Lectures on diseases of children ... / by Edward Henoch.
- Henoch, Eduard Heinrich, 1820-1900.
- Date:
- 1883
Licence: Public Domain Mark
Credit: Lectures on diseases of children ... / by Edward Henoch. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![hand is carefully placed upon the thorax or abdomen, the number of the respiratory movements can be readily determined. When the child is awake, even if it is not crying, this examination is often disturbed by the fact that tlie patient holds l)is breatli. It is, therefore, not easy to give the normal frequency of respirations for any given age in childhood. It is greater in children under seven or eight years than in adults, and the frequency is greater, the younger the cliild, corresponding to the rapid- ity of the pulse. The heart's action is in itself more rapid than that of adults, very irritable under psychical impressions, and dread of the physi- cian often increases its frequency to such an extent as to render it value- less for diagnosis. This is best shown in children suffering from icterus. The retardation of the pulse, so characteristic of this disease in the adult, I have never observed before the seventh year, and can only account for this fact by the above-mentioned irritability of the cardiac nerves. The pulse, especially in small children, can, tiierefore, alone be properly count- ed during sleep. But it must be remembered that, even in perfectly liealthy children, the pulse is sometimes somewhat irregular during sleep. On the average, 1 believe that a frequency, during the first few months, of 120-140, and, during the second year, of 100-120, should be regarded as normal. After this period a gradual reduction occurs. In cliildren of three to six years the pulse is always above 90, and it is only after the second dentition tliat it approaches the conditions of adult life. The frequency of the respirations changes in a corresponding manner, its re- lation to that of the pulse being as one to three and one-half or four. But I repeat that very little is gained in practice by these averages. It is only under very definite circumstances that the rapidity of the pulse assumes a diagnostic or prognostic importance, as, for instance, its re- tardation in the beginning of tubercular meningitis and its remarkable acceleration at the close, and its extreme rapidity in scarlatina. On the whole, the rhythm and qualitv of the pulse have always appeared to me to possess greater importance to the ])hysician. This is also true of the relation of the pulse to the respirations, Avhich is, under normal conditions, as three and one-half or four to one. If this is permanently disturbed— if there are 40 to 60 respirations, with a pulse of 120 to 140—you may almost certainly assume that there is some disease of the respiratory organs. Only in exceptional instances is this due to nervous influences. Tlie certainty of the diagnosis is increased if the respirations are not alone more rapid and superficial, but, at the same time, more labored, when certain accessory muscles are brought into play and expiration is stertorous. Bronchitis, pneumonia, or pleurisy is almost always present under these circumstances. The examination of the heart in early childhood is attended with, perhaps, even greater difficulties. The rapid succession of the beats and the frequently accompanying cries not infrequently render it impossible, at the first examination, to form a decisive opinion concerning the clear- ness of the sounds and the conditions of percussion. The laryngoscop- ical examination of the larynx is, however, the most difficult. While there is scarcely any question of such an examination in very young children, even in older ones the physician, as a rule, meets with oppo- sition which can with difficulty be overcome. Even if the laryngoscopic mirror is properly introduced, its surface is soon obscured by moisture, so that a distinct image cannot be obtained. In the large majority of cases, therefore, no results, or very uncertain ones, are obtained by this method. Still more unsatisfactory are the conclusions drawn by the older writers](https://iiif.wellcomecollection.org/image/b21512140_0016.jp2/full/800%2C/0/default.jpg)
