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

  • Meigs, J. Forsyth (John Forsyth), 1818-1882.
Date:
1877
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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    the palms of the hand, and the fingers clasped over them ; or the toes are strongly bent towards the sole of the foot, or rigidly extended ; sometimes the fingers are for an instant convulsively extended upon the hand and drawn widely apart from each other; or lastly, the muscular movements, instead of being easy, steady, and natural, are badly co-ordinated; they are irregular, uncertain, and tremulous. This latter character, tremulous- ness and uncertainty, we have often noticed. The occurrence of paralysis will often be unperceived for some length of time by an inattentive observer. It is to be discovered by the failure of the child to move one limb, whilst the others are more or less agitated, or by taking hold of the limb, and comparing the total want of resistance in it, with a certain stiffness and opposition to movement almost invari- ably present in the healthful condition. The state of the cutaneous surface is always important, and ought to be carefully and systematically examined. The points most requiring to be noted are its temperature, dryness or moisture, coloration, and the presence of eruptions or swellings. By the temperature, and dryness or moisture, taken in connection with the rate of circulation, we must judge as to the existence of fever. The inferences to be drawn from the condition of the surface in these respects are the same in children as in adults, and they need therefore no particular consideration in this place. The coloration of the skin, on the contrary, owing to its great suscepti- bility to change in certain affections, becomes, in the diseases of early life, of very considerable importance in diagnosis, and deserves therefore some special remarks. The physician should be aware, in the first place, that the color of a new- born infant is some shade of red, varying from a deep brick-red tint, to one of a much lighter hue. The red appearance fades aways usually in about four or five days, and leaves the surface of a yellowish-white, or in some instances of a decidedly yellow color. The yellow color is sometimes so marked as to impose very readily upon an inexperienced person the idea that it must depend on an affection of the liver, or, in other words, that it constitutes a true jaundice. In a very large majority of cases, however, the conjunctiva retains its natural white tint, the digestive functions go on with perfect regularity, there is no fever, and indeed no marks of de- cided disorder of the health, so that the icterode hue cannot depend, under these circumstances, on any serious lesion of the liver or its append- ages, and it is manifestly wrong to regard the case as one of disease, or as requiring any treatment. Besides the yellow color just described, the cutaneous surface in chil- dren, and particularly in those under three or four years of age, very often exhibits different shades of a bluish color, which need some atten- tion. When the whole skin assumes a decidedly blue tint, the case is one of cyanosis or morbus cceruleus, depending on some malformation or dis- ease of the heart or lungs. In severe cases of this kind, the blue color deepens into a purple or even blackish hue. If this appearance last more than a very few days, there can be little doubt that it depends on some malformation or disease of the heart.