On the wasting diseases of infants and children / by Eustace Smith.

  • Smith, Eustace, 1835-1914.
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: On the wasting diseases of infants and children / by Eustace Smith. 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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    lungs, it is often, owing to the obscurity of the physical signs, impossible at the first, or even after several successive examinations, to come to any positive conclusion as to the exact nature of the disease. To arrive at a diagnosis we must take into account the family history, the special history, the conformation of body, and especially the course of the physical signs. Thus, if a child, born of consumptive parents, and whose general build corresponds to the type which has been described as significant of the tuberculous diathesis, becomes languid and mopes ; if he has irregular attacks of febrile disturbance, loses flesh, has short, dry cough, and complains of vague pains and oppression about the chest, we should suspect phthisis. If these symptoms have succeeded to an attack of measles or whooping-cough, our suspicions are strengthened ; but so long as percussion of the chest shows no dulness, and auscultation reveals nothing but harshness of respiration, with here and there dry rhonchi, there is nothing upon which to found a positive diagnosis. If the dry sounds become replaced by submucous rhonchus, there is still nothing which may not be accounted for by ordinary catarrh attacking a weakly child. If, how- ever, the dry rhonchi persist and become general, being heard from apex to base, and if this condition continues without improvement for several weeks, and without moist sounds replacing the dry rales, the case assumes a very much graver aspect, and the diagnosis of phthisis becomes almost a certainty. Such cases are, however, more common in the acute form of the disease. In chronic phthisis the tubercles have a greater tendency to become grouped at the apices, both lungs being affected. Here there is dulness on percussion, and the stethoscope reveals weak or bronchial breathing, with often increased resonance of the voice or cry. The dulness, however, to be trustworthy, must be well marked : slight shades of variation from a healthy resonance being worthless as evidence of consolidation. Should the percussion dulness be distinct, and the breathing bronchial,