Paralysis 98 E Esu measles. of turning the eye inwards, and the dilatation of the pupil. The optic nerve is not affected, and, nevertheless, vision is nearly abolished. Paralysis of the iris is the cause of it. Paulus Ægineta (lib. iv, cap. 57), Avicenna (lib. iii), and Thomas Fieni (loc. cit.), considered the half-closed eyes in sleep as a sign of worms in children of good health, but this is, however, an observation to which I attribute no importance whatever. We often observe in the eyes the indications of several other morbid conditions of the child. Who does not recognize, for instance, the redness of the eyes, the swelling of the eyelids, and lachrymation, as the precursors of measles? Who cannot appreciate the brilliant aspect Artium of the iris, the extreme contraction of the pupils, provoked by the ingestion of a small dose of opium? I shall not here again remark upon the pearl-like condition of the conjunctiva, which has been looked upon as characteristic of the verminous affection; this fact requires to be verified by fresh observations in order to prove its exactitude and constancy. 1. CHAPTER II. ON THE GESTURE AND ATTITUDE. All those who have studied the physiognomy have necessarily devoted a chapter to the development of the signs furnished by the various gestures and attitudes of individuals; these signs are but very rarely deceptive. The quick and firm walk of the man who carries his head proudly, whose chest is ample, and whose upper limbs move in unison, is as imposing as the stern aspect of a face the features of which are refined, the lips compressed, and the look determined. As the attitude often betrays him who would render his physiognomy impassive, so also it furnishes the physician with signs which he must not neglect. If these signs possess considerable value in the physiological state, their importance is not less in the morbid condition. In every disease the patient instinctively seeks the most favourable and the least painful attitude. With respect to the movements of the body and the gestures, as they are wrung out by suffering, independent of the influence of the will, they must be taken into consideration, for they may enlighten the physician in his investigations. It has been observed, with a show of reason, that children at the breast, confined in their infantile trappings, were not at liberty to assume the attitude most advantageous to them, and that they remained lude in the position in which it was desired to place them. Thence the conclusion has been arrived at, that the signs furnished by the attitude of children are of no account. It might as well be said that the physiognomy has no expression in people who, as a matter of custom, veil their countenance. We must not reason thus. The expression of the face is studied when it is placed in the most advantageous position for the examination of the features, that is to say, when the face is uncovered. Let the children be free, and the gestures and attitude which betray the suffering of such and such an organ may be appreciated. Thus when we observe a young child attacked with cerebral fever, at the commencement, during the stage of germination, he is suddenly heard to utter piercing cries; the hand is either raised, striking the air, u or pulling at a portion of his clothing or of the materials which cover bral him, as if to remove an object which frightens him. This gesture is characteristic, and in children of more advanced age, speech comes Trvez. to their aid, they call their mother to their assistance to deliver them from the beast which they perceive before them. Sometimes, at this moment, the body assumes a strange attitude; the face expresses fright; the children sit upright, and are much concerned to get rid of the object of their terror. Fises i it At a more advanced period of the disease, in the convulsive stage, the lovin' gestures and attitudes are different. The movements are automatic; Are Authus the hand wandering over the counterpane labours to pluck off the nap; moreover, the limbs are agitated by general convulsive movements, or are contracted. Lastly, in some patients, the body is in the most profound state of prostration; one of the sides is affected with paralysis, and is observed in the most complete resolution; the other alone remains capable of motion. Are these gestures then of no value, and is this attitude insignificant? No; there is no physician who is not already cognizant of its complete importance. In the diseases of the mouth, at the period of dentition, when the buccal mucous membrane is intensely inflamed, perhaps ulcerated, Ouu particular gestures indicate the seat of the suffering which the unit & evolution of the teeth occasions. In a little girl, twenty months old, in whom the process of dentition was tedious, the lips were forcibly separated, the mouth half open, and the four fingers of both hands were incessantly pressed between the dental arches. In the diseases of the larynx, in croup, the children cannot remain bullion completely recumbent; they become suffocated, and utter cries until they are placed in a sitting posture, supported by pillows which keep don them in this position. They wish to be incessantly carried on the aliral arm, because in this vertical attitude they find a point of support which ' facilitates their respiration. they high When they are observed at the periods of the crisis of suffocation, sit up.. and of the attack of dyspnoea, which determine the asphyxia in the last The Scrum, stage of the disease, they are heard to utter screams; and when they are laid down they make violent efforts to raise themselves. Thus, And rise, when the hand is presented to them, they seize it with a convulsive oh ww backgrasp, and, pulling it rapidly, raise themselves on their bed, throwing the head, back the head so as to seize the air which seems to escape them. In some children it is not the attitude alone which must be considered; 4 will hit the gestures are also at this time very significant. How many times, lisa in these cases, has one not seen them carry their hands to the neck, and compress the larynx laterally, as if to remove the obstacle to the introduction of air in the chest. There is no tracheotomised child Comixssorin whom similar movements are not observed. They are not the Laryng result of the pain caused by the presence of the canula, for they It is, further, by particular movements, without the aid of speech, that the child expresses to us the suffering which it experiences in the interior of the abdomen. These movements are fugitive; they are correctly referred to the pain produced by colic. In fact, in the course of a slight irritation of the bowels, the face, usually calm, becomes suddenly contracted; the child cries out; flexes the thighs on the abdomen, which it forcibly makes tense; twists about for a moment, and all these symptoms disappear at the end of some seconds, when, at the same time, the habitual serenity of the face reappears. The observation of the attitude and gestures presents, then, whatever may have been said to the contrary, characteristics sufficiently interesting to fix the attention of the pathologist; but we have not yet enumerated all of them. There are diseases of childhood in which these characters form the indispensable basis of the diagnosis. Thus, the involuntary and tumultuous gestures of the limbs most surely betray the affection known as St. Vitus's dance. However, it must be admitted, that this disease is scarcely ever observed in children at the breast. The feeble attitude, so to speak, of certain children arrived at the e age of fifteen or twenty months, the impossibility which they experience of holding themselves upright, even when the hand is given them as a support; the incurvation of the vertebral column, the legs, and the thighs; the deformity of the chest; are the only characteristics of a disease of rather common occurrence in the early stages of childhood; Pachiles they indicate rachitis: it is important, then, to recognize them. Lastly, we may mention the different attitudes of the body consequent on muscular retractions; the nature of which is, at present, little known. Thus, the deviation of the head, of the stature, &c., in consequence of the retraction of the sterno-mastoid and spinal muscles, are diseases which inspection alone will detect; it would be puerile to dwell upon them further. CHAPTER III. ON DEVELOPMENT AND ON PLUMPNESS. The size of children, their degree of plumpness, can only furnish general notions, very imperfect ones it is true, but which, however, must be taken into consideration. They may be insufficient when it is required to give a precise diagnosis, but they may be of assistance to the physician. Thus, it is remarked, such a child does not make us m progress, because it is feeble, of small size, and that at its age other children are much more developed than it. The fault of this is often bud in the nurse, who is too indifferent; who saves herself by giving it too little suck; or who affords a poor and insufficient supply of milk. In these cases, change the nurse, and the child will recover its strength, and will become developed with an increased vigour. When we make an observation on a sick child, its condition of thinness or of plumpness produces a certain impression on the physician, which, alone, is often sufficient to indicate the nature of the disease, its acute or chronic form, and even its approximative duration. It is thus that an acute or chronic diarrhoea, or a case of rachitis, may sometimes be recognized. In the acute state, the emaciation is rapid; the flesh, naturally hid smooth, is soft and flabby, but the skin is still rather firm its surface is not yet thrown into folds. In the chronic state, on the contrary, besides the flaccidity and the softness of the tissues, the skin appears to have lost its elasticity; it preserves the fold which the pressure of the finger causes; it is covered with wrinkles which become still acute more decided at the period of muscular contraction. The persistence chie of the fold of the skin consequent on the pressure of the fingers is especially observed in the diseases of the abdomen.) It is sufficiently constant in entero-colitis to be ranked amongst the symptoms of this disease. In rachitis, the disproportion between the head and the limbs, which are relatively smaller; the latteral flattening of the chest; the size of the belly; and the enlargement of the larger articulations, are sufficient to establish the diagnosis. Paralysis && 98 GENERAL PATHOLOGY OF INFANCY. [Part II. of turning the eye inwards, and the dilatation of the pupil. The optic Paulus Ægineta (lib. iv, cap. 57), Avicenna (lib. iii), and Thomas Fieni (loc. cit.), considered the half-closed eyes in sleep as a sign of worms in children of good health, but this is, however, an observation to which I attribute no importance whatever. We often observe in the eyes the indications of several other morbid conditions of the child. Who does not recognize, for instance, the redness of the eyes, the swelling of the eyelids, and lachrymation, as the precursors of measles? Who cannot appreciate the brilliant aspect &um of the iris, the extreme contraction of the pupils, provoked by the ingestion of a small dose of opium? I shall not here again remark upon the pearl-like condition of the conjunctiva, which has been looked upon as characteristic of the verminous affection; this fact requires to be verified by fresh observations in order to prove its exactitude and constancy. Sorable CHAPTER II. ON THE GESTURE AND ATTITUDE. All those who have studied the physiognomy have necessarily devoted a chapter to the development of the signs furnished by the various gestures and attitudes of individuals; these signs are but very rarely deceptive. The quick and firm walk of the man who carries his head proudly, whose chest is ample, and whose upper limbs move in unison, is as imposing as the stern aspect of a face the features of which are refined, the lips compressed, and the look determined. As the attitude often betrays him who would render his physiognomy impassive, so also it furnishes the physician with signs which he must not neglect. If these signs possess considerable value in the physiological state, their importance is not less in the morbid condition. In every disease the patient instinctively seeks the most favourable and the least painful attitude. With respect to the movements of the body and the gestures, as they are wrung out by suffering, independent of the influence of the will, they must be taken into consideration, for they may enlighten the physician in his investigations. It has been observed, with a show of reason, that children at the breast, confined in their infantile trappings, were not at liberty to assume the attitude most advantageous to them, and that they remained attitude in the position in which it was desired to place them. Thence the conclusion has been arrived at, that the signs furnished by the attitude |