The medical diseases of children . g, and a high leucocy-tosis. The cough may beparoxysmal in type. Club-bing of the fingers arisesrapidly, and as the collec-tion of fluid becomes larger,the dyspnoea increases andcyanosis appears. Attacksof transient high fever withmuch dyspncea and sweating, may occur from time to time if a large dose of poison be absorbedsuddenly. In other cases, where the empyema is small and does not increasein size, the symptoms are much less suggestive. With some irregularfever, pallor, and perhaps slight clubbing of the fingers, wasting isthe most prominent symptom. Suc
The medical diseases of children . g, and a high leucocy-tosis. The cough may beparoxysmal in type. Club-bing of the fingers arisesrapidly, and as the collec-tion of fluid becomes larger,the dyspnoea increases andcyanosis appears. Attacksof transient high fever withmuch dyspncea and sweating, may occur from time to time if a large dose of poison be absorbedsuddenly. In other cases, where the empyema is small and does not increasein size, the symptoms are much less suggestive. With some irregularfever, pallor, and perhaps slight clubbing of the fingers, wasting isthe most prominent symptom. Such cases may be mistaken ininfants for simple marasmus, and in older children for pulmonarytuberculosis. If not drained, an empyema may be expectorated, or may aftermany weeks point, the swelling usually appearing in the front of thechest under the edge of the pectoral muscles. Some of the more latentcases may probably become absorbed or calcified, but we know verylittle of such occurrences in children. More often, a neglected case. Fig. -Empyema pointing in unusual position. 102 INFECTIVE DISEASES makes its way into a bronchus and is expectorated, sometimes withimmediately fatal results. Physical Signs.—Of the signs in the chest, the most important is theresistant character of the dullness over the affected area. The upperborder of the dullness is a sinuous line, high in the axilla. The air-entry over the dull area may be absent, often it is only diminishedtowards the base of the lung. In some cases the breath-sounds areloud. The relative diminution of the breath-sounds at the base ofthe lung is therefore of more importance than their actual loudnessor softness. Where audible, the breath-sounds are in the greatmajority of cases bronchial in character, being conducted by com-pressed lung. The vocal resonance and fremitus tend to be diminishedor absent. Skodaic resonance, scgophony, Groccos sign, displacementof viscera, and bulging of the intercostal spaces may be present, as i
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
