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Book VI, Chap. IV.]



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in thirty-six, or in thirteen per cent.; and the observations of West, which are based on fifty-four cases wherein tubercle was present in the thoracic viscera, uberste the lead to very nearly the same result. Another anatomical peculiarity of the disease and further illustrative of the acute course of tuberculization of the lungs (ssorials

in childre

in children, is the great frequency with which yellow infiltration of tubercle is observed in early life; MM. Rilliet and Barthez having met with it in eightyeight out of two hundred and sixty-five children, or in thirty-three per cent., Juberde and West in sixteen out of fifty-five, or in just the same proportion. In the phthisis of children, moreover, cavities in the lungs are rarely observed. Out of Children two hundred and sixty-five cases that came under the notice of MM. Rilliet and Barthez, only seventy-six, or 28.6, presented cavities in the lungs, and they existed in only thirty per cent. of the cases which came under the observation of fulti in West. Lastly, in the phthisis of children abundant deposit of tubercle is observed

Eurrly le in the bronchial glands, constituting an important form of the disease.-P.H.B.] Cavities The phthisis of young children presents itself under two distinct forms; it is acute or chronic.

In many patients the symptoms are very difficult to distinguish, especially in acute phthisis, which may be confounded with pneumonia, of which it is, in truth, only a variety known under the name of granular and tubercular pneumonia. In fact, there may be established between the acute phthisis of infants and pneumonia, the same relation which already exists between granular meningitis and simple meningitis. This view, actual clinical observation enforces on the judgment.

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Acute phthisis, whether granular or tubercular, is very frequent (le amongst young children, especially at a hospital. It is much less prevalent in the upper classes of the city. It is everywhere mistaken and passes for lobular pneumonia. In fact, the symptoms of these (LL LL two diseases are very nearly the same, and if the children die quickly, it is at the autopsy alone that the presence of fibro-plastic granulations and tubercles in the lung is recognized. Therefore we may refer to 20 the chapter on the varieties of lobular pneumonia, to the article on 山 granular pneumonia, for what relates to the symptoms of acute granular and tubercular phthisis.

Chronic phthisis is more rare, so rare indeed that it has been said that pulmonary phthisis in the true acceptation of the term does not exist amongst children. If, in fact, by pulmonary phthisis we would really understand the consumption which results from pulmonary excavation by tubercles, as we say when speaking of it in man, then there is no such thing as phthisis in the infant. But if phthisis, in the modern acceptation of this word, represents the acute or chronic

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evolution of symptoms due to the presence of pulmonary tubercles, Chronis then, on the contrary, phthisis is very frequent amongst young children. Ju Chronic phthisis succeeds acute phthisis and lobular pneumonia. After the usual train of inflammatory phenomena which accompany G pulmonary catarrh and inflammation of the lungs, the child appears in its

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to recover his strength and to progress towards recovery. But the
convalescence is not realized, the child languishes and daily loses flesh;
the skin becomes thin, wrinkled, and cadaverous; the face contracts,
and assumes an appearance of premature senility. The fever wears
the child away in a slow, but continuous manner.
There is cough,

no expectoration, neither mucus, nor pus, and still less blood.

The shrunken chest permits all the parts being seen. It resounds less than natural, and dulness sometimes exists on the summit of the uken apex of the lung, or when the granulations and true tubercles are

surrounded by chronic pneumonia. Sibilant, mucous, and subcrepitant râles, may be heard on both sides of the chest, sometimes on one Sometimes side, sometimes on the other, or on both sides at once. a souffle exists behind at the apex of the bronchi, and it might give Renal rise to the inquiry whether it is a cavernous souffle, or a bronchial souffle. But as we are aware that in young children, cavities do not al den exist of a sufficient size to produce this phenomena, it must be referred to bronchial respiration, in consequence of chronic pneumonia, or to a considerable dilatation of the bronchi.


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The cry resounds more or less according to the degree of induration of the lungs, and it is never more decided than when a well-characterized souffle exists.

Notwithstanding all these phenomena which indicate an extensive material affection of the pulmonary parenchyma, the children eat Swillingly-it is even difficult to restrain them in this respect. They digest well; sometimes diarrhoea supervenes and still more exhausts them, but their appetite is not on that account less manifested, and it is necessary to give them food in order to avoid scenes of temper which the parents cannot endure. The abdomen swells, and contrasts by its size with the thinness of the fleshless and withered limbs; the prostration still daily increases; the wants of the children are infinite; they must be carried in the arms; it is necessary to walk about with them day and night, and all this lasts for weeks, months, and even more than a year.

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However, one day or other, without cause or reason, the diarrhoea establishes itself, never to cease; the mouth becomes deprived of its epithelium, thrush supervenes, the powers are still more exhausted, and the child, like a lamp ready to become extinguished, raises itself, sinks, oscillates, and at last dies in the extreme state of weakness, languor, and marasmus, or in the midst of unexpected convulsions, which soon put an end to existence.

[According to West, the general characteristics of the phthisis of childhood are1st. The frequent latency of the thoracic symptoms during its early stages. 2nd. The almost invariable absence of hæmoptysis at the commencement of the disease, and its comparatively rare occurrence during its subsequent progress.

3rd. The partial or complete absence of expectoration.

4th. The rarity of profuse general sweats, and the ill-marked character of the

hectic symptoms.

5th. The frequency with which death takes place from intercurrent bronchitis or


Bronchial phthisis is characterized by―

1st. The frequent development of its symptoms out of one or more attacks of bronchitis.

2nd. The peculiar paroxysmal cough which attends it, resembling that of the incipient pertussis.

3rd. The great and frequent fluctuations in the patient's condition, and the Dikin's

occasional, apparently causeless, aggravation, both of the cough and dyspnoea.

In very early infancy phthisis is remarkable for the very frequent latency of the Childur chest symptoms, which, through its entire course, are often entirely merged in the signs of impaired nutrition.

The most important peculiarities in the auscultatory phenomena of consumption in the child are

The Chest

1st. The smaller value of coarse respiration, prolonged expiration, and inter- Suplemes


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rupted breathing, owing to their general diffusion over the chest, and to their occasional existence independent of phthisis. 2nd. The apparent, and to some extent the real, exaggeration of the signs both Qui not of early and of far advanced diseases of the lungs in some cases of bronchial phthisis.

3rd. The loss of that information which the phenomena of the voice furnish in the case of the adult.

4th. The small value of inequality of breathing in the two lungs.

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5th. The difficulty of detecting minute variations in the sonoriety of the chest; Creek In:


6th. The existence of dulness in the interscapular region, together with moderate resonance of the upper parts of the chest and tolerably good respiration there, which are characteristic of the presence of enlarged bronchial glands.

It would appear from the returns of the Registrar General, that in London in 1849, of 3,318 males and 3,009 females who died from phthisis, 228 males and 236 females were under five years of age.-P.H.B.]


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Acute phthisis should be treated, like acute lobular pneumonia, by antiphlogistics, one or two leeches, several times repeated according outs. to the vital energy of the children, by cutaneous revulsives to the chest, and by emetics several times repeated.

Chronic phthisis does not, in any way, require the employment of abstraction of blood. Flying blisters on the chest, frictions with tartar emetic ointment, frictions with croton oil, are infinitely more useful. The employment of these means may be left off and resumed several times during the duration of the disease.

Internally, pectoral drinks, emollients, draughts of mucilage, juleps, combined with narcotics or opiates, should be given to young children, provided that the distaste for these medicines is not decided.

Cod's liver oil, in the dose of 3 v a day; the iodide of potassium in a julep, three and a half to seven grains; tartar emetic, in the dose of 15 grain; oxysulphuret of antimony, three to three and a

half grains in the twenty-four hours, have been administered, and may be so with advantage.

The complications of the disease by thrush, diarrhoea, and convulsions, should be treated by means of the medicines which have been indicated in each of these diseases.



Hooping cough is a contagious, and at times an epidemic, disease, characterized by a convulsive cough, returning in frequent, and more or less prolonged paroxysms. These paroxysms possess a particular character. The expirations, of which the fits of coughing are composed, succeed each other with great rapidity, and are followed by a long, distressing, and sonorous inspiration, which is called the hoop.

History. The term hooping cough (coqueluche) has not always possessed the signification which physicians now apply to it. In the fifteenth century, this name was applied to a species of epidemic catarrh, which Mézeray, De Thou, and Pasquier (Etienne), mention in their works. One of these epidemics, described by Valleriola, does not present any resemblance with the disease, as it is observed at the present age, but was more allied to influenza. Without dwelling any longer on this historical question, which I cannot decide in this work, I shall confine myself to the statement that the Greek and Arabian physicians make no mention of hooping cough. Those authors, then, are quite in the wrong who have pretended to recognize this disease in a passage in the Epidemics of Hippocrates, in which it is simply a question of an epidemic disease of the throat, which was often complicated by A inflammation of the larynx.

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According to M. Blache, Willis is perhaps the first who, under the denomination of tussis puerorum convulsiva, suffocativa, really appears to have indicated the disease we are about to study.

In the eighteenth century only, has hooping cough been described as a distinct disease, and it has been termed pertussis (Sydenham); tussis clangosa (Basseville); bex convulsiva (Good); bronchitis convulsion (Bourdet); affection pneumo-gastro-pituiteuse (Tourtelle); bronchocéphalite (Desruelles); catarrh-convulsif (Laennec); tussis spasmodica, strangulans, orthopnoea, &c. (different authors.)

The etymology of the word coqueluche, generally adopted in France, is rather uncertain; some derive it from coquelhuchon, a cowl, a sort of hood with which people covered themselves in the epidemics of 1414, 1510, 1557, &c.; others would originate it in the extensive

use that was made of the corn-poppy flower (coquelicot) in the treatment of this disease. According to some authors, the term is due to the fact that during the fits, the sonorous respiration resembles the crowing of a cock (coq). Lastly, according to Cabanis, the name is derived because that in the epidemic disease of 1414, 1519, 1557, &c., in connection with rheumatism, it attacked the muscles of the neck, the back, and the shoulders like a cowl (coquelhucon).


Age. Hooping cough is met with nearly exclusively in children, te from the period of birth to that of second dentition; sometimes youths, Renar adults, and even old men, are attacked by it, but much more rarely. We, who have had the opportunity of especially observing children alli at the breast, and at the period of early childhood, can testify that the earliest period of infancy is liable to hooping cough.

In fact, in thirty-three children attacked by this disease, six were less than two months old and three were only one month.

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Ser. Girls appear more disposed to contract hooping cough than t boys. In the thirty-three cases to which we have alluded, twenty-one mosh were amongst girls and twelve amongst boys. This result agrees with that pointed out by all writers.

Constitution and mode of living. Lymphatic and nervous subjects are especially exposed to contract this disease, which equally prevails

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in all classes of society. It develops itself, in preference, amongst these children who live in unfavourable hygienic conditions, in dull, damp, unwholesome situations, and especially amongst those who are poor, and are not properly clothed, nor sufficiently protected against the rigours of temperature.

Season and climate.

This disease appears almost indifferently in all seasons of the year and in the most extreme climates. Watt, however, affirms that it is more frequent and more severe in northern regions; Pénada, on the contrary, states that in the meridianal districts of France and Italy its returns are more frequent and its consequences more to be dreaded. At Paris it is observed at all seasons, but perhaps a little more frequently in spring and in autumn.

We may here remark that, according to Ozanam, hooping cough is never observed between the tropics, and that it does not appear to be dependent on atmospheric changes.

Epidemics. All authors agree in regarding hooping cough as an epidemic disease. It is observed to invade a hamlet, a town, an entire district, and to attack all the inhabitants indiscriminately, and especially the children. It is impossible to appreciate the causes either of its appearance or of its disappearance. The return of these epidemics is not at all regular, their duration is very variable, and sometimes

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