A practical treatise on the diseases of children : By J. Forsyth Meigs and William Pepper.

  • J. Forsyth Meigs
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of children : By J. Forsyth Meigs and William Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    space it is clear and strong, and more so in tlie lower than in the upper half. Beneath the inferior angle of the scapula, likewise, it is clear and full, until we approach the inferior margin of the thorax, where it is dulled, even above the lower edge of the lungs, by the presence beneath of the liver on one side and of the spleen on the other. Over the right side the dulness begins a little higher than over the left, in consequence of the greater bulk of the liver than of the spleen. The lateral regions are very resonant in their upper portions, but become dull as we approach the liver on the right side and the spleen on the left. On the left side the pulmonary sound is often entirely eclipsed by a tym- panitic resonance occasioned by the presence of gas in the stomach. In practicing percussion in children it is necessary to strike gently, be- cause, from the great natural sonorousness of the chest in early life, any considerable force would bring out so much sound as to prevent the recog- nition of a degree of dulness which might readily be perceived by the use of more gentle blows. It is necessary always to compare the two sides to- gether, as in adults, since this often leads to the detection of a degree of impaired resonance which might be otherwise inappreciable. Yet, and the physician ought to be well aware of this, the comparison of the two sides is not quite so useful in young as in mature subjects, because of the fact that the diseases in which the differential comparison is most impor- tant, ]incumonia and pleurisy, are more frequently doulde than in adults. It becomes, for tlie same reason, very important to com[iare the upper and lower iiortions of the thorax behind, since we may assure ourselves of the existence of dulness below, of which we were before doubtful, by the fact that the sound is less sonorous in that region than above; which is, as alreadj' stated, the very opposite of the healthy condition. Examination oi^' the Abdomen It is often very important to ascer- tain, by palpation, the form, size, and degree of tension of the abdomen, the presence or absence of effusions within its cavity, and the condition of the organs which it contains; to learn by percussion the degree of reso- nance which it affords; and lastly, to find by pressure whether it be un- naturally tender to tlie touch or not. By a careful inquiry into these various points, and a proper comparison between'them and the rational symptoms presented by the patient, we shall be able to discover the exist- ence of tumors, of hypertrophied organs, of unusual developments of gas in the intestines, of dropsical effusions, of enlarged and hardened mesenteric glands, of gurgling, and of soreness on pressure caused by inflammation of some of the contents of the cavity. The examination should be made, if possible, whilst the child is still and composed. It is best, therefore, to perform it before auscultation and percussion, in children who are old enough or amiable enough to be willingly quiet, since the length of the examination of the thorax often wearies out their patience, and they refuse to submit to further inspection; whilst, in infants and in children who ob- stinately resist the examination, it matters little at what particular period it is attempted, since it must be done at last in the midst of cries and gen- eral agitation. It is, at all times, a difficult and not very useful examina- tion, unless the patient consents to it freely and without fear. It is very