A FEW REMARKS ON THE DISEASES OF CHILDREN.

505 according to the ingenuity of the surgeon, fails to do so eN’ect.ual manner, and never can give that perfect rest

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in

an

which the

splint a.9’ord=.

The second object to be attained by the use of the straight splint is the prevention of suppuration, or if pus has formed, by the perfect rest which is obtained to induce absorption, or -at all events to determine the point at which the matter shall ’Come to the surface. During the time I was dressing for Mr. Key, and when he first proposed this plan of treatment, two cases came my care at Guy’s Hospital, in both of which matter had formed previous to admission, the straight splint was applied, and in each case the abscess burst on the fore part of the tensor vaginse femoris. These cases were alluded to in Mr. Key’s remarks, in the ...7I,{cdical Gazette, concerning this mode of treatment, and in Case No. 1, mentioned above, matter had apparently formed, and was coming to the same point at the fore part of the limb until absorption took place. I confess that as regards this question, there is some difficulty in deciding, and it is one which must always be open to doubt, as we so frequently see matter point at all parts around a diseased hip-joint, apparently without anv reason; at all events the fact of, in three cases, two of which matter came to the surface, and one in which it nearly did so, no tendency to pointing taking place at any other place, is a remarkable coincidence, and one well deserving of notice. Further experience in the subject will, I trust, enable me to say more upon it at a<* future period. 3rdly, and this is the greatest advantage which the application of the straight splint holds out-viz., the future position

prolix, but the judgment of the surgeon will, and always must, be used in diseases of joints, perhaps more than in any other class of cases, and therefore I have thought that his discretion should be used as to the time of applying the splint, the length of its continuance on the patient, and numerous minor details, which slight experience will soon bring before his notice. In all the cases I have mentioned, excepting No. 1, I was, I must confess, agreeably astonished to find the great amount of motion which existed in the joint. In Case 2, you would have examined the hip, and scarcely been aware that there had been any mischief whatever, except when attempting to bring the thigh to an acute angle with the to be

pelvis. Case 4 was very quickly relieved, and there was also great and the immense advantage in all-viz., that both legs, when the patients were standing erect, were of the same

motion,

length. Wellington-street, London-bridge,

1851.

A FEW REMARKS ON THE DISEASES OF CHILDREN. By EDWARD WILLIAMS, M.D., Dublin. RESIDENT PHYSICIAN TO THE SOUTH-EASTERN LYING-IN

HOSPITAL,

DUBLIN.

IN treating the diseases of children the following essentials should be borne in mind:-lst, They bear blood-letting badly, of the limb. with not unfrequently fatal results; much caution therefore is When one is culled to a patient with hip-joint disease in either required, and the bleeding from leeches is difficult to check. of the first two stages, we almost invariably find them lying 2ndly, Tartar-emetic prostrates them much more than adults, on the opposite side to that which is affected, with the diseased nor do they rally soon from its effects; the nervous system thigh bentupon the pelvis, and the leg on the thigh, a position becomes partially paralysed, and the injurious tendency of the I cannot imagine any one would say was the most likely to be medicine is shown on all the functions of the body. 3rdly, of permanent usefulness should anchylosis occur, or such an Opium is more or less a direct poison, causing not unfrequently, imperfect amount of motion as usually follows acute mischief congestion of the cerebral substance and an apoplectic tenin any joint; indeed, the miserable objects one constantly dency. 4thly, Mercury never salivates the very young child. sees about the streets with knees drawn up, and high-heeled 5thly, Blisters are apt to slough, and therefore should never be shoes, sufficiently attest the truth of my remark; and I there- used in the first stage of acute inflammation where there is capilfore, whenever called to see a patient labouring under this lary engorgement and irritation, but rather in the subacute or disease, after copious bleeding by leeches over the joint, place chronic stage, where these vessels are stagnated-and indolent, them on their back, and cautiously and carefully bring down and where a stimulus is required to bring into healthy action the thigh to the level of the bed, and thereby straighten the these dormant vessels. 6thly, The diagnosis of disease in chilknee. But one caution is necessary to be given in so doing: so dren must naturally be difficult; they cannot, like adults, tell tenacious is the hip-joint when in this state, of any even the you of their sufferings, and the skill of the medical practislightest motion, so firmly have the muscles round about fixed tioner will be required to diagnose disease through indirect the head of the bone in the acetabulum, that in doing so the means. 7thly, Mind not to go to the other extreme, and never spine frequently becomes arched about the lumbar vertebrae, bleed, never give tartar-emetic, never give opium, never blister: and in reality the thigh is at the same angle with the pelvis as ’, remember, extremes are dangerous, in medias res tutissimu8 it was before the leg was touched; this, however, I have gene- ibis. Sometimes you have two evils to choose between-viz., rally found relieve itself very shortly. The splint, when the injurious tendency of the disease if left unchecked by placed on for the first time, soon requires re-adjusting, and active treatment, and the probably injurious action of the ’upon the second application, should the bandage be starched, treatment: remember, one is a certainty, the other an unthe whole pelvis and thigh becomes one solid mass, and pre- certainty, and therefore you should choose’the lesser evil. When the patients have the serves the most perfect rest. In the first ten or twelve months of infant life, when it is splint removed, and first get up, of course I need hardly supported entirely by the mother’s milk, we should, if the inmention how excessively cautious we should be that they do fant suffers from ill-health, always make inquiries as to the not use the unsound leg until they have cautiously and care- state of the health of the mother; for feeding the child with fully felt their way; two crutches are absolutely necessary at other milk, either artificial or human (that of a nurse), will first, and one must be taken away at a time, lest too much nearly always, in these cases, effect a cure without the assistance of medicine, the child here suffering through the weight should be thrown upon the leg at once. I doaht not that it will he remarked that I have only pre- mother. - sented the bright side of the picture, and have not shown any Of course infants require smaller doses than adults: where of the disadvantages resulting from this mode of practice. in one, you would give an ounce, in the other, a year or two old, that I know, and it may be urged as you would give a drachm. There is but one a. serious one by many, and it is, that the patient is unable, if But the greatest skill is to discover the seat of the disease, perfect anchylosis occurs, as in Case 1, to sit down as comfort- for they cannot tell you; and here I refer you to Drs. Maunsell ably as formerly. It is i-. convenient, it is true, to be com- and Evanson’s work on the " Diseases of Children." At pelled to sit at the edge of a chair always, or with the leg bent page 105, they beautifully describe the means of diagnosis of under the seat, in consequence of the hip-joint being fixed, disease in the three great cavities of the body-head, chest, or but I cannot conceive that it is a less awkward position than abdomen. "Three principal indications of physiognomy prehaving the thigh fixed at an angle when standing erect, and sent themselves," say the authors, " connecting a particular it is necessary that one of the t.vo evils should occur; besides, set of features with one of the three great cavities, as we obfor working men, I am confident the former is much the less served when speaking of the temperaments, and related in a evil. Consequently, this which I have raised as an objection, similar manner: the expression of the upper part of the becomes onlv a question of evils. There is a minor inconve- face, the forehead, eyes, and brows indicating disease of the nience which I may mention, and it is, that when the patient brain or nervous system; the features of the middle of the first gets up, from having kept the knee fixed in a position face, in particular the nose, being affected by morbid conditions of the organs of circulation or respiration; while abdosome time pain is experienced there when it is first moved, and, indeed, more pain is usually spoken of as attending that minal affections are in a peculiar manner pointed out by the part than the hip, which pain is easily distinguished from expression of the mouth or state of the lips." I will now give a few of the symptoms of disease in the the superficial pain occurring in hip-joint disease. I trust it may not be considered that I have n(,glected to givesufficiently three great cavities: if you wish for more, I refer you to the n detail the reports of the cases; 1 have been anxious not, j authors,

objection

.

,

.

....

506 eyes fixed and staring, or turient women at their own residences, rather than collect them attention is at once directed to in large maternity institutions, hold an opinion conducive to the head; we observe whether the child puts its hand to its the safety of the mothers. It certainly appears that this opinion has had much weight head, as in health infants seldom raise the hand above the mouth; next examine the pupils, and whether the limbs are in this metropolis, as the absence of large lying-in hospitals is rigid; these and other symptoms are evidences of disease of a striking feature in the nosocomial arrangements of London. boast of Whilst Dublin, Edinburgh, Paris, Vienna, &c., the brain. Disease of the chest is more apparent, and the diagnosis splendid edifices which give shelter to large numbers of easier; the ear will do much, assisted by the eye, and other women during their confinement, London presents only a few small obstetric hospitals, which are evidently intended to ob. symptoms. In disease of the abdomen the lips are retracted or drawn, viate occasional cases of complete destitution, or other circum. so as to show the teeth or gums; the countenance pale, stances which may render a house of the kind very desirable. sallow, or sunk; the child lies on its back with its knees bent Such is the fact; and many members of the profession will or drawn up, and is pained by pressure on the abdomen; side with us when we say that this state of things is rather a diarrhoea constantly attends, the stools being generally thin, subject of congratulation than regret; for how often has it green or dark brown and foatid; there is much wasting; great occurred that the majestic piles of buildings of the abovethirst, particularly craving for cold water, and other symptoms. mentioned capitals have been completely empty, the patients Teething commences in children about six months after birth, being either driven out or destroyed by the epidemic scourge when there is sympathetic irritation in various parts of the which has been known to make such fearful ravages in lyingbody, which is more easily relieved by lancing the gums, thus in hospitals. If we mistake not, some of the highest authorities in obeasing the pressure of the tooth, the cause also being removed, than by giving medicines, which only palliate for a time, the stetric matters are decidedly opposed to large establishments. We find, for instance, Dr. Ramsbotham saying, in his"Prin. primary cause of the ailments still remaining. riples of Obstetric Medicine and Surgery," p. 586: "Some Merrion-square, Dublin, 1851. years ago I was solicited to take the medical superintendence of a lying-in hospital, which it was proposed to establish in the eastern part of London. Although I might have derived A SIMPLE PROCESS FOR PRECIPITATING THE no little personal advantage from the connexion, I declined the proffered honour, and gave the gentlemen who called on COTTON CONTAINED IN COLLODION. me such reasons for doing so, as induced them immediately to BY THOMAS CATTELL, M.D., M.R.C.S. Eng. &c., abandon the undertaking, and it has never been revived. Braunston. Should such an establishment again be formed in any large A SHORT time since, I ascertained that on mixing bisulphuret town, it should consist of a number of small houses detached, of carbon with collodion, an immediate precipitation or or at least separated from each other; and no more than one separation of the cotton takes place, leaving a limpid fluid woman should be permitted to occupy any single apartment at a time." Dr. Ferguson’s opinion is thus quoted in the same consisting only of the solvent and precipitant. The cotton presents the same fibrous appearance as though work: " Happily this form of puerperal fever exists with such it had not been in a previous state of solution, and as gun- fatality in hospitals alone. I believe the single chamber of cotton would do if simply immersed in water. When dried the pauper is more wholesome than the spacious ward of the (as much moisture as possible being first pressed out between hospital patient." The foregoing statements would certainly have but little folds of linen or bibulous paper) it cannot be distinguished from the dried pulp of the paper-maker. weight with those who completely deny the contagiousness of This singular reaction of the bisulphuret on the collodion, puerperal fever, yet in the presence of the facts which have would lead to the supposition that the gun-cotton performs from time to time been recorded, it is strange that doubts on the part of a base to the oxide of ethyl (ether), for this sub- this subject should still be entertained. But we need not stance is at once deprived of the peculiar properties which it wonder at this, since the same difference of opinion exists in various quarters regarding the contagiousness of cholera. possessed previous to solution. We have used the term puerperal fever, but we are quite It may serve also to explain more clearly the chemical composition of gun-cotton, or lignine, as acted on by nitric, or aware that these words do not convey an exact meaning, for the term is often used for inflammation of the uterus alone, nitrico-sulphuric acid. for peritonitis following parturi tion, or for a typhoid state akin Braunston, Northamptonshire, 1851. to erysipelas. We have this day, however, to treat of peri. tonitis only, as manifested in connexion with the puerperal state, and accompanied by some symptoms very often met with, (as obstruction of the venous circulation of one lower extremity,) and by others of rare occurrence, as perforation OF THE PRACTICE OF of intestine. And here we would just mention, that a case of this kind might correctly be characterized by the comMEDICINE AND SURGERY pound word metro-pe1’itonitis, as the affection of the peritoIN THE naeum seems certainly to be subordinate to the inflammation of the uterus itself, or at least of its immediate investments. HOSPITALS OF LONDON. This term is very frequently used by French authors; and as Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum, et some good reasons may be urged for its employment, it may dissectionum historias, turn aliorum proprias, collectas habere et inter se be as well to take advantage of it. The case, derived from comparare.-MORGAGNi. De Sed. et Caus. Blorb., lib. 14. Prooemium. Mr. Maurice Davis’s notes, runs as follows:Catherine B-, aged twenty-eight years, has always lived KING’S COLLEGE HOSPITAL. in London or Greenwich. She is married, and has had four children. With the three first she never had any difficulty; Puerperal Peritonitis; Perforation of the Colon; Death; have there been any unusual symptoms after these neither Autopsy. confinement. She was admitted into King’s College Hospital (Under the care of Dr. TODD.) on Sept. 22, 1851, and stated that she had been confined about IT is gratifying to observe, in directing attention to a case of three weeks. On Aug. 16, being then in the latter end of her puerperal peritonitis, that we have not to record an epidemic pregnancy, (seventh month,) the patient was seized with a of this destructive affection, but that the case was of a sporadic violent pain in the right side, extending from the abdomen ilium to the spinal column. This pain nature. It presents, however, a feature not frequently met over the crest of the came on suddenly white she was raising her arm to clean some with-viz., perforation of intestine, and consequent effusion of paint on the wall, and she never lost it till she was confined, its contents into the peritoneeal cavity. The patient was con- though at some times it was more severe than at others. After the birth of this last child, there was some btmorveyed from her residence to King’s College Hospital in a very weak state, and her death was not followed by any analogous rhage; but the patient went on pretty well till the second day, morbid manifestations among the sick lying in the same ward. when the pain before mentioned became more severe. No appeared; but this circumstance did not surprise her, Would the same innocuity have existed had the patient died in lochia as she had not had any such discharge after previous labours. a lying-in hospital ? Probably not; and thus it may be sur- It appears the uterus never properly contracted, and signs of mised that those who advocate the practice of attending par- peritonitis exhibited themselves on the third day. She con-

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