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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    When croupous exudate plugs and distends alveoli, a second physical sign appears—slight prolongation of expiratory sound. In a young child there is practically no expiratory sound in health. It is so short, so slight, that much care is required to detect it. When a fibrinous exudate is poured into the alveoli a slight indistinct blow is heard at beginning of expiration. This elusive sign will be overlooked unless the auscultator listen with utmost concentration during a single expiration on each side and at identical points. With complete solidification and no intervening urn involved lung, high-pitched tubular breathing is heard during whole of expiratory act. Rales. Fine crepitations, typical in adult, are seldom heard in a child. Imperfect development of intercos- tal muscles; circular thorax; horizontal direction of ribs; abdominal respiration with slight lateral ex- pansion, smallness of alveoli (less than half the adult size) are anatomico-physiological conditions inimical to production of crepitations. With resolution rales are abundant. Short, dull percussion note is diagnostic, but is only present when inflammation comes to surface and no un- involved lung intervenes. Bronchial voice, like dull percussion, is a late sign— late signs have no value for patient. Examination during sleep is an element in early diagnosis—to note frequency of respirations, short, quick, audible expiration, reversed respiratory pause, altered pulse-respiration ratio. With care and gentle- ness auscultation with phonendoscope may be accom- plished without disturbing sleep. Examination is not complete without immediate auscultation, the ear being applied to the bared chest. With the child upright on nurse’s knee, by placing [5]