impression is easily in Sufen. made, it is more profound and more serious than in the adult; the 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. In a general manner it may be stated, without fear of deceiving and Beasts ourselves, that the anatomical lesions of the diseases occuring during the first stage of infancy are less purely inflammatory than the diseases of the second stage of infancy, and those of the adult; they 420 ulting are more destructive it is true, but death is less frequently the from, an result of the material disorders which they produce, than of the less duti blow given to a weak organization by a too considerable dynamic in the reaction. Infsent. 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 phlegmasia, 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 Certai incapable of effecting their removal. If the infant does not sink, the disease often passes into the chronic state. Diseases The subacute or chronic form is, in my opinion, one of the most important characteristics of these diseases: it is the one which assimi- to lates them, up to a certain point, to the diseases of aged people. Thus, pneumonia much more often assumes the chronic form at these on two extreme periods of existence than at the adult age. The same is the case with pleurisy and entero-colitis, the latter is especially the 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 an difference we find in the symptoms according to the disease! (Isolati 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? Is it not to the excessive 444sort. 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? Tems Lastly, are there not in the febrile reaction evident differential characteristics of the highest importance?) the aged are 1 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 tu more would seem to indicate an unimportant disorder; in the latter, it is int to the weak, sometimes wanting, notwithstanding the presence of very serious anatomical lesions; it is only in the adult where the balance maintains foth lisims in some respects its equilibrium, and where one can judge of material injuries from the amount of reaction taking place. The disparity existing between the amount of reaction and of lesion, is one of the most curious phenomena of infantile pathology, and 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 * 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. Judy In young children, the reaction is made up of the whole of the general phenomena, such as affections of the general sensibility and Imotive faculty, disorder of the cutaneous calorification, and, lastly, 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, 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 Abecomes considerably diminished and then remounts to a very high degree. These alternations are especially remarkable at the end of some days of continued inflammation, either of the lungs or large Mel intestine; they become very apparent when these diseases pass into a chronic form. 糖 The affections of early infancy differ, then, from those of the adult 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, the rapid progress of symptoms, the precipitate terminations of the same, whether a cure is effected, whether death or a chronic state supervene; everything, however, permits us to state that the diseases Sect. II.] MEANS OF EXPRESSION IN CHILDREN. 89 Slitution of infants at the breast show the stamp of excessive debility, which is in accordance with the delicate constitutions of the sufferers. These general pathological considerations indicate the manner in which we intend to investigate the diseases of new-born infants and children at the breast. The opinions we have expressed will be confirmed in the following pages, and in the chapter which we shall devote to the consideration of febrile reaction. We will now consider the general external characteristics of these diseases, such as observation has pointed them out to us; they are of the highest importance and are furnished us by the means of expression peculiar to infancy. of the Sufferus SECTION II. ON THE MEANS OF EXPRESSION IN CHILDREN. It is by no means an easy thing to understand a helpless infant, who at first seems to have no want but that of nourishment and sleep; whose intelligence is only commencing to develop itself, and who seeks to take cognizance of all the unknown bodies which surround it. If the task becomes less difficult at a more advanced period, it must, nevertheless, child pu be granted that it still remains troublesome as long as speech does bious not aid the embarrassed patients in the expression of their sensations. Up to this period, then, the practitioner who examines a suffering such ha child, derives nothing from articulate language, since it is insufficient ; he must have recourse to other means. Previous to speech, God stu laugur has given to the child a language which philosophers call natural language it is the language of signs. The practitioner should recognize it, and should even study it scientifically, in order to avoid the commissioniun of the most serious errors. The knowledge of this language is especially precious to him in the observation of diseases of infancy; as in the case of a dumb person, a glance of the eye should direct the practitioner so as to apply the resources of medicine. In the child, in order to be the wise interpreter of his natural language, his physiognomy, features, eyes, gestures, cry, and attitude must be studied; if we add to this study, on the one hand, the observation of certain characters derived from the state of agitation, or of rest, in little children, and on the other, the results of the inspections of certain important external symptoms, such as the examination of the pulse, mouth, abdomen, products of secretion, vomitings, stools, &c., we shall be possessed of all the information necessary to form a correct w meta opinion on the greater part of the diseases of childhood. |