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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    abdominal wall with the tips of two or three fingers, as the muscles are provoked to action by this means also, and nothing can be felt behind them. Palpation can only be properly con- ducted by placing the warm palm perfectly flat and open upon the abdominal wall and by then making pressure at any part that requires examination with the flat of one or two fingers. Any abnormal tumours can in this way be readily detected and their edges defined—be they hepatic or splenic or what not. Splenic and renal tumours are best examined by one hand placed flat beneath the body supporting the flank, while the other, flat and open as before, makes pressiire from above upon the abdominal wall supported by the hand behind. Any ejecta should be examined, whether vomited or passed from the bladder or rectum : particularly would we insist upon the need for familiarity with the various abnormalities of stools, which, especially in infancy, may give valuable indications for treatment (see chap. ix.). The sleep of a child should be watched if opportunity offer. Healthy children sleep quite calmly, and for a long time at a stretch when the first few months have passed over and the necessity of frequent suckling has gone by, but ill-health at all times quickly disturbs. Slight attacks of fever, gastro-intestinal derangements, dentition, brain disease, &c., all make the sleep uneasy, although not much differentiation of disease can be accomplished by observations of this kind. The presence of adenoid overgrowth or tonsillar hypertrophy may be indicated by the open mouth and noisy, snoring respiration of a sleeping child : the lips should be lightly closed and the breathing quiet and easy during sleep. It is a common symptom of illness, especially of exhausting diseases such as gastro-enteritis, for an infant to sleep with the eyes more or less open. The respira- tion during sleep even in healthy children is often periodic in its rhythm, approximating closely at times to the Cheyne-Stokes type, so that too much significance must not be attached to this symptom if observed during sleep. The pulse also is sometimes irregular in children during sleep. The manner of deglutition is another feature which will sometimes convey an indication of disease. In any interference with the freedom of respiration a child will take a few snatches of food and turn away with a splutter, or cough, or cry. If children refuse food without any