The diseases of children / by James Frederic Goodhart.

  • Goodhart, James Frederic, 1845-1916.
Date:
1913
Catalogue details

Licence: In copyright

Credit: The diseases of children / by James Frederic Goodhart. Source: Wellcome Collection.

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

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    for not examining the chest—crying necessitates deep respira- tion, and is often advantageous for this reason. All that we need is more patience. In auscultation, also, it is often necessary to listen to the respiratory or heart sounds in snatches, and to fill in by repeated observations what is not permitted by con- tinuous examination ; and in many cases it is advisable to examine the back of the chest first. After these few hints upon what to avoid, a few may follow concerning what has to be done—and first we must be careful to maintain an attitude of close observation. The points to be observed are often apparently trivial and difficult to keep in mind in any systematic way. There is the complexion of the child ; the formation of its bones, the state of its skin and muscle—is it fat, spare, firm or flabby ; its size in proportion to its age ; its general build ; the shape of its head ; the state of its fontanelle ; the relative proportions of head and face ; the condition of corneae and pupils; the lines upon the face ; the state of the nostrils ; the gums, the teeth, the tongue ; the ears ; the shape of the chest and its movements ; the abdomen and its movement; the character of the cry and the state of the nervous system. All these details, and many more, indicating as they do points negative and positive which are absolutely essential to the formation of a diagnosis and for forecasting the issues of the case and for treatment, must yet, being but pre- liminaries, often be taken in almost at a glance. To allow of this being done in any sense completely, it is well to take each step in a regular method. Start where you will, adopt any plan, but proceed as much as possible upon this plan ; and, while rapidity of execution comes with practice, abundant com- pensation will be obtained for any trouble that may be involved, in the frequency with which by so doing conclusions will be arrived at, and results obtained, which had not previously been expected, and would in all probability have been missed by less methodical observation. It is impossible to go much into detail in a preliminary chapter, but one or two points may be selected to illustrate the importance of what has been said. For instance, the cry of a child may help to distinguish the ailment under which it is labouring. There is the noisy, passionate cry of hunger ; the wail of abdominal disease ; the whine of exhaustion ; the short, sharp shriek of cerebral disease ; the hoarse whispering