Diseases of children : a short introduction to their study / by the late Sir James Frederic Goodhart.

  • Goodhart, James Frederic, Sir, 1845-1916.
Date:
1921
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of children : a short introduction to their study / by the late Sir James Frederic Goodhart. Source: Wellcome Collection.

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    congested eyelids and ecchymosed face of whooping-cough. For the chest we have the immobility of pleurisy ; the unnatural prye- cordial bulging of a large heart ; the sinking m of the lower ribs with atelectasis ; the depression of the ensiform cartilage and lower end of sternum with chronic nasal or pharyngeal obstruction. Of the abdomen it may be said that enlargement is not necessarily due to disease. Children will constantly be brought for “ consumption of the bowels,” because they have diarrhoea and a large stomach. In the great majority of cases the enlargement is due to flatulent distension from defective feeding : sometimes to displacement of the liver and spleen by distortion of the thorax in rickety children. In many such there will be but few cases of organic disease, and of mesenteric disease it may be said that it is but seldom associated with any abdominal enlargement sufficient to attract the attention of the child’s mother, and in our experience there has not often been any disease of the glands that could be felt by external palpation. Of other diseases which give rise to abdominal enlargement in child¬ hood, a large liver or spleen, ascites, or renal tumours are perhaps the most frequent. In the wasting infant within the first few months of life it may be necessary to watch for the large wave of gastric peristalsis which indicates “ congenital hypertrophy of the pylorus.” When we come to the more personal examination of the child, the necessity of routine must still be borne in mind. It matters not how we proceed, so long as some definite plan is regularly followed. Supposing, as is probable, that some idea of the nature of the case has been gleaned from the preliminary survey, it is a good plan to start with the organ which is supposed to be at fault. If there be any reason for suspecting disease of the nervous system, it is as well at once to examine the eyes with the opthalmoscope, lest any sub¬ sequent action on our part may frighten the child and render the fundus oculi inaccessible. It is impossible to make any satisfactory use of the ophthalmoscope if the child is, or has been recently, crying. This done, and the state of the pupil and movements of the eyeball ascertained, the sight and hearing can be tested by a watch ; and the precision of the various muscular movements of the extremities by giving the child something to hold or pick up, and by making it walk, if old enough, or by watching the movements of the limbs in infants too young to walk, as they lie in the mother’s lap. The knee jerks should be examined, if possible, in all cases. Both diphtheritic and infantile paralysis have been overlooked by neglect of this precaution, but tact and patience may be needed in eliciting the
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