Physing.. 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 would to guide them, and often form a diagnosis of a disease without addressing a single question to the patients. The natural language 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 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. M. 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. ON THE COLOUR OF THE FACE AND INTEGUMENT. Children which are just born, present a red colouration on the face and f body, which preserves its intensity for about four or five days. During this time, if pressure is made on the integument, the colouration is borne C. 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 54 Sometimes this more or less intense yellow coppery colouration, is the fir. 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 * Underwood, Treatise on Diseases of Children. Part II. ON THE GENERAL PATHOLOGY OF INFANCY. SECTION I. GENERAL CONSIDERATIONS ON THE DISEASES ON THE FIRST THEIR DIAGNOSIS. It is impossible to account for the phenomena which accompany disease in the first stage of infancy, without a knowledge of the principles and laws which govern the affections of that tender age; and this knowledge is more especially requisite for the due appreciation of the difference existing between the affections of infancy and the same affections developed in the adult. Nothing is to be compared to the influence of age on the character of disease, without it is the influence which climate exerts on the strength and form of plants and the large animals. When we observe the puny specimens of ricinus of our own country, and then compare them to the superb and gigantic ricini of inter-tropical countries-when we see the pale cacti of our hot#houses in juxta position with the brilliant and celebrated cacti of the New World-when we compare animals of the same species born in different latitudes, the Polar bear, for instance, with the bear of the Pyrenees-the lion of the desert with the lion of the forests of Brazil-we shall then comprehend the whole extent of the modifications produced in the development of individuals of the same species according to their place of birth, and consequently be struck with the difference which exists between the disease of a growing infant and the same disease in a well formed man in all the vigour of life. In this chapter I will consider the general conditions by reason of which the diseases of infants differ from those of adults. I will then point out the most suitable methods for the diagnosis of these diseases; and will treat of the physiognomy of children, of their gestures, attitudes, cry, stature, and of all those external signs furnished by 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. Certain organs, hitherto inactive, commence their functions; they develop and modify themselves; others disappear; the infant passes Efforts i into entirely new spheres of existence, first into extra uterine life, then into that of the senses, and, lastly, into the sphere of the 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 le other circumstances, we should take for a disease, is here the effect and the symptoms of the work of nature, occupied in creation and Illuritate 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, re 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 functional activity is truly remarkable: nutrition, circulation, and activity 1. 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 susceptibilitylly 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 highest importance I allude to the mortality of new-born infants. The first day is the most terrible to surmount: one-tenth of all new-born children perish; and we know that in France out of a million Hate Qearring to Pensieri butos spons 2 makes Euch enough in buc. 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, their moral disposition, their diseases, &c.: it controls from the cradle certain unknown predisposing causes which may induce, at a later period, a great number of diseases, such as syphilis, scrofula, gout, 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 desing latest, six weeks or two months after birth. Help There are a # some diseases peculiar to infancy; and others which are common to this age, and to every other period of life. The former, 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 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 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 le 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. 2 supussing All infantile diseases are but impressions transformed, and result |