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.

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    the afternoon and evening, but thirst is often very much increased on account of the copious losses of blood. The further course is the same as that already described under the liead of atrophy. Much more rarely the dyspepsia begins so acutely that a grave and even fatal condition of exhaustion may develop in a few days. The symptomatology is the same as that of infantile cholera, but tliese cases always occur sporadically and even in midwinter. A gross dietetic error may almost always be detected as the cause. Severe vomiting, profuse, rapidly repeated, thin and stinking evacuations, which gradually become clearer and more colorless, intense thirst, changed features, espe- cially sinking of the eyes, cool skin, disappearance of the pulse and de- pression of the fontanelle are found in this affection as in cholera. The cause of the rapid collapse noticeable in these cases is apparentl}- the profuse serous evacuations, which are produced by the irritation of fer- menting masses upon the mucous membrane and by the reflex action upon peristalsis. These etiormous serous losses ex])lain the rapid absorp- tion of the parenchymatous fluids which cause the emaciation of the features and the depression of the fontanelle, and also the extreme weak- ness of the heart which finds its expression in the apathy and somnolence (arterial anaemia and venous hyperaemia of the brain), in the disappear- ance of the pulse and the depression of temperature. Such cases may prove as fatal as the epidemic cholera of the summer months, but, as a rule, their prognosis is more favorable, because the affection usually ceases after the discharge of the deleterious contents of the intestines. In fatal cases, the autopsy shows no changes or, at the most, slight catarrhal changes of the gastric and intestinal mucous membrane, occa- sionally extreme pallor with slight swelling of the follicles. Under these conditions you may expect to find the peculiar gastric change known as gelatinous softening of the stomach, or gastromalacia. The slightest grade, which is found quite often, consists of a pulpy softness of the mucous membrane of the fundus and posterior wall of the stomach, so that it can be removed with the handle of the scalpel like a thick solu- tion of gum; these portions are the ones which are most subject to the action of the gastric contents in the usual position of the corpse. More rarely the softening involves all layers of the stomach, which become con- verted into a gray, reddish or dark brown, semitranslucent jelly, which smells like butyric acid and reddens litmus-paper. The serous coat usu- ally remains intact, but this also may readily tear before the autopsy. No trace of inflammatory changes can be found and the microscojic shows a mucoid substance containing a few epithelium-cells and some intact blood-vessels filled with dark clots. It is now positively known that gas- tromalacia is a chemical change in the stomach occurring after death, a post-mortem self-digestion of the walls of the stomach by its contents, which can only be expected in cases in which nourishment lias been taken and death occurred during digestion. This also explains the fact that adjacent organs, the spleen, left kidney, omentum, diaphragm and even the lower lobe of the left lung are found more or less digested and softened. The dangerous consequences which we have found develop from a dyspepsia which is at first neglected, make earlj' and careful treatment our duty, which can only be fulfilled with hopes of success when the sur- rounding conditions of life are favorable and our directions are carefully carried out. In many cases you will only appear at the bedside after nature has