Remarks on Some Diseases of Infants – Doepp 1835

Machine translation of the German language original. The original disease names (German/Latin) are given in brackets at first mention and the source page numbers are included for citation.

XXII. Remarks on some diseases of infants
[Bemerkungen über einige Krankheiten der Säuglinge]

By Philipp Doepp [Döpp], Senior Physician [Oberarzt] of the Imperial Foundling Hospital (Findelhaus) at St. Petersburg.*)

Published in Analekten über Kinderkrankheiten, Drittes Heft, Stuttgart 1835, pp. 149–168

[p. 149] In contrast to the Paris foundling hospital, induration of the cellular tissue [Zellgewebeverhärtung; sclerema neonatorum] occurs extremely rarely in the Petersburg one. Only three cases of it occurred in four years,**) and all ran a fatal course within the first four days. In two of these cases the color of the skin was yellow and marbled; in the third, however, bluish. Voiceless, motionless, and scarcely breathing, the poor creatures lay there mummy-like, with lustreless, half-opened eyes. The hardness and marble-coldness was already spread evenly over the whole body [p. 151] before they were brought into the house; I could therefore not determine whether it had shown itself earlier in any one part than in others. The autopsy [Sektion] revealed only an exudation of fluid lymph beneath the cellular tissue, whose color in the two first cases was yellow, in the third resembled that of the serum of the blood; its quantity was considerable in only one case.

Jaundice [Gelbsucht], on the other hand, behaves with us entirely as in Paris with respect to frequency and harmlessness. Roughly every ninth or tenth child brought into the house is certainly icteric; more often it is the smaller, prematurely born ones than the larger and more mature, and they always come into the house already yellow — very rarely does the disease appear later. It is therefore probable that the coloring of the skin takes place soon after birth, if not perhaps often already before it. I cannot, however, assert the latter with certainty, since no opportunity for exact and definite observation has presented itself to me. As in Paris, the icteric children are treated just like the perfectly healthy, and after one or two weeks — sometimes later — the color becomes normal. A newborn child never dies of jaundice, but it does die with it of some other, incidentally supervening disease. From this it is evident that its remote cause can be sought neither, with Gardien, in the milk of too old a wet-nurse, nor, with Pieper, in the pressure exerted on the child during birth. This latter opinion is further refuted by the fact that it is not always the raised parts exposed to pressure that are more strongly colored, as Pieper believed he observed, but often the deeper-lying parts protected against contusion during birth — such as the eyes, [p. 152] around the nose, and so forth — and further, that the coloring also extends to internal organs and even passes over into secreted fluids, e.g. the pus in blennorrhea of the eyelids [Augenliederblennorrhöe] and the lymph of the vaccine pustules. —

Still more frequently the aphthae [Aphthen] occur with us, for scarcely any of our newborn children escapes them. They always appear in the form described by Guersent and Billard under the name Muguet [thrush]: as small white dots which, gradually merging into one another, finally form general coverings resembling curdled milk, often over the entire inner surface of the mouth. I have likewise always seen them outside the institution in small children, and in adults often as a symptom added to other diseases. When, therefore, textbooks usually describe aphthae as vesicles [Bläschen], those white dots are most probably what is meant, which, closely examined, present nothing vesicular. I have, moreover, also seen true vesicles arise on the tongue and lips in children, but so rarely and under manifestations so different from those of true aphthae that I regard them as a distinct eruptive disease — whereas the latter are evidently the product of an inflammatory affection of the inner mucous membrane of the mouth, as Billard, Heyfelder, and Pieper have already assumed. Striking is the great mortality which the thrush [Schwämmchen] entails in the Paris foundling hospital, since according to Heyfelder five out of six are said to die. With us, on the contrary, it is an almost harmless malady; rarely does the coating take on a yellow — even brownish — color and a thicker consistency; it then sometimes spreads even over the lips and deprives the tongue and the other parts of the mouth cavity of all mobility. [p. 153] This condition some call sphacelous [gangrenous], but most erroneously, since it belongs not to the organism itself but only to one of its secretions; a better designation, in my opinion, is Aphthae malignae. Extremely rarely have I seen this degree of the malady arise in the house itself; it was always the consequence of great neglect of already weakly children before their entry into the house. — The treatment of aphthae with us is most simple: frequent squirting of wet-nurse’s milk into the mouth and painting of it with an aqueous solution of borax; only occasionally something of magnesia with rhubarb internally. In malignant aphthae, camphor in a mucilaginous vehicle is used for painting, and internally an infusion of valerian with a little camphor. This procedure has often proved helpful even in apparently desperate cases. Above all, however — with Heyfelder, against Guersent and Pieper — I hold it indispensable not to take the wet-nurse from the child and to have her milk squirted into its mouth quite often; already after two or three days it begins to suck again. Perhaps herein lies the reason for the difference in outcome of this disease between our house and that of Paris. —

Erysipelas of the newborn [Rose der Neugebornen] is very frequent with us; about 300 cases present themselves annually to our observation. It appears both as primary and as secondary. The secondary is a very bad symptom of internal inflammations, especially of the abdomen; it is very fleeting, appearing and disappearing quickly on this or that part of the body, and very rarely covers it entirely. The primary is the true erysipelas of the newborn. It is at first only local and usually begins from the upper extremities — more rarely from the lower and from the belly — and then spreads [p. 154] rapidly over the whole body in the course of a few days. Only about the fifth day after its first appearance, when it has already occupied the greatest part of the body, does it leave its local character: fever arises, rapid short respiration, violent thirst, and now the transition is near either into inflammation of internal organs or into external suppuration. If the former is the case, death almost always follows; the suppuration, however, kills only when it takes place deeper beneath the cellular tissue and is more extensive. Usually small abscesses form on various parts of the body, particularly on the extremities — of which we have counted over twelve on one subject — and then the disease ends happily, if it does not recur, which sometimes happens several times. Quite recently a three-month-old child died on us after the sixth relapse of the erysipelas. The best but, unfortunately, also the rarest outcome is naturally that in which the inflammation stops without forming abscesses and gradually resolves. Sometimes individual indurations remain in the cellular tissue, which do also resolve, but often later pass into suppuration. The outcome in gangrene [Brand] is rare with us; as often as it occurred, it was always at the scrotum and in the inguinal region.

Frequently the erysipelas is occasioned with us by vaccination; it sometimes arises on the second or third day after it on the vaccinated arms, as it were a traumatic inflammation, but more often on the eighth, ninth, and tenth day as a consequence of the further spread of the inflammatory areola [Entzündungshof] of the vaccine. The cause of this lies most probably in the fact that we are compelled to vaccinate our infants very early, in order to be able to send them out to the country at the appointed time with the vaccination fully completed. [p. 155] For this opinion the experience evidently speaks that this phenomenon is now noticed much more rarely with us, since I have the children vaccinated on the fourteenth day after birth, whereas earlier they were vaccinated already on the seventh or eighth day. Very often, however, the erysipelas also attacks unvaccinated children, and often long-since vaccinated ones, and then it seems to depend more on an epidemic constitution. At least it is a fact that we often have, for weeks, no children suffering from it at all, but then again suddenly many at the same time. That it is, moreover, not contagious, daily experience teaches us. Recently, however, the case occurred that in nine children out of eleven who were vaccinated from a child in whom the erysipelas developed a few hours after the taking of the lymph, this disease arose at the vaccination sites on the second day and spread over the whole body.

The outcome of this disease convinces us that in its treatment everything depends on setting limits as quickly as possible to its further spread — or, if this does not succeed, on promoting the suppuration while at the same time restricting it to the smallest possible spots. A means answering especially to the first indication I believe to have found in scarification of the inflamed parts. Namely, many long incisions, going only just deep enough through the epidermis, are made into it, so that the blood wells forth from them drop by drop, resembling a string of coral beads; the parts are then covered with dry, somewhat warmed and soft cloths, in order to let the blood be absorbed into them and to keep the parts as dry as possible. The redness usually disappears soon after, but sometimes recurs at the same spot or spreads further; in these [p. 156] both cases the scarification too is repeated, and thus the erysipelas is pursued everywhere it shows itself, even on the face. Where, however, an inclination to the formation of abscesses becomes noticeable, I hold it necessary, for the fulfillment of the other indication, to apply at once emollient, suppuration-promoting means and to open the abscesses as soon as the slightest fluctuation can be felt. The parts already freed from the erysipelas are meanwhile wrapped in soft linen and generally preserved from pressure, friction, moisture, and the influence of the air. That every other harmful agent — such as acid and impurities in the first passages [primae viae], bad nourishment, and so forth — must also be removed goes without saying. To this method, which we have practiced now for a year and a half, we owe the fortunate result that at least four-fifths of all children suffering from this murderous disease are now saved, whereas earlier approximately as many died. Enveloping the inflamed parts in fine powders has the disadvantage that the transition into suppuration and the state of the disease generally cannot be observed; and, in the lower parts, the still more essential disadvantage that cleaning the children is thereby much impeded, and the urine forms clumps with the powder which through friction increase the malady still further.

Of the cephalhematoma [Kopfblutgeschwulst; Cephalaematoma] we have about thirty cases annually. Never have I seen it arise after the first day of life, and the children were always brought into the house already having it. [p. 157] The ring given by Michaelis as characteristic — raised, hardish, bounding the tumor — is indeed always present, according to my experience too; but he erroneously holds it to be a proof of the absent bony lamella [Knochenlamelle], for by probing after the opening of the tumor I have convinced myself that this not only is never missing, but that the skull is only laid bare when the tumor, left to itself, has suppuration and caries as a consequence. Moreover, the disease is perfectly harmless, the child’s general condition always good, and I have never noticed the soporous state that Gölis claims to have seen. The tumor sometimes resolves after constant fomenting with warm Balsamus Embryonum; usually, however, we open it by a puncture with the oncotome, press out the black, always fluid blood, and then cover it again with the same fomentation. Sometimes the incision must be repeated. Recently I have also, by Henschel’s method, raised the tumor by pressure, and I can therefore recommend this where circumstances forbid the incision — which I otherwise prefer on account of the quicker healing; I have never seen from it the bad consequences mentioned by Gölis. —

Of the trismus of the newborn [Trismus der Neugebornen; trismus nascentium], a disease fortunately rare with us, I must unfortunately confess that I have not succeeded in saving even a single one of the yearly roughly twenty children afflicted with it, though I have applied the most diverse treatment methods, all without success. Meissner, moreover, erroneously believes that no remedy can be introduced to the patients by mouth; this is the case only later, when the cramp has already seized the esophagus. Only the sucking becomes impossible for the child right from the start, because the mouth, with the upper lip drawn into folds, [p. 158] from which the lower lip is somewhat removed, remains immobile and half-opened. The facial expression thereby formed is unmistakable to anyone who has once had opportunity to observe it. —

From blepharoblennorrhea [Blepharoblennorrhöe] there always suffer about forty out of the roughly five hundred infants resident with us at any one time; however, only the more severe cases of this kind are sent to the infirmary [Lazareth]. The malady mostly resolves with us, but unfortunately sometimes leaves behind spots on the cornea, even destruction of the eyeball, though rarely. This last seems to be connected with such important anomalies of other organs — or perhaps even to have brought them about — that children who lose their sight entirely usually also soon die atrophic. Residence in darker rooms, frequent careful cleaning and washing of the eyes with half-diluted and warmed Aqua saturnina [lead-water], and light purgatives suffice to heal the slighter degrees. In more violent inflammation our patients receive leeches under the eyes and behind the ears, vesicatories on the nape, and internally calomel in larger doses; the chronic form is treated with a weak sublimate solution and opium. —

Syphilis neonatorum shows itself in our house in about a hundred infants annually, and indeed under the following symptoms:

1. the well-known copper-colored spots;
2. round, greasy little ulcers on the tongue, the lips, the mucous membrane of the nose, and the anus, which form from broken-open pustules;
3. shining, strongly tense, and easily inflamed swelling of the mouth, its immediate surroundings, and the chin. It shows itself also on the upper and inner parts of the loins, where it is confused with intertrigo; further on the [p. 159] buttocks, the scrotum, the labia, and the soles of the feet. On these there later appear vesicles which form into round little ulcers, sometimes also small crusts. This is the Cutis tensa chronica of Gölis, who already surmised their syphilitic origin;
4. bumps over the whole body, especially on the head;
5. blocked nose; this is often the first sign of the beginning outbreak of the syphilis and therefore always requires great attention. Soon after its appearance the little ulcers show themselves also on the mucous membrane, sometimes, however, so high up that only the most exact examination can discover them;
6. swelling and inflammation of the finger- and toe-tips, around the nail-roots, with suppuration or at least small pus-vesicles; this symptom is one of the rarer ones;
7. desquamations of the epidermis on various parts of the body, but especially on the extremities, in small, somewhat thickened, crust-like pieces. This too does not occur often, and is not to be confused with the peeling of the epidermis peculiar to many newborns in the first three weeks of life, which occurs in larger, very tender pieces and in perfect health.

The sequence of these symptoms is very inconstant. Usually the blocked nose shows itself first, as already mentioned; then follow the little ulcers, and so forth — though not seldom it is also the reverse. Often the Cutis tensa appears again, sometimes even the exanthem first. I never saw a single symptom long alone; already after some days another, or several, joined it, and only then was I certain in the diagnosis.

As to their manner of arising, I believe I may assert from my experience that Syphilis neonatorum is very rarely congenital, i.e. communicated from [p. 160] the sick mother to the child during birth, but rather for the most part inherited from the father suffering from consecutive syphilis. Very often we see with us infants at the breast of their perfectly healthy mothers become syphilitic — even die of it — while the mothers always remain healthy. Frequently the disease arises in the children when they have already long been in the country and are thus several months old, without even the slightest probability of contagion being demonstrable. On the other hand, I have not yet seen a newborn child afflicted with syphilis, nor any attacked by it soon after birth. It seems, therefore, that some external condition is still required to promote its outbreak. A woman, pregnant in the fifth month, was infected by her husband, who — by his own assurance — had been sick and cured months before, but at that time, without new fault, had again developed ulcers on the genitals. Spots on the face, however, testified to consecutive syphilis having been present. The woman had ulcers in the throat and on the genitals, condylomata, and an exanthem spread over the whole body, but was perfectly cured before her delivery, of which I convinced myself. The very small and weakly child she brought into the world at the proper time developed, eight days after birth, the inflamed swellings on all finger- and toe-tips and ulcers at the anus. The mother remained perfectly healthy after her delivery, as she had also been at the time of conception; the father, however, suffered at that time from consecutive syphilis.

For me, up to now, the success of the treatment of Syphilis neonatorum has been most sad. All children who — as is natural — were taken from the wet-nurse’s breast [p. 161] as soon as the first symptoms showed themselves died without exception. Both the disease itself and the mercury directed against it act too invasively on the anyhow weakly childish organism under artificial nutrition; it succumbs to these three noxious agents with certainty. Its rescue succeeds only at the breast of the child’s own mother, or of a noble-minded wet-nurse who — foreseeing the certain death of the little one — cannot, despite all warnings about the harmful consequences to her own health, resolve to withdraw her breast from it. Such examples of true magnanimity and love toward the entrusted nurslings are not at all rare with us; unfortunately, they are not always rewarded by the recovery of the poor unfortunates — only about a fourth of them survive. The older, however, the diseased child is, the more hope the cure gives. This consists with us always in the application of sweetened mercury [calomel] or of Hahnemann’s mercury, in doses of an eighth to a quarter grain, given to the children themselves. All the attempts I permitted myself to make — to heal the suffering child by applying mercury to the suckling mother — failed.

Of Atrophia infantum, Meissner gives, in his very estimable handbook of children’s diseases, a description true to nature; he too, however, assumes with several other writers that it is peculiar only to the artificially fed and to children weaned from the breast. According to our daily experience, however, most prematurely born children too die of it, and many other diseases — namely syphilis and several skin diseases — usually terminate in it. An undeveloped or already deranged function of the intestinal canal, in consequence of anomalies of it and of the mesentery [Gekröse], seems to lie at its [p. 162] basis; its symptoms at least point to this, and the autopsy too frequently showed me considerable thinnings of the walls and narrowings of the intestinal canal, small corpuscles resembling millet-grains in shape and color on its outer walls, as also enlarged, indurated mesenteric glands.

Prematurely born atrophic children are often kept alive with us by careful squirting of good wet-nurse’s milk into the mouth and continual care for an even warmth constantly surrounding them. For this last purpose a cradle presented to the institution by the Court Physician [Leibmedicus] von Rühl, and invented by him, has proved very useful. It is of sheet iron and has a double wall, the interspace of which is filled with warm water, whose temperature can be constantly regulated by means of a thermometer fixed to the cradle. In older atrophic infants their nutrition requires the greatest attention. The wet-nurse’s milk must be examined rather often, both as to quantity and quality — and all the more carefully the more cause one has to fear deception and abuses, as is, e.g., the case with us. Change of the wet-nurse here often works wonders, even where nothing is to be faulted in her or her milk. Sometimes bouillon-baths [Bouillonbäder] have proved a splendid adjuvant to me in the treatment of such atrophic children; often too Iceland moss [isländisches Moos], which I always have boiled for children with fresh lime-water instead of ordinary water, in order to remove its bitterness harmlessly. —

Softening and perforation of the stomach [Erweichung und Durchlöcherung des Magens] we have several times discovered through autopsies, where the symptoms had given no hint whatever of these maladies; indeed, precisely the [p. 163] unquenchable thirst and continual vomiting given by Cruveilhier as characteristic had been absent. These cases may perhaps belong to those in which the destruction of the tunica villosa and musculosa occurs, according to Camerer’s experiments, only after death. —

Equally uncertain — perhaps for the same reason — was our diagnosis, hitherto, of intussusception [Intussusception] of the intestines, which we have very often found in the corpses of our children, and several — up to ten, even — in one and the same child. Sometimes not the slightest sign pointed to their presence, which was especially the case in chronic diarrheas. Where, however, the disease ran quickly, the most constant symptoms were the following: great restlessness, anxiety, rapid sinking of the eyeballs into their sockets, a dull and yet unsteady, meanwhile rather upward-directed gaze, infrequent but thin, greenish stools, vomiting of everything taken into the stomach — but not at once, rather only after the lapse of several minutes; and yet the abdomen was neither tense, nor painful on touching, nor could individual hardish spots be felt on it, as they have been felt by some observers in adult subjects.

Diarrheas [Diarrhöen] often prevail with us epidemically, especially in spring and summer. They carry off many of our infants and are usually of catarrhal, but often also of inflammatory, nature. Sporadically they occur not seldom purely gastric, arising from indigestible foods and overfeeding. In the catarrhal form our infants receive warm baths and mucilaginous means with some watery rhubarb-tincture and fennel-water; when it becomes chronic, a light valerian infusion and saffron-syrup; later, with the addition of a few drops of Sydenham’s liquid laudanum [Laudanum liq. Sydenh.], which I generally apply in small [p. 164] doses frequently in small children, without in this way experiencing the various ill effects of it so commonly ascribed to it; therewith, balsamic inunctions with opium on the abdomen, and covering of it with warm flannel, or with a plaster to which tartar emetic [Brechweinstein] is sometimes added. The gastric diarrhea distinguishes itself by a thick, doughy-feeling, painless belly and fluid stools which often contain variously colored little pieces, in which the administered foods can not seldom be recognized. In its treatment, change of the wet-nurse and more frequent rubbing of the abdomen with balsamic salves is the main thing. In the inflammatory form we use, as indicated, leeches, mustard-poultices, and even vesicatories on the abdomen; internally natrum nitricum in a salep-decoction, calomel with opium in small doses. When the course of this form is very acute, it takes on a cholera-like appearance, in that great anxiety, watery stools, vomiting, and sudden general collapse — especially of the eyes — vividly recall cholera [Brechdurchfall]. The absence of the chief symptoms, however — namely of pulselessness, of the cramps, and of the marble-coldness of the body (there is, on the contrary, feverish heat, or at least elevated warmth) — proves sufficiently that one is not dealing with that disease. The autopsies too always showed us distinct inflammations in the intestines, sometimes even in the peritoneum. —

Hydrorrhachitis [Hydrorrhachitis; spina bifida with hydrops] occurred two or three times yearly with us; the tumor was almost always already open and mortified, probably in consequence of rough handling during birth. A child with a sphacelous [gangrenous] cauda equina nevertheless lived ten days. Another, whose tumor was punctured with a cataract-needle [Staarnadel] and from which an ounce [p. 165] of fluid was several times withdrawn in this way, screamed incessantly until the tumor had completely filled up again; only then did it become calm and tolerate every touch — even pressure on the tumor — without sign of pain. It is still alive at present and four months old. — The location of the tumor on the vertebral column itself, and indeed far more frequently on its lowest parts, together with its rather complete transparency, seem to me its surest diagnostic marks. In the already-open case they are the following: the same location; shrunken, mostly half-inflamed skin round about; an unclean, gangrenescent appearance of the ulcer; signs of pain on rough touching of it; and incessant seeping of a thin fluid out of it. The designations “vertebral fissure” [Wirbelspalte] and “cleft spine” [gespaltenes Rückgrat] lead to false notions of the essence of this malformation of the spine. In all the cases I have seen — as also in most observed by other writers — there existed by no means a fissure in the vertebral bones; rather, the hinder half of their bodies, together with the spinous processes, was entirely missing at the spot where the tumor lay, and instead of the canal of the vertebral column there was here only a concave surface to receive the spinal cord. —

In Hydrocephalus chronicus, of which we have several cases yearly, we have performed the puncture without success. In one child, however, which had already lost the powers of sight and hearing, it evidently prolonged life: it took the breast again and became even somewhat livelier, but died nonetheless after the fourth puncture. The autopsy proved in this child that only the front parts, located under the frontal bones, still existed — though these too were already, especially toward the back, caught up in complete dissolution; the hinder parts [p. 166] were entirely missing and were replaced by water. — The operation itself was easily performed by a puncture with a small trocar, beside the large fontanelle, close to the bone-edge. —

Hydrocephalus acutus occurs frequently in our infants, even in the smaller ones. In summer — especially in the hot summer of 1831 — it was often the distinct consequence of sunstroke. Leeches, cold fomenting of the head, mustard-poultices, purgatives, natrum nitricum, and calomel, with and without Digitalis purp., are the means we apply, often with success. A more detailed communication of my experiences of this important disease I reserve for the future. —

To vaccination [Vaccination] all the pupils [Zöglinge] are subjected, as already mentioned, on the fourteenth day after birth. Yearly, over four thousand pupils of the house and about two thousand children of city-dwellers are vaccinated. Our present method of inoculation is the following: all children are inoculated on both arms by different physicians and with lymph from different children; the lymph is taken from the merely pricked pustules, not deprived of their little cuticle. The lancet-tip charged with this fluid lymph is pushed from above downward under the epidermis, then turned several times about its axis in the small pocket thus formed, and the inoculation-site is then lightly pressed with the flat of the lancet, in order to bring the lymph into more intimate contact with the wounded point. Each arm receives six inoculation-pricks — partly to gain more lymph, partly also to secure the success of the operation more fully — which therefore turns out so favorably with us that it fails, on average, in only eight out of a hundred children.

The vaccine pustules are, in form, size, [p. 167] areola [Entzündungshof], and so forth, very different according to the nature of the inoculated subjects. In non-prematurely born and otherwise healthy children the pustules have, with rare exceptions, perfectly the appearance of those so often depicted in Jenner’s day, and keep exactly the same course. I cannot therefore agree with the opinion of Rust and some others regarding the gradual degeneration of the vaccine — and all the less so, since our lymph has not been renewed since Jenner’s time and would therefore certainly long ago have had to become entirely degenerate, if it were capable of it. In its protective power against the smallpox-poison too it proves itself, as already mentioned, still worthy of the earlier confidence. More do I think, incidentally, of the necessity of revaccination after ten to fifteen years. In our children, revaccinated two years ago, genuine vaccine pustules arose in three out of a hundred.

In thus closing these — as briefly as possible framed — purely practical remarks on individual diseases of the newborn, I believe I must add that my experiences too confirm the truth, recognized of late by many, that the acute diseases of infants incline mostly to the congestive and the inflammatory. Not only did numerous corpse-autopsies show us existing inflammation, or at least congestion, in almost all the viscera,*) but also [p. 168] the more fortunate success of the more antiphlogistic method of treatment I have adopted gives evidence of this.

End of the third issue.

Footnotes

* [attribution] From his Notes on the Imperial Foundling Hospital at St. Petersburg, comprising the years 1830, 1831, 1832, and 1833, in the fifth collection of miscellaneous treatises from the field of medicine by a society of practical physicians at St. Petersburg. Hamburg, 1835.

* [on the three sclerema cases] During this time there were about 18,000 infants in the institution. So rich a field of experience is at the command of almost no other physician, which is why the remarks of the very learned author are here given a place with full right. May this communication also serve to make better known the journal from which it is taken. — The Editor.

* [p. 156, on scarification] Hutchinson treated erysipelas phlegmonodes by deep incisions reaching down to the muscles; Bright, according to Dobson, has of late [treated] facial erysipelas by puncturing with the lancet. That scarifications have been applied by anyone in the erysipelas of the newborn is not known to me.

* [p. 167, on post-mortem congestion] Not to be overlooked here is a circumstance that can easily give rise to errors, namely that in children of tenderer age, during the act of dying and shortly after, the blood accumulates more in the lower-lying parts than in adults — whence one almost always finds the hinder portions of the lungs and the liver gorged with blood, because they usually die lying on the back. I convinced myself of this by having some children laid, shortly before death, on the right side and others on the left, whereupon I always found the blood sunk toward the side on which they had lain.

Two translation notes: “Rose der Neugebornen” is rendered throughout as erysipelas of the newborn (the standard 19th-c. equivalent); and the “sweetened / Hahnemannian mercury” pair refers to calomel (mercurius dulcis) and mercurius solubilis Hahnemanni respectively. The author’s name is also spelled Döpp.

Last Updated on 08/13/26