Clinical observations on pneumonia in children / by William Stephenson.

  • Stephenson, William, 1837-1919.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: Clinical observations on pneumonia in children / by William Stephenson. Source: Wellcome Collection.

    13/28 (page 11)
    and vomiting, quick breathing, and high fever, with a good deal of wandering. When seen at home (by Dr Stephenson) at 11 A.M. the skin was pungently hot, his breathing rapid, with audible expiration. The child was exceedingly restless. A hurried exa¬ mination of the chest revealed perfect dulness at right apex ante¬ riorly. Posteriorly there did not seem to be any dulness, but further examination was prevented by the restlessness of the child. After admission—(4.30 P.M.).—Pulse 144, small and feeble; res¬ pirations 70 per minute, audible and expiratory in character; skin feels cool, face pale, no flush. Chest, front, right side.—Dulness absolute at apex, less so below nipple, clear in the axillary region; bronchial breathing through¬ out. Left.—Percussion natural, harsh vesicular breathing, no rales. Back, right side above spine of scapula.—Dull, but not nearly so decided as in front; respiratory murmur over the same region also bronchial, but not so harsh as in front; the rest of chest is resonant, breathing harsh, vesicular; some coarse moist rales at left base. Patient inclines to doze off asleep, but starts up every few minutes in great alarm. Ordered mixture containing citrate of ammonia and sp. chloroformi. Plot fomentations to chest. Four ounces sherry to be made into wine-whey. Temperature in axilla, half an hour after being put to bed, was 99-4°; at 5 p.m. 104-3°. During the afternoon the breathing continued much the same, until a few minutes past 8 o’clock, when the nurse, while applying fresh fomentations, observed that the breathing was very calm, and getting slower. The house-surgeon having been summoned, he found the respirations were feeble, the eyes squinting, pupils dilated, hands clenched, and all the muscles in a state of fixed contraction. In this state the child died at 8.40. Post-mortem Examination (by Prof. Sanders).—Heart—pericar¬ dium healthy, right auricle and ventricle full of blood, left auricle and ventricle empty. Left pleura healthy, left lung con¬ gested, otherwise healthy. Light pleura contained about 10 oz. clear serum. Pleura pulmonalis and costalis covered with white exudation bands, which unite the surface of the lungs to the chest- walls superiorly and posteriorly. Upper lobe swollen and hard (pneumonic); lower compressed, but soft. On section of lung there are found in upper lobe, towards the anterior margin, circumscribed patches from the size of a pea to an almond, consisting of soft white exudation; the larger, of red haemorrhagic exudation. Liver and spleen healthy. Kidneys congested; otherwise healthy. This case belongs to a type of the disease which is not uncommon in children, and which, I think, ought to be clinically disassociated from the others. The example given is exceptional in the extreme rapidity of the fatal termination; but I have met with several cases possessing the same characters, all of which proved fatal within three, or at most four, days. They are marked by the intensity of