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

  • Meigs, J. Forsyth (John Forsyth), 1818-1882.
Date:
1874
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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    surface and becoming visible. Careful inquiry now brought to light the fact that the bab)', all through the f5icknesa, had cried severely, as tiiough in sharp pain, whenever it was moved, and especially when its napkins were changed. The distress observed when the napkins were being changed, had been ascribed to some smarting from the urine. Had the surface of the child been more carefully examined at an early period, the swelling of the thigh, and the pain on motion, might, no doubt, have been detected then, and the intense febrile reaction, with the nervous symptoms, which were thought too great for simple func- tional disorder of the digestive functions, would at once have been ex- plained. It is clear, therefore, that in infants and in children under six or even eight years of age, the physician must depend, in great measure, for in- formation as to tiie nature of the case, on his own unassisted explora- tions; and, knowing this, he should leave nothing neglected that may aid him to gauge with accuracy the state of health of the individual before him. He should cultivate a habit of minute, systematic, and patient investigation, since, by accustoming himself to such a method in his daily walks, be will assuredly attain, in the end, a tact and sa- gacity that will not often be at fault. The Pulse.—The pulse of the child, in order to be judged of to any real advantage, must be examined during the state of quiet, and, if pos- sible, it should be ielt whilst the child is either asleep or dozing. During the waking state a young infant is in such constant motion, that it is very diflScult to perceive the pulsations of the radial artery, and impos- sible to judge of their force or volume, in consequence of the rising and falling of the flexor tendons of the forearm, and because, also, of the natural softness and delicacy of the pulse at that age. In older chil- dren, the moral disturbance occasioned by the visit of the physician in most instances, and the irritability and nervousness aecompanj'ing the sickness, will either cause the patient to resist the attempt to touch the arm, or else jiroduce so great an effect upon the rate and force of the circulation, as to render very uncertain and unsatisfactory any conclu- sions to be drawn from the examination. If possible, therefore, the circulation should be examined during sleep. If this be impracticable, the child ought, when still nursing, to be put to the breast, or, when weaned, it ought to be quieted by soothing treatment, by toys, or by the promise of a toy. It is essential that we should know what is the average of the healthy pulsations of the child, in order to obtain a standard of comparison by which to judge of any departure from that average in disease. Observ- ers have varied not a little in the results at which they have arrived by their examinations upon this point. By selecting those, however, which appear to have been made with the greatest care, and under the most favorable circumstances, we shall, doubtless, obtain an average entirely worthy of confidence. It will be necessary, also, to obtain averages for different periods of childhood, since the rate of the circulation varies to a very great extent at different ages. We shall, therefore, give the rate 3