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When pain and difficulty are experienced in urinating, it is indicative of inflammation of the kidneys, neck of the bladder, or urethra; or of calculous concretions in the ureters, bladder, or urethra. It may originate, however, from irritations seated in the rectum, or of the digestive organs generally.

In young children, scanty and painful urination occurs from disease of the kidneys, connected, most generally, with long-continued intestinal disease, or with some affection of the brain. In these cases, the urine is passed only in small quantities, and is usually high-colored, and stains the linen yellow.

Retention of urine is occasionally present during difficult dentition. In very young infants it is sometimes produced by some peculiarity of the mother's milk. We have known it, also, to be a symptom of worms in the rectum.

Scanty urine occurring towards the decline of scarlatina, and other acute exanthemata, is in general connected with dropsical effusion within the abdomen or in the cellular tissue.

11. The Bones.

A premature, or very rapid development, in the longitudinal dimension of the long bones, particularly if, at the same time, there is not a correspondent but rather a deficient development in the dimensions of the chest, very generally indicates a predisposition to tubercular disease of the lungs.

A rapid increase of the osseous structure in length, is a very frequent occurrence towards the decline or immediately after fevers, especially the febrile exanthemata. With this direction of the nutritive process, the development of rachitis and tubercles, so generally consequent upon rapid growth, would seem to be connected. (Schill.)

Curvatures of the long bones of the lower extremities are often the result of too early attempts to induce the child to walk; of a bending or imperfect fracture of the bones from violence; this occasionally occurs in the upper extremities, from imprudently lifting an infant by the arms. Curvature of the bones is also one of the symptoms of rickets.

Curvatures of the spinal column, in young infants, are sometimes the result of placing them too early in the sitting posture. In chil dren they may arise from debility of the spinal muscles, or disturbed equilibrium in their action, the result of improper positions of the body, too long continued, and of defective exercise. Curvature of the spine is, also, the effect of rickets, and of caries of the vertebræ. Lengthening of one of the lower extremities exists as a symptom of the second stage, and a shortening of the extremity, of the third stage of hip disease.

Enlargement of the articular extremities of the long bones is common in scrofula and rickets. Enlargements of the larger joints occur. sometimes after the acute exanthemata, or upon the sudden repulsion of chronic eruptions.

Excessive development of the skull is a symptom of hypertrophy

of the brain; it also takes place in chronic hydrocephalus, and apparently so in rickets. In idiocy there is commonly a very decided diminution in the development of the skull, especially of its anterior portion.

A diminished development in the capacity of the chest, or a flattening of the ribs at the sides, with undue projection of the sternum, is common in children predisposed to tubercular disease of the lungs.

Before quitting the subject of semeiology, we would call attention to papers of the late Dr. Fisher, of Boston, on cerebral auscultation, as a means of diagnosis, especially during infancy and childhood (see Amer. Journ. Med. Sciences, Nov. 1833, and Aug. 1838); and to a memoir on the same subject by Roger, of Paris. (Bull. de l'Académ., t. xxv.) The general conclusions of the latter gentleman are as follows:

Acephalic souffle is frequently heard in cases of impoverished blood (chloroanæmia), occurring in very young children-the sound being quite exceptional in affections of the encephalon. It is invariably dependent upon a morbid condition of the blood. It is of frequent occurrence also during the first year after birth, and at the period of dentition. It is also a frequent accompaniment of pertussis. By cranial auscultation the abnormal condition of the blood may be early recognized and at a period when it is capable of being counteracted a fact of great importance, inasmuch as, in cases, especially, when a predisposition exists, the impoverished state of the blood is liable to bring on general tuberculization. The cephalic souffle is frequently, if not always, heard in rickets. It aids in determining, also, the nature of the latter affection, which should not be considered as a special disease of the osseous system, but as one due to a morbid condition of the blood, capable of implicating the entire organism.

THE

DISEASES OF
OF CHILDREN.

SECTION I.

DISEASES OF THE DIGESTIVE ORGANS.

CHAPTER I.

DISEASES OF THE MOUTH.

STOMATITIS-INFLAMMATION OF THE MOUTH.

1.-Erythematic Stomatitis.

ERYTHEMATIC inflammation of the mucous membrane of the mouth is a common disease during infancy. The inflammation may be confined to the tongue, or to a portion of the parietes of the mouth; or it may be universally diffused over the entire cavity. It varies in intensity in different cases. In some, being so slight as scarcely to attract the attention, and disappearing promptlywhile in others it assumes a considerable degree of severity, and causes intense suffering to the little patient for many days or weeks, and by extending to the oesophagus and stomach, or into the larynx and trachea, it may prove finally fatal.

Simple erythematic inflammation of the mouth is characterized by increased heat and redness of a part or of the whole of the parietes of the mouth and surface of the tongue, accompanied with more or less dryness of the affected surface. The sensibility of the inflamed membrane is increased, and pain is experienced by the infant, when any part of the mouth is touched, and in the motions of the tongue and lips in the act of sucking.

The first indications of the disease are, in general, fretfulness and restlessness on the part of the infant; its suddenly quitting the nipple after sucking for a few moments-or, when fed by the hand, refusing its food, or crying when this is attempted to be forced upon it. When the inflammation extends over the whole surface of the mouth, it often spreads, also, to the lips, which tumefy, excoriate, and crack, and not unfrequently become affected with herpes.

In

very young infants, the disease is seldom attended with febrile

reaction; but when it appears about the period of dentition, it is usually accompanied by some degree of fever, and when of any duration, it is often attended also by profuse ptyalism.

Simple erythematic stomatitis may occur as an idiopathic affection, or it may be symptomatic of a diseased condition of the alimentary canal. In the first case it may be produced by exposure to cold, by too hot or stimulating food, by the violent exertions of the tongue and muscles of the mouth, in attempting to derive nourishment from an over-distended breast or from a too small or badly formed nipple, or, finally, it may result from the irritation of the mouth consequent upon dentition.

In its simplest form, erythematic stomatitis is seldom a very violent or obstinate disease, and is very promptly relieved by simple emollient washes, as a solution of the pith of sassafras or of the inner bark of the slippery elm, in cold water. When marked by a greater degree of severity, it may be necessary to apply a leech or two at the angle of the jaws. In aggravated cases of the disease, we have derived advantage from washing the parts affected with a weak solution of acetate of lead in water. (Three grains of the acetate of lead in one fluidounce of water.)

When the inflammation of the mouth is symptomatic of irritation or inflammation of the alimentary canal, it will, in general, disappear upon the removal of the latter.

2. Erythematic Stomatitis with curd-like Exudation. A common result of erythematic stomatitis is the secretion of a white matter, which appears, usually, in the form of small points or patches, resembling minute portions of curd, adhering to the surface of the inflamed membrane; this is particularly the case in infants at the breast. It constitutes the muguet of the French writers, the thrush or children's sore mouth, of nurses; and the aphtha lactumina and aphthæ infantiles of the older physicians.

It is among the most common of the affections incident to the early stage of infancy, and many nurses are under the impression, that if it does not occur within the month, the infant is rendered liable at a later period to some other form of disease, which it might have escaped, had it gone through "the sore mouth," at the proper

age.

By most pathologists, the affection under consideration has been confounded with aphtha. From the latter it differs, however, in many important particulars.

In many cases it is preceded by no very striking symptoms. The infant is, however, generally peevish and fretful, and exhibits more or less pain and difficulty in sucking, and often abruptly quits its hold of the nipple, or cries when attempted to be applied to it, or to be fed with artificial food. Occasionally there is considerable languor, or even drowsiness, and, not unfrequently, more or less disturbance of the stomach and bowels. If the mouth be now examined, the whole of its cavity will be found red, hot, and preternaturally dry. After a day or two, sometimes within a few hours, small white

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