A practical treatise on the diseases of children / by Alfred Vogel ; translated and edited by H. Raphael.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of children / by Alfred Vogel ; translated and edited by H. Raphael. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    without disturbing it, the instrument should be placed in the axilla, and, by pressing the arm tightly against the thorax of the child, the instrument will soon indicate the temperature. In this manner, however, only an approximate degree can be obtained, the ther- mometer in the axilla marking from one-half to one degree less than in the mouth, vagina, or rectum ; a much longer time will also be necessary for the instrument to be retained in the former than in the latter places. For the purpose of avoiding all possible danger of transmitting infectious diseases from one patient to another, the thermometer should be carefully cleansed in some disinfecting solu- tion before and after using it. I have seen at least two lamentable instances occurring from the neglect of this precaution.] The examination of the respiratory organs in small children is attended by the gTcatest difficulties, occasioned as much by the smallness of the affected organs as by the restlessness and refractori- ness of the child. The physical examination embraces inspection, percussion, auscultation, and palpation, the first two of which can only be performed during perfect quiet, but the last two even in cry- ing children. Inspection.—First of aU, as regards the number and kind of respi- rations in children who have not yet passed the first year of life, it appears, from the very positive statements of the most conscientious authors, that upon this point no definite normal numbers can be given. These statements fluctuate between eighteen and thirty-five respira- tions per minute. Above all, wm must remember that the respira- tions, even of healthy children, are not alike during sleep and wake- fulness. Only during sleep is respiration performed in a perfectly regular and rhythmical manner. Sixty experiments, which I instituted in twenty-two sleeping children from three to four weeks old, gave me, as a medium, 26.4 inspirations per minute. As soon as the children are roused and have become somewhat lively, the respira- tions are changed by every touch, every unusual noise, and every change in the light of the room ; the interval is longer than usual, and is followed by a few short, very quick or deep and slow breathings; and, if the children now begin to cry at all, the rhythm will be entirely ; abobshed; in general, however, the respirations increase in frequency during crying. Owing to this great physiological variation, no diagnostic conclusion can readily be arrived at from any small devia- ^ tions from the medium number. f In children who have passed the first year of life, the respiratory I acts are more uniform in the wakeful state. In pulmonary affec- \ tions, which occur extremely often in childhood, particularly lobular ^ pneumonia and rachitic cumification, the breathing is accelerated ’■ r 1*. t - 1 1