CHAPTER III.
DIAGNOSIS OF DISEASES IN CHILDREN, EARLY TREATMENT, &C.
It is not often that a correct diagnosis can be made of a disease by a single symptom, but there are marked and characteristic symptoms which indicate some diseases in children with considerable certainty.
A strongly marked nasal or palate sound in the child’s cry indicates an abscess behind the pharynx. When this nasal tone is heard we should palpate with the finger on the throat to ascertain the degree of soreness.
A long drawn, ten times lengthened, loud sounding expiration with normal inspiration, and no dyspnœa is sufficient for the diagnosis of CHOREA MAJOR (St. Vitus dance.)
A high thoracic continually sighing inspiration, the upper part of the thorax doing the work of breathing, and with a sighing or groaning sound, shows the commencement of HEART WEAKNESS, CARDIAC PARALYSIS OR FATTY DEGENERATION OF THE HEART, and will probably be followed by such symptoms as cyanosis, coldness of the extremities, &c.
Strongly marked diaphragmatic expiration accompanied by a fine, high whistling sound, points to BRONCHIAL ASTHMA. This sound, however, resembles that made in croup. If there is a pause between the end of expiration and the beginning of inspiration, croup may be excluded.
Sleepiness, lasting twenty-four to thirty-six hours, occurring without fever or other disturbance to account for it, is an initial symptom of MENINGITIS, though it might be caused by narcotics or uremia.
A prominent, firm fontanelle means increase in quantity of the contents of the cranium-exudation of some sort. It cannot be caused by fullness of the vessels alone if it is firm and resisting. We know that we have cerebral disease with DROPSY or exudation (Hydrocephalus).
When the fontanelle is deeply sunken, it points to loss of blood or other nutritive juices, as in cholera, &c.
A sharp, shrill cry, accompanied by an expression of fright or great anxiety, and occurring about an hour after the child has fallen asleep, is the only symptom of the “ALP”—night terrors, sudden awaking from bad dreams.
Periodical crying, lasting from five to ten minutes, should always make us think of spasm of the bladder or PAINFUL URINATIONS.
Violent crying at stool with fear of the act, and general avoidance of it, points to FISSURE OF THE ANUS, and is usually accompanied with constipation.
A violent cry full of pain and almost continuous, with the throwing about of the head on the pillow and grasping it with the hands, means OTITIS or EARACHE.
Weakness or immobility of the child, after a comparatively slight or short illness, points to SPINAL PARALYSIS.
Delayed ossification of the cranial bones is an early sign of RICKETS, as is crying continued for weeks (increased on touch of the extremities), accompanied with fever and incessant sweating.
Vomiting of all kinds of food continued for weeks in children of closed cranium but with large cranial measurements, when there is no fever, pain, idiopathic disease, or a cerebral tumor, indicates chronic HYDROCEPHALUS with an acute onset.
Congestion of the cheeks in children, excepting in cases of cachexia and chronic disease, indicates an INFLAMMATION or a febrile condition.
Congestion of the face, ears and forehead of short duration, strabismus with febrile reaction, oscillation of the iris, irregularity of the pupil with falling of the upper lids, indicates a brain affection.
Enlargement of the spongy portions of the bones indicates RICKETS.
A thick and purulent secretion between the eyelids may indicate great PROSTRATION of the general powers.
Passive congestion of the conjunctival vessels indicates approaching DEATH.
Long continued lividity, as well as lividity produced by excitement or exercise, the respirations continuing normal, are indices of FAULT IN THE FORMATION OF THE HEART, or great blood vessels.
A temporary lividity indicates the existence of a grave acute disease, especially of the respiratory organs.
Irregular muscular movements, which are partly under the control of the will, indicates the existence of CHOREA (St. Vitus dance).
The contraction of the eyebrows, together with a turning of the head and eyes to avert the light, is a sign of cephalalgia (headache).
When the child holds its hand upon its head, or strives to rest the head upon the bosom of the mother or nurse, it may be suffering from ear disease.
When the fingers are carried to the mouth, and there is besides great agitation apparent, and when it turns its head from one side to another, there is probably some obstruction or some abnormal condition of the larynx.
A feeble and plaintive cry indicates a trouble in the abdominal regions.
If the respiration is intermittent but accelerated, there is capillary bronchitis. In bronchitis the cough is clear and distinct.
A hoarse and rough cough is indicative of true CROUP. When the cough is suppressed and painful, there is PNEUMONIA or PLEURISY.
In diseases of the stomach, liver or bowels we have usually a coated tongue; a white tongue indicates FEBRILE disturbance or some THROAT trouble; a brown moist tongue, INDIGESTION; a brown dry tongue, DEPRESSION, BLOOD POISONING or TYPHOID FEVER; a red moist tongue, INFLAMMATORY FEVER; a broad, pale flabby tongue accompanies a DROPSICAL CONDITION of the system; a tremulous, moist and flabby tongue indicates FEEBLENESS, NERVOUSNESS; a pale flabby tongue which shows the pressure of the teeth, a generally relaxed condition of the system; the irritable or strawberry tongue with its red papilla, points to an irritated stomach, and is met with in SCARLET FEVER; a furred and dry tongue is indicative of VIOLENT LOCAL INFLAMMATION; if afterwards clean, red and dry, protracted INFLAMMATORY FEVER.
Wheezing cough and wheezing breathing indicates ASTHMA; dull, heavy aching pain at the base of the chest, ACUTE BRONCHITIS; urgent desire to go to stool, DYSENTERY; diminished secretion of urine, INFLAMMATORY and FEBRILE DISORDERS; cold hands and feet, NERVOUS DISEASES and low states of the blood.
In general, the diagnosis of diseases of children is easy if we simply compare the objective symptoms with those which should obtain in a healthy child of the same age. But we must remember that with children symptoms which appear very grave are often evanescent, and on the other hand the indications of very serious disease may be disregarded on account of their natural vivacity and recuperative powers. In each case each child should be studied by itself considering its antecedents, its peculiarities, its surroundings, and its relations to them.
The mother has the best chance to know these; she sees the child when awake and asleep, when dressed and undressed; she knows its history, what has been its diet, what her own health has been, her own habits, her surroundings and occupations, and whether there may or may not have been anything to cause sickness of the child in her own toils or trials. The nurse and the mother should note all the facts, for their own guidance and for the guidance of the physician if he is called.
EARLY TREATMENT OF INFANTILE DISEASES.
Very few of the symptoms heretofore mentioned can be neglected with impunity. While some cases of sickness may be left to the powers of nature to restore health, others require judicious early treatment, and a physician should be called. We should generally enjoin rest, but we should act by our medicines to meet every positive indication.
We are the assistants of nature; we must act by removing the causes where they can be reached; we must relieve pain, but we must not by officious kindness do too much and interfere with the natural return to health. Remember that drugs are not all powerful, that time, rest, diet and numberless little things are the means by which we aid in the fight against disease.
It is an excellent plan not to continue medicine too long. Place the child on the road to health and see if it will not with a little supervision improve—still, however, using proper rest, diet, &c.
But as the apparently trifling symptoms of to-day may become the full fledged attack of to-morrow, we must pay attention to every untoward symptom. Parents are liable to be unnecessarily scared, and afterwards go to the other extreme and neglect calling a physician until serious injury has occurred.
I will here give you a few aphorism and general rules: Treatment of the sick should be according to the patient as well as according to the disease. Adult males are not so sensitive as females; young children, whether male or female, are sensitive, tender and excitable, and alive to every irritation. But young children differ in their constitution, and some have peculiarities or idiosyncracies so that medicines of ordinary activity act very powerfully or even violently.
Small children are always sensitive to the action of medicine, and small doses only are required for them. And in consequence of the activity of the vital powers, and the quickness and force of the circulation, there is a remarkable susceptibility to inflammatory action, disease sometimes running on rapidly to organic and incurable mischief.
In treating children employ the mildest remedies at first, and aid their action by regimen. When an emergency demands, use those articles which experience has shown to have power to meet such an emergency. Exhibit such medicine in the minimum dose and increase or repeat until the desired effect is produced. Be very careful not to fill the child with nostrums for some imaginary ill, lest you thereby make it ill. Always remember that the first step in treatment is to change the conditions which produced the disease—remove the cause and assist nature to repair the injury.