Treatment of croupous pneumonia in children / by Joseph E. Winters.

  • Winters, Joseph Edcil, 1848-1922.
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of croupous pneumonia in children / by Joseph E. Winters. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Inverted respiratory pause is unequivocally, abso- lutely diagnostic of pneumonia. At end of expiration there is usually a slight moan. Abrupt onset, high temperature, pungent heat of skin; somnolence; alteration of pulse—respiration ratio; mis- placement of respiratory pause; short, quick, audible expiration; remittent type of fever, make a clinical pic- ture to be umnistakably labeled, pneumonia. With every physical sign absent, these symptoms be- tray central pneumonia—sudden abridgment of alveolar area. Pause at end of inspiration and audible expiration, even in the absence of any physical sign, make a diagnosis of pneumonia. These symptoms abide four to six days when inflam- mation usually ceases, terminating either by lysis or crisis. In a child far oftener than in adults by lysis; this is fortunate, as crisis in a child is exceedingly grave. Physical Signs. Puerile breathing abates with inception. Exaggerated vesicular breathing, a health-characteristic in a child, is curtailed with first anatomical alteration. Abbre- viation of puerile quality is due to distention of ves- sels, narrowing of alveoli, diminution of respiratory space. Functionally the involved area is practically non-existent. Impairment of vesicular murmur is diagnostic. To appreciate it compare corresponding points on opposite sides during one inspiration on each side. Prolonged auscultation for delicate signs is confusing. Only by comparing corresponding points quickly are slight differences detected and impressed. In a young child vesicular murmur is so intense (loud) that medical students constantly mistake it for bronchial. Subdued, abbreviated, curtailed vesicular murmur is diagnostic 'of distended vessels encroaching on alveo- lar spaces. 14]