Pediatrics : the hygienic and medical treatment of children . ateseverity. The pulse does not feel particularly weak, and does notshow any marked irregularity, except an occasional is usually absent in this stage of the disease, even though 38 Diseases of Heart, Pericardium and Blood Vessels dyspnea and cough l^e quite marked. Exceptionally severe casesmay die in this stage of the disease, without the appearance of edemaof the skin. The unfavorable features which precede a fatal endingare the sudden appearance of obstinate vomiting, and a rapid diminu-tion in the quantity of
Pediatrics : the hygienic and medical treatment of children . ateseverity. The pulse does not feel particularly weak, and does notshow any marked irregularity, except an occasional is usually absent in this stage of the disease, even though 38 Diseases of Heart, Pericardium and Blood Vessels dyspnea and cough l^e quite marked. Exceptionally severe casesmay die in this stage of the disease, without the appearance of edemaof the skin. The unfavorable features which precede a fatal endingare the sudden appearance of obstinate vomiting, and a rapid diminu-tion in the quantity of the urine excreted. The character of theradial pulse is very deceptive in these cases, remaining comparativelystrong up to the end. The heart sounds, however, become weak,with more and more frequent intermitting of the heart action, untildeath occurs suddenly. In more prolonged cases of the severer type the progress is moregradual. The patients condition varies from day to day. Some-times cough, dyspnea, and precordial distress are less, sometimes Fig. 220. Acute endocarditis. Mitral insufficiency. Lack of , 9 years old Orthopnoea. greater. The fever continues. There is, however, a gradual diminu-tion in the quantity of urine excreted. Eventually edema develops,beginning in the feet, ankles, or legs. At any time, the course ofthe disease may take a favorable turn, edema may disappear, thetemperature may fall, and the cough, dyspnea and precordial distressmay lessen. In some cases edema may become general, and fluidmay appear in the peritoneal or pleural cavities. There is alwaysstill the possibiHty of rally. If, however, obstinate vomiting setsin, the outcome is usually unfavorable. It appears, then, that the clinical picture presented by acuteendocarditis in childhood is often the same as that with which weassociate the term broken compensation in adults. I have oftenheard the term broken compensation applied to cases in children Acute Endocarditis 39 showi
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatr, bookyear1917
