HISTORY OF PEDIATRICS 511 



column, which at best measures only 2.2 cm., even a coryza in the 

 narrow nose of a small infant filled or not with adenoids are 

 causes of sudden death. 



The nervous system furnishes many such cases. It is true there is 

 no longer a diffuse interstitial encephalitis, such as Jastrowitz would 

 have it, nor is the hypertrophy of the brain by far so frequent as 

 Hiittenbrenner taught, but there are sudden collapses and deaths by 

 falls on the abdomen, by sudden strangulation of large herniae, and 

 other shocks of the splanchnic nerve. There are sudden and unex- 

 plained deaths in unnoticed attacks of convulsions, in the first paraly- 

 tic stage of laryngismus stridulus, in glottic spasms from whatever 

 cause, in the paralysis or, according to Escherich, laryngo-spasm 

 of what since Paltauf has been denominated status lymphaticus, 

 in cerebral anemia, no matter whether it is the result of exhaustion 

 or, as Charles West taught us 60 years ago, from the mere change of 

 position of a pneumonic or otherwise sick baby, when suddenly 

 raised from its bed. Or death may occur suddenly (a very frequent 

 occurrence) in the heart-failure of parenchymatous degeneration of 

 the heart -muscle as it occurs in and after diphtheria, influenza, and 

 other infectious diseases, or in the acute sepsis of appendicitis and 

 other intraperitoneal affections, whether recognized or not. For the 

 absorbing power, even of the normal peritoneum, is enormous. Of a 

 very acute infection ("infectio acutissima ") Wernich spoke as early 

 as 1883. 



In gastroenteritis, the terminating broncho-pneumonia may de- 

 stroy life quite suddenly; there is a capillary bronchitis of the very 

 young with no cry, no moan, and no cough, but with sudden death; 

 there are in extreme atrophy fatal emboli into the pulmonary, 

 sometimes renal, more often cerebral arteries. There are the cases of 

 uremic convulsions, sudden, with sudden death, which are often 

 taken to be merely reflected or "providential," because the frequency 

 of acute nephritis in the newly-born and the infant, with its fever and 

 its uremia, in spite of the publications of Martin and Ruge, Virchow, 

 Orth, Epstein, and my own, is not yet fully appreciated. That is so 

 much the more deplorable as the diagnosis of nephritis at any age 

 is readily made by the examination of the urine, which is so easy to 

 obtain in the young. Other suddenly fatal conditions, such as the 

 acute or chronic sepsis I mentioned before, often quite unsuspected, 

 entering through the umbilicus, the intestine, or the middle ear, are 

 quite frequent. 



I have been careful not to mention any cause of death that may 

 just as well be and has been studied in the adult: hemorrhages, the 

 many forms of sepsis of later periods of life, poisons, such as carbolic 

 acid and iodoform, intense cold or heat, insolation, etc., for it is my 

 duty to exhibit the relation to forensic medicine of pediatrics only. 



