A manual of clinical medicine and physical diagnosis / by Thomas Hawkes Tanner.

  • Thomas Hawkes Tanner
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: A manual of clinical medicine and physical diagnosis / by Thomas Hawkes Tanner. Source: Wellcome Collection.

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    wlien the cliild is awake. A very rapid pulse is little guide to disease in children; a slow pulse is of more consequence. When the child wakes, its expression, the state of surface, and position may be observed; a smile is inconsistent with serious illness. In abdominal affections, the mouth is pinched up, the legs drawn up ; the expres- sion is one of suffering in colic; of languor in typhoid; there is a wasted look in chronic diarrhoea; a shrivelled face in muco-enteritis; an earthy hue of skin, with fissured corners of the mouth and condylomata in con- genital syphilis. The hand should always be passed over the head, which is enlarged in hydrocephalus, rickets, and hypertrophy of the brain, the fontanelles being much opened. Then the child should be stripped, when rickety deformities can be seen, enlarged glands and eruptions be detected, the anus and feet examined for syphiHtic erup- tions, and the buttocks for itch. The shape of the chest is peculiar in young children; there is a constriction at the upper border of the liver on the right side, and the upper border of the stomach on the left side. The chest is altered in shape chiefly by disease of the spine, by rickets, and by disease of the pleura. The apex of the heart beats rather more to the left than in the adult. Marked signs of lung disease are found at the back, and friction sounds between the scapulae are due to diseases of the bronchial glands. The belly is big in children and this is accounted for by the short pelvis, the large liver, the thin and unresisting abdominal walls, and the fact that the diaphragm is less arched than in the adult. The spleen and kidneys and liver are readily felt, and indeed the abdomen easily examined for disease. The child should now be made to put its arms round the mother's neck, if it be frightened it clings all the closer, and renders the back tense, which can then be percussed and auscultated mediately or immediately. The chest is not very resonant, since the walls are flaccid and do not vibrate. A supposed big head is often a trouble to mothers. If the fontanelles are closed, and the child be about two years of age, or they be just open and no cerebral symptoms be present, there is no need for anxiety. In practising percussion, care must be taken not to strike too smartly, the variations in resonance being more readily appreciated by a gentle stroke: it is almost unnecessary to say that mediate percussion must be employed, that is to say, the blow must fall on the
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