Dr. Cassels: In April, 1954, a 19-month-old white female was admitted to the hospital. Her family history was irrelevant. She had a normal birth and had not been ill until about a week before admission. At that time, while sitting at the table eating, she suddenly made a noise, threw up her hands and became unconscious, and would have fallen if she had not been caught. She regained consciousness, and promptly again lost consciousness. On the way to a neighborhood hospital she regained and lost consciousness twice. During the first 24 hours of illness she had eight episodes of unconsciousness. In each of these she was limp and flaccid. At no time was there any rigidity or movement nor did she vomit or lose sphincter control. At that hospital it was noted that the eyes were swollen somewhat and the abdomen was protuberant. Urinalysis revealed 2+ albumin. No other abnormalities were found.
On admission to Bobs Roberts Hospital there was only a trace of albumin in the urine without other abnormalities. The eyes were swollen, the abdomen greatly distended, and the liver was very large. There was no evidence of cardiac disease and the blood pressure was normal in all extremities.
During the first month or two of hospitalization she was quite distressed. She had difficulty in breathing, urinated poorly, and developed marked generalized edema. She had astonishing dyspnea without orthopnea and, curiously, she sought peculiar positions of comfort in the oxygen tent. One of the peculiar positions of comfort was lying on the left side, turned at about a 45-degree angle toward a face-down position. She resumed this position repeatedly when moved for examination or nursing care and resisted the usual sitting position assumed for comfort by a patient with respiratory distress.
- Copyright © 1957 by the American Academy of Pediatrics