In the diagnosis of diseases of children, the closest observation possible is essential. It is necessary to note every expression, every muscular movement. The cry, the respiration, and certain appearances are indications of importance in the diagnosis of obscure cases.
The cry of a child has more in it than a careless observer would suppose. In some cases of croup the condition actually develops without cough. In these cases the cry will suggest to the physician the actual condition. It has a peculiar metallic sound, is uttered with unusual force, and is followed by a crowing inspiration. The crowing inspiration will sometimes be observed forty-eight hours before the cough is particularly croupal in character.
The sharp, quick, sudden cry, or the scream when the patient is in apparent health or when awakened out of sleep, indicates acute cutting pain. If attended with tossing of the head, or pulling at the ears,
will indicate earache, if attended with drawing up of the limbs, will indicate colic. Continued, severe crying indicates a persistent cause of pain, which may be located by other symptoms. A constant worry denotes an irritability such as exists in teething.
The cry in pneumonia is severe after an effort at cough, and more or less constant and muffled between the coughing spells when awake, with a little catch at the end of the inspiratory effort in the respiration when asleep.
The cry of meningitis, and in every acute inflammation of the nerve structure and in hydrocephalis is a short, sharp cry, preceded by a moment of quiet, with an expression of pain on the countenance. The pain in pleurisy is evidenced by a sharp cry with nearly every inspiration.
In any condition that induces general wasting of the body, there is continual fretfulness, accompanied with moaning, and the patient cries as if exhausted.
These evidences, as we have said, are important and should impress themselves upon the mind of the physician, as the cry alone, will enable the physician at times to determine the seat of the malady.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.