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 Jufun, 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. Past. Lesens 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 cutting diseases of the second stage of infancy, and those of the adult; they from, are more destructive it is true, but death is less frequently the result of the material disorders which they produce, than of the less miki blow given to a weak organization by a too considerable dynamic 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 Certain 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 two extreme periods of existence than at the adult age. The same 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, lim and termination, tend to confirm this assertion. In fact, what a difference we find in the symptoms according to the disease! (Is 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 user. 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? que Tems Lastly, are there not in the febrile reaction evident differential A characteristics of the highest importance?) In the infant, as in the aged, the febrile reaction bears no exact the aged an relation to the material lesion: in the former it is very intense, and Lu uuris would seem to indicate an unimportant disorder; in the latter, it is intele the weak, sometimes wanting, notwithstanding the presence of very serious anatomical lesions; it is only in the adult where the balance maintains both lisins in some respects its equilibrium, and where one can judge of material injuries from the amount of reaction taking place. In Adult The disparity existing between the amount of reaction and of lesion, like they is one of the most curious phenomena of infantile pathology, and In nearly possesses, in my opinion, an important medical signification. brianced. 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. udy 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, 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 44becomes 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 Ml intestine; they become very apparent when these diseases pass into a chronic form. " 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 Stitution of the 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 Sufferus. 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. SECTION II. ON THE MEANS OF EXPRESSION IN CHILDREN. Ir 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 pre= be granted that it still remains troublesome as long as speech does not aid the embarrassed patients in the expression of their sensations. bucus to Up to this period, then, the practitioner who examines a suffering child, derives nothing from articulate language, since it is insufficient; ech how he must have recourse to other means. Previous to speech, God the langur has given to the child a language which philosophers call natural • language: it is the language of signs. The practitioner should recognize Should. it, and should even study it scientifically, in order to avoid the commissione 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 inspection 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 hea tow opinion on the greater part of the diseases of childhood. Physiog CHAPTER I. ON THE PHYSIOGNOMY OF SICK CHILDREN. Criticism has been severe on those who have endeavoured to read on the face that which is buried deep in the soul. In this there is nothing which should surprise us. It has not been less merciful to those physicians who have conceived themselves able, without neglecting the other means of exploration, to determine the existence of a certain number of diseases from the inspection of the physiognomy, the attitude, the gesture, &c. This may surprise us the more, especially when we consider that most of our experienced teachers permit their genius hould to guide them, and often form a diagnosis of a disease without addressing a single question to the patients. The natural language is only unintelligible to those who will not make efforts to comprehend it. The works of Hippocrates, Galen, Avicenna, and Boerhaave, contain much valuable information relating to the changes of the physiognomy in the diseases of the adult. They contain but a few observations tal applicable to children. The same is the case with the treatise of Stahl (De facie morborum indice); of Quelmalz (De prosocopia medica). The work of Thomas Fieni (Philosophi ac Medici praestantissimi semeiotice sive de signis medicis) includes more details; but it contains nothing which has not already appeared in Galen and in Hippocrates. Authors of modern treatises on diseases of children have united in their attempt to destroy the results obtained by some physicians in their studies on the physiognomy of disease. With the exception of Underwood, the translation of Eusèbe de Salle, Jadelot, and Billard, there are scarcely any who have understood the importance of these studies, when they are not exclusive, and who have decided in according them the importance they deserve. SM. Jadelot, who has never published any of his researches, has, nevertheless, contributed more than any one to diffuse this valuable knowledge. All the pupils may have seen him practising at the bedside of the patients. He excelled in the difficult art of scrutinizing the physiognomy of children, in order that he might there discover the nature and progress of their diseases. According to this physician, it is especially from the period of dentition to puberty that some assistance may be derived from semiologic physiognomy. Still, if M. Jadelot, with his spirit of observation, can readily appreciate, and in a very decided manner too, those modifications, often as variable as they are fleeting, impressed by diseases on the countenance of children, he is probably in error in wishing to translate them in precise terms, with too absolute or too restricted a signification. A portrait cannot be described, it is painted; happy the inspired artist who animated the canvass; unhappy he who replaces the brush by the pen in the description of a face. The portrait would always be inferior to the model. The aptitude of judging of physiognomies depends much upon genius. Certain men have been richly favoured by nature in this respect; there are some who possess this talent in the highest degree, but, in my opinion, habit and experience may do much for those who have been less favoured. I shall now attempt to interpret, clearly, the results of my observations on the morbid physiognomy of children at the breast. To this I shall devote the more care, since M. Jadelot and his commentator, M. Eusébe de Salle,* have only studied the alterations of the physiognomy in the second stage of infancy, declaring very erroneously that in the first, that is to say in children at the breast, the face had no decided features, and that it is impossible to discover anything there in a semeiotic point of view. This is a gap which these authors have left for me to fill up, and very fortunate shall I esteem myself if I can do so properly. Promess ON THE COLOUR OF THE FACE AND INTEGUMENT. Children which are just born, present a red colouration on the face and body, which preserves its intensity for about four or five days. During this time, if pressure is made on the integument, the colouration is born, effaced and the skin appears yellow; then the blood gradually returning into the capillaries from which the pressure had driven it, this yellow tint is replaced by the previous red colour. From the fifth to the eighth day this colour disappears, the skin now presents a general yellowish tint, which results from the slow absorption of the blood infiltrated into the tissues at the time of birth. # [This assertion, that the yellow colour of new-born children depends on the slow absorption of the blood infiltrated into the tissues at birth, would appear to be erroneous, from the fact that not half of new-born children are thus affected; but that, on the other hand, it seems most likely to be the result of slight jaundice, from the great frequency of this disease in new-born children, and the influence which purgatives exert in removing this yellow colour of the skin.-P.H.B.] # Yellowish from Sometimes this more or less intense yellow coppery colouration, is observed beneath the skin, at the same time that it exists under the conjunctiva and beneath the tongue; it then constitutes a true jaundice which depends on the passage of the bile in the blood, and which is question |