GENERAL SIGNS OF DISEASE IN CHILDREN Much may be learned as to the state of health of a person by examining the face, eyes, month, and various parts of the body ; but in dealing with children, who cannot express their feelings, this examination becomes of very great impor tance. It is possible from it not only to tell whether a child is well or ill, but often also, if ill, what is the character of the ailment and I situation of the disease. The information is to be obtained from observing (1) the colour of the skin, face, eyes, lips, (2) the expression of the face and eyes, (3) the state of the mouth and teeth, ears, and throat, (4) the gesture and attitude, (5) the movements of the chest, (6) the movements of the belly, (7) the general state and warmth of the body, (8) the cry of the child, (9) the character of the stools, and (10) the nature of the sleep.
What should be looked for in each of these respects will be briefly indicated.
The Colour of the Skin, Face, Eyes, and Lips.—The transparent rosy tint of the skin of the healthy child may be replaced by a general yellow colour, seen not only over the whole skin, but also in the white of the eye, indicating jaundice, i.e. some affection of the liver. A form of jaundice is not uncommon in newly-born children (see p. 595). The skin may be dusky, the lips being bluish, and the same duskiness showing strongly under the finger and toe nails. This is associated with a peculiar condition of the heart (See BLUE DISEASE, p. 593). In affec tions of the lungs, where the breathing is seri ously impeded, a similar alteration of colour affects the face and lips. Serious disease of the stomach or bowels produces a dull, sallow, or leaden hue of the face.
In children, nipping of the bowel, as in intus susception (p. 604), or obstruction by a band of adhesion, is accompanied by deathlike pallor.
Expression and Features.—The most re markable and sudden alteration of features is seen in diseases of some part of the bowel, where the face is pinched and furrowed, and becomes rapidly emaciated, sunken, and lustre less, and, as noted above, extremely pale. The
rapid movements of the nostrils, accompanying laboured breathing, is a sign of afection of the lungs. Hacks and fissures about the corners of the mouth, sunken bridge of the nose, and a general withered and old-mannish look are frequent in a disease of the blood called syphilis (p. 546). A large head, with prominent over arching forehead, and small development of the face, is the well-known characteristic of a chronic form of brain disorder—water-in-the head—(p. 155). In the early stage of this ail ment the child is dtowsy, dull, and listless, however lively and active it may naturally have been. The eyes should be observed as to the way in which they close, the complete or incomplete way in which the eyelids meet, the presence of squinting ; and the pupil should be watched to note whether it responds to light —becoming small rapidly when light is directed on the eyes, and again expanding when the light is withdrawn. A wide and fixed pupil is almost certainly a sign of serious nervous disturbance.
Mouth and points to notice here are the heat and state of moisture of the mouth, the condition of the gums, the number of the teeth cut or near to cutting, the softness or dryness of the tongue, its colour and clean ness.
This examination is made by means of the finger, and the person making the examination ought always to wash the finger thoroughly immediately before introducing it into the child's mouth, as well as immediately afterwards.
In teething, of course, the mouth is hot and -perhaps dripping with saliva, and the gums may be swollen, tender, and florid. A white tongue points to disorder about the stomach. A brown dry tongue is the state in fever of the typhoid type. The tongue is also frequently covered with patches of a white vegetable growth (THRUSH, p. 599). The inside of the lips and cheeks are to be inspected for the presence of small ulcers.