THE BROOKLYN MEDICAL JOURNAL Published Monthly under the supervision of the Medical Society of the County of Kings. ENTERED AT BROOKLYN, N. Y. POST OFFICE AS SECOND CLASS MATTER. ORIGINAL ARTICLES. No paper published or to be published elsewhere as original will be accepted in this department. CONDITIONS OF DIAGNOSTIC VALUE IN INFANCY AND CHILDHOOD. BY FRANK WHITFIELD SHAW, M.D., Attending Physician Brooklyn Orphan Asylum; Asst. Attending Physician Methodist The almost classical description of the objective symptoms of disease to be found among the writings of the older contributors to medical literature are as valuable to-day to a proper understanding of disease as they were before the age of the microscope and other instruments of precision now at our command. With the advance of medical learning, treatment has been greatly modified, new varieties of disease discovered and described, and an ease and accuracy of diagnosis secured which was then quite impossi One feature, however, which stands out boldly and which marks the great learning of these men of early times, is the account of disease as we find it presenting itself to the senses. The objective knowledge which they possessed was applied in a manner not so often found to-day and deductions were reached which are now furnished by more modern methods. There still remains at least one class of cases where these early methods must be constantly observed and where the usual signs or indications of a departure from health must at all times be carefully observed. This applies to disease as it is found in infancy and childhood. Perhaps with not the same rapidity of advancement or with quite the same willingness to accept it, is the study of children's diseases becoming the distinct specialty already shown in other branches of medicine, but that it is tending in that direction is undoubtedly true. There are both clinical and anatomical reasons why this is so and why special hospitals and training are not only justifiable but necessary. For the sake of convenience, early life is divided into three periods, "infancy," or the period from birth to the completion of the first dentition; "early childhood," from the beginning of the third to the ending of the fourth year; and "childhood," from the fourth year to the end of puberty. During the latter part of childhood disease presents less distinctive features. It is during the earlier years of life, therefore, when disease modified by age is more specially to be studied as applied to the alimentary, respiratory, and nervous symptoms. This is the period of most rapid growth and development, and is the period also of the greatest susceptibility to slight causes. Anatomically the respiratory organs are in a condition of development until the end of early childhood, passing from the condition at birth when they are simply fetal or embryonic to the condition of lung structure found in the adult and thus exercising a very modifying influence upon diseases of these organs. The functions of the digestive apparatus are but imperfectly exercised and are easily modified or arrested by slight disturbances. of the peripheral nerve distribution and by local irritation and imperfect feeding. The one thing, however, which is probably responsible for a greater range of disturbances during this period than any other is the nervous system. Although the list of diseases which can strictly be called nervous as applied to this age is somewhat limited, those of excess and degeneration, having to be eliminated, the indirect effect of this system is far from slight. The cerebral cortex as compared with that of the adult is structurally far less complex and is undergoing a very rapid development. Coordination exists only to a limited degree and there is very little stability of nervous mechanism. During this period there are many instances of arrest of development and both temporary and permanent departures from the normal. The pathological part played by the spinal cord and the |