Lectures on diseases of children ... / by Edward Henoch.

  • Henoch, Eduard Heinrich, 1820-1900.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on diseases of children ... / by Edward Henoch. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    326/374 (page 314)
    II. Anemia. The diminution of the red blood-globules and hsemoglobulin, which we term an;emia, is extremely frequent in cliildhood, especially in con- sequence of all diseases attended with losses of secretion. Children suffering from chronic diarrhcea, extensive tuberculosis, scarlatinous ne- phritis, are always ans3mic. Those who have become atrophic in conse- quence of deficient nutrition, or who live in crowded rooms or in the damp air of cellars, also present the external appearances of impoverishment of the blood. Wo will not discuss these cases, in which the anaemia only possesses secondary importance, but rather that form which develops in otherwise healthy children and presents in general the same symptoms as the chlorosis of puberty. This form of ansemia is not infrequently ob- served in children from eight to ten years old, and almost as frequently in boys as in girls. Every physician is acquainted with such cases, which are presented by the anxious parents with the statement that nothing ails tlie children but the lack of a healthy complexion. The yellowish, pale color of the skin does not always correspond to a similar lack of color in the visible mucous membranes, which may appear quite red. But the children almost always present an unusual llaccidity, and are readily fatigued, with moodiness or increased nervous excitability, often with loss of appetite—es])ecially for meat, while the well-known pica of chlorotic individuals rarely occurs. Frequent complaint is made of painful sensa- tions in the region of the stomach or in the intercostal spaces, although no material cause for these complaints can be discovered. The anajmic ven- ous murmur in the neck is verv often, though not constantly present, and is entirely like that observed in chlorotic subjects, i.e.. it is found chiefly or exclusively on the right side of the neck, is markedly increased by turning the head to the left or by pressure with the stethoscope, and is occasionally heard in the upper part of the right border of the sternum, along the course of the common jugular vein, as a dull roaring, sounding from within. But this murmur does not present a diagnostic significance to me unless it is also heard while the head is kept perfectly erect, since an analogous murmur may be produced by muscular pressure in healthy individuals when the head is turned to the left. I could never detect any abnormal cardiac murmurs if I used the precaution of applying the steth- oscope lightly; any considerable pressure of the latter upon the costal cartilages may at once mal^je the first sound indistinct, or cause a murmur more readily, as it appears to me, in ansemic than in healthy cliildren. The implication of the nervous system is often manifested by attacks of headache, more rarely by dizziness or flashes before the eyes, to which reference has been pi-eviouslv made in the description of migraine and its relations to excessive mental work (page 131). It has also been repeat- edly mentioned that more serious neuroses (chorea, hysteria, cataleptic conditions) may develop from this cause. Before coming under my care, almost all these children liad already taken iron without any permanent benefit, because the most frequent cause of tiie affection, in my opinion, viz., the constant presence in the poisoned air of a large city, especially in oveicrowded school-rooms, and mental overwork, can rarely be removed. When circumstances permit, it is best to remove the children altogether from the city, and to have them edu- cated in country schools, as very little is accomnlished, as a rule, by a vacation of several weeks at the sea-shore or in the mountains. If tlie i