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DR. BILLARD on the Diseases of Newly-born Infants. 111

On the whole, Dr. Roupell's is one of the best books that has been published on cholera. It is written with great candour and good sense, and contains more original matter than might have been expected in treating of a subject on which Medicine has expended all her resources, and, we may add, Fiction not a few of her embellishments.

A Treatise on the Diseases of Newly-born Infants, and of their Diseases during Lactation; founded on Clinical Observations, and on Pathological Anatomy, made at the Foundling Hospital, Paris. By C. M. BILLARD, Doctor of Medicine of the Faculty of Paris, and Member of other Learned Societies. Second Edi tion, enlarged by a Medico-legal Memoir on the Vitality of the Fatus, with Notes, and a Notice of the Life and Works of the Author, by M. OLLIVIER (D'ANGERS.)-Paris. Pp. 720. THE diseases of children have received less attention than they deserve, which is more surprising and to be regretted, considering their importance and the interesting character of the sufferers. The fact cannot be concealed, and assuredly not excused. If an objector should be found to this proposition, we challenge the production of any work comprehending the peculiarities of infant health and disease, on which the practitioner can rely for sure guidance, when embarrassed by their apparent anomalies. Anomalous they may be called, because, although they are subject to the same general laws as in adults, the ever-varying conditions of infancy give them a new character, and compel a corresponding variation in the treatment. It were useless to insist upon propositions all but self-evident: frequently has the humane practitioner looked back with sorrow and regret upon that period of his career, when, not having by time acquired experience in treating the diseases of children, his failures bore a painful and humiliating contrast to the success of his riper knowledge. Indolence or culpable indifference may attempt to screen itself under the excuse of the difficulty of a diagnosis formed from data rendered uncertain by the inaptitude of the patient to give an account of the origin, progress, and symptoms of disease. Often as this disqualification is insisted on, we have never assented to it: on the contrary, we hold fast by a belief, a conviction directly the reverse; for it can frequently be shewn that the diseases of children admit of a much more accurate distinction than the same in adults. Suppose a child breathing with frightful rapidity, seventy in a minute, pulse 140 or 160, skin hot, eyes suffused, features swollen and anxious, cough frequent, restlessness incessant; is a single question necessary to determine that the disease is pneumonia, which will almost certainly prove fatal? Ce

rebral affections are also much more distinctly and strongly marked in infancy. The simple habits of children also exempt them from many diseases of adolescence. Again, the latency of some functions only to be developed by puberty prevents many complications which embarrass in the diseases of maturity. It is, however, needless to multiply examples, though to do so would be easy. The infant sick are also more manageable; for the recusancy of children is controllable, while contention with the ignorance or obstinacy of grown persons is often as useless as it is disgusting. In another number of this Journal we have put upon record our opinion, that our defective knowledge on the subject before us was mainly attributable to the ignorance or supineness of the teachers of midwifery. Take a fair sample of the whole class.

The lecturer, for whose opinion and prelections we have the highest respect, whose judgment and opportunities place him, in our estimation, immeasurably in the van of his competitors, was in the habit of contenting himself with alluding to "hydrocephalus" (the name of a species, although always employed for the genus in these days,) in the tail of one lecture. His description of the symptoms was as brief as his directions for the treatment: "Fever-constipation-vomiting-green stools-convulsions-squinting-death. Treatment: Leeches-venesection-cold applications to the headblisters to the nape of the neck-warm bath-calomel inside, and ungt. hydrarg. all over out,-winding up with foetid enemata." And, by way of fortifying these directions, it was added, "Gentlemen: the reason of our too frequent failure in the treatment of this disease is, that we do not bleed sufficiently. If you treat an inflamed knee, do you tamper with three or four, or even a dozen leeches? No! to be sure, you apply twenty or thirty, or a hundred: and, gentlemen, what is the corollary? Why, if an inflamed knee require so many leeches, what must an inflamed brain do? If it require many for the member for genuflexion, it must require more for the organ of thought."

Something like this was the peroration of a lecture by at least as able a teacher, and as skilful a practitioner, as any in these islands, ever excepting on the theme in hand.

An extensive acquaintance with our brethren justifies the assertion, that the most successful are those whose knowledge is the result of a large experience, rather than the inculcation of sound principles in connexion with the subject of infantile diseases: their knowledge is therefore almost purely empirical; and, as it was conceived in ignorance, its first fruits must have been bitter. No humane man can do otherwise

than lament the want of a guide in this wilderness, until familiarity with the oft-travelled track shall enable him to journey alone. This is written advisedly, and with the full conviction of the great merits of Underwood, Burns, and Dewees, whose works are indispensable to a good intelligence of these maladies.

In pathology it is no longer disputed that the French have almost incalculable advantages over the English, and in no instance is this advantage more conspicuous than the present. Even our national self-love cannot conceal the fact demonstrable in every line of this treatise, that M. Billard has alone distanced all the English pathologists who have devoted their best time to the morbid anatomy of the diseases of children.

We have no motive for selecting any one portion of the work in preference to another for especial notice, because the details are desultory, and not of the systematising kind, so frequently distinguishing the labours of French pathologists. The orthodoxy of ignorance may reject some of M. Billard's views as visionary, and there may be some who, glorying in the description of " practical men," will reject his theories, when they occur, as refined and unsubstantial subtleties. To these it were useless to commend the present volume.

Clinical and pathological reports, form a large portion of the book, and constitute its chief value. M. Billard's reasonings are never inconsequent, and but rarely savouring of the imaginative character of French theorists: he instructs more by the faithful and vivid portraiture of symptoms and morbid appearances, than by his hypotheses on their producing causes.

The following case is an interesting one:

"Marie Dumé, aged six days, of rather a strong constitution, entered the Infirmary on the 13th October. The countenance was flushed, but the limbs and trunk were slightly jaundiced; she cried but little, and slept quietly; the mucous membrane of the mouth was in the natural state, but the tongue was red at the tip and edges. On the 15th October the jaundice was less intense, and a rather copious diarrhoea followed; the gums were swollen, without being red; the child cried much, and was paler. This state of things continued till the 20th October, when the purging increased, and the child became very pale; the upper gums were swollen, and of a livid red colour. On the 25th all these symptoms increased; the child's cry became feeble, the pulse gentle and slow; but there was no cessation of the diarrhoea, and it died in the night.

“On examination post-mortem, the upper gum on the right side

NO. III.

I

presented a livid tumefaction with fluctuation: in the three sockets of the first teeth there was an effusion of blackish fluid blood. The incisors, and that part of the germ which is not ossified, floated free and detached in the effused blood which distended the tumour; the bony cavities of the teeth were flabby, red, and as it were infused in the fluid. The surrounding soft parts began to detach themselves from the alveolar edge. The rest of the mouth was healthy. At the cardiac orifice some red striæ crossed the surface of the stomach; the mucous membrane at the end of the duodenum was thick and tumefied; near the valvula coli were red and tumified follicles. The liver was gorged with blood; the bile was abundant, viscid, and of a pale green. The lungs, heart, and brain, were healthy."

He proceeds to observe, that the case offers two remarkable circumstances for consideration: one, that symptoms having their seat in the teeth and their germs can occur in the first days of life; the other, that hemorrhages occur, as in the present example, from congestion of those parts, which is so common in infants at their birth.

While admiring the clear and luminous description, English practitioners will marvel at the obvious inertness of the treatment, often the characteristic of French therapeutics, as uncalled-for energy too frequently distinguishes our own.

We will now gratify our readers with a larger extract from this useful work.

"1. Congestions. Passive congestion of the cerebral and spinal system is very common in new-born infants. It results from the high vascularity and slow circulation of the parts, and the influence of breathing upon their circulation. Protracted labour, the force necessarily used in particular cases of manual delivery, the difficulty with which respiration is established, the sudden change which takes place in the circulation of the infant, are additional and frequent causes of this affection; and it may exist in any degree from simple injection of the meninges to true apoplexy.

"Various degrees of cerebral congestion are comprehended under the general term of apoplexy of new-born infants; nor must we expect, in the majority of those who die apoplectic, to find that peculiar extravasation of blood, or any circumscribed cerebral hæmorrhage, which constitutes the malady of the same name in adults. We will now proceed to review the different lesions which are found in connexion with this disease.

"Injection of the meninges, of the chord, and of the brain, is so common in the new-born infant, that I am disposed to consider it rather as a natural state of parts than as a disease. It is found in the greater number of instances. Vascular injection, and even extravasation of blood at the inferior and posterior extremity of the spine, are very frequent. I have often observed it, though there had been no appreciable symptoms of such an affection during life.

"If the injection be excessive, a bloody exudation quickly takes place on the surfaces of the meninges, and the blood thus exhaled, commonly more or less coagulated, compresses the brain or the spinal marrow, and gives rise to the state of stupor or depression which characterizes apoplexy. This hemorrhage, external to the cerebral mass, is almost constantly met with in infants who are said to have died of apoplexy. It is this which M. Serres denominates meningeal apoplexy, and which he attributes to the rupture of some of the vascular branches which are distributed on the surface of the brain.

"Injection of the pulp of the brain is also not uncommon. It appears in the form of minute red points or dots, occasionally tinges the substance of the organ with a somewhat deep red colour, and is chiefly found on the lateral parts of the corpora striata and the optic thalami. It is here, in fact, that the vessels of the brain are the most abundant, and that cerebral hemorrhages and inflammations are most frequent at every period of life. This point has been incontestably proved by the writings of Morgagni, and the recent researches of MM. Lallemand and Bouillaud.

"Cerebral hemorrhage is found sometimes, but rarely; I have met with but a single example of it. The infant had died on the third day after birth, and with the ordinary symptoms of apoplexy: upon opening the body, a clot of blood was found in the substance of the left hemisphere, by the side of the corpus striatum. There was apparently no cyst; the cerebral substance was only a little softened in the neighbourhood of the clot, which was about an inch long and half an inch broad.*

"II. Softening without Inflammation. This is a lesion peculiar to the brain of new-born infants, and is evidently the result of the congestions of this organ. I speak of a species of local or general softening, which, far from presenting the characters of inflammation, offers, on the contrary, all the appearances of the decomposition, I might almost say putrefaction, of the organ. I will begin by relating an instance of this.

"Alexis Lonatt, aged three days, was placed in the Infirmary on the 18th of May. He was affected with general induration of the cellular tissue; the integuments were of a violet red colour all over the body; his cry was feeble and uneasy, and occasionally piercing; there was very slight resonance of the chest upon percussion; he was moreover affected with a very abundant diarrhoea, and the stools were green; the pulsations of the heart were rapid, but extremely feeble. No change took place during the next few

"A fact observed by the younger Bérard proves that cerebral hemorrhage may take place in the fœtus in utero; so that apoplexy should be enumerated among those diseases of which a child may perish before its birth, and which may cause abortion. The foetus in which M. Bérard observed this remarkable lesion was aged eight months and a half; the clot, of the size of a nut, was lodged in the substance of the brain.”—Compte rendu de la Société Anatomique, pour l'année

1828.

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