The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland.
- Luther Emmett Holt
- Date:
- 1911
Licence: Public Domain Mark
Credit: The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
1107/1178 page 1045
![TTJBERGIILOSIS. ] 045 lallcr iii-(' cliicdy iin'c-liaiiical, and (Icpciid iipun tiu,' size (jf tlic ;/laiii1s and upon (licic aiiaioiiiical I'clations^ and vimt little oi' not at all npon llu; nature of the cliauges in them. The most important relations, so tar as tlie production of symptoms is concerned, are those whicli they bear to the pneumogastric and reeun-ent laryngeal nerves, the superior vena cava, the trachea, and bronchi; those less important are to the aorta, pulmonary artery, and oesophagus. Pressure upon or irritation of the pneumogastric or recurrent nerves produces cough, dyspnoea, and sometimes a change in the voice. The cough is hoarse, persistent, and teasing, and frequently occurs in parox- ysms which in many respects resemble those of pertussis, but it lacks the characteristic whoop, and is not accompanied by the expectoration of a mass of tenacious mucus. These paroxysms are severe and often pro- longed, but careful observation shows distinct differences from those of pertussis, though by an unfamiliar ear the two are easily confounded. The dyspnoea, like the cough, is paroxysmal, and sometimes sti-ongly resembles ordinary spasmodic croup; at otlier times it is like a severe attack of asthma. Such symptoms may come and go, but they are fre- quently prolonged, and usiially in the interval between the severe seizures the patient is not wholly free from dyspnasa. Althougli the chief cause of dyspnoea is no doubt nerve irritation, it may be due in part to pressure upon the trachea or one of the large bronchi. In dvspnoea from pressure on the trachea the head is usually thrown back, and the obstruction is more frequently on expiration than on inspiration. After such symptoms as those mentioned liave existed for a few days or weeks, and in some cases without any warning, there may occur a sud- den attack of asphyxia which may prove fatal. This is generally due to ulceration of a caseous gland into the trachea or a large bronchus and the escape of a large mass into the air passages, where it produces the same effects as does any other foreign body. Of fifteen cases of this kind collected by Loeb, death by suffocation occurred in most in from five to ten minutes after the first definite symp- toms; in some the fatal attack was preceded for some time by milder attacks or by a cough; in others no previous symptoms were present, the child being apparently in perfect health. Earely after ulceration into the trachea the patient has recovered after coughing up a large amount of foul pus. Pressure upon the superior vena cava is usually associated with spas- modic dyspnoea and cough, and causes cyanosis of the face and blueness of the lips. There is frequently a puffiness of the face, and there may be marked oedema. The coexistence of cyanosis with such oedema, when the urine is free from signs of renal disease, should always lead one to suspect pressure at the root of the lung. In some rare cases the interfer- ence with the return circulation has been so marked that mening'eal](https://iiif.wellcomecollection.org/image/b21218407_1107.jp2/full/800%2C/0/default.jpg)
