Lectures on children's diseases : A handbook for practitioners and students.

  • Henoch, E. H. (Eduard Heinrich), 1820-1900.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on children's diseases : A handbook for practitioners and students. 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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    no means rare, may render the diagnosis difficult owing to the addition of its auscultatory signs. Emil P., 11 years old, about whom I was consulted on 19th December, 1877, had taken ill about a week before with a feverish sore throat. A few days afterwards painful swelling and immo- bility of both ankles and knee-joints, for which acid, salicyl. grs. ivss. every 3 hours, was given with good results. Since the 17th, sudden violent pains in the left side of the chest and increased fever. P. 132 regular. There was a loud systolic murmur at the apex which became less distinct above, and at the same time a friction-sound over the lower half of the sternum accom- panying both sounds of the heart, and extending beyond the epigastrium, and as far as the mamma. Percussion unaltered. Blister between the nipple and sternum; digitalis. Eight days later the fever and pericardial friction had disappeared. The endocardial murmur, however, remained unchanged, and the boy still complained of sharp pains, and a feeling of oppression, and was often obliged to stop for breath in the midst of talking. Pot. iod. On 3rd January, 1878, the child was well, but for rheumatic pains in the left shoulder. The mitral murmur was still present for 2 years after, so that there must have been permanent valvular disease. Carl S., 8 years old, took ill in the end of December with a slight attack of articular rheumatism. A few days after, endo- carditis set in (high fever, quick breathing, pains in the left side of the chest, and loud blowing murmurs, accompanying both sounds of the heart). Ice-bag and digitalis. After some days no heart- sounds could any longer be heard, but only two murmurs. Blister. Two days after, the murmurs were less loud, and both sounds of the heart could again be made out; at the same time, however, there was pericardial friction at the middle of the sternum and at its right border. The cardiac dulness now gradually ex- tended beyond the sternum, and on the 13th January reached to about s inches beyond its right border, while the dyspnoea was considerably aggravated by the occurrence of p 1 e u r o - ] > n e u m o n i a of the left lower lobe. P. 150 pretty full; B. 50—60. Dry-cupping, digitalis, wet compresses, ice-bag over the heart when the pain was severe. Although the disease had taken the form of pneumonia migrans, and had affected the left upper lobe by the 17th, there nevertheless occurred, to our surprise, a gradual improvement of all the threatening symptoms. The pericardial friction had dis- appeared by the 15th. The enlarged cardiac dulness (pericardial effusion) receded within its normal limits, and by the 27th the child was able to leave his bed. The striking fact remained, how- ever, that the apex beat could always be felt j—1| inches outside the left nipple line, even when the child was lying on his right