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

  • Meigs, J. Forsyth (John Forsyth), 1818-1882.
Date:
1886
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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    Examination of the Heart The examination of the heart by aus- cultation and percussion ought, and, to be of essential aid in diagnosis, must be performed while the child is still and quiet. It is best made dur- ing sleep, especially in infants; when this is impossible, it can be performed with great advantage during the state of quiet that follows nursing, or during that which may often be procured by soothing management, or by taking advantage of the fondness that infants show for a strong light, the view of which will generally suffice to occupy and keep them still. The sounds of the heart present the same general characters in the child as in the adult. They are, of course, more feeble and more rapid; condi- tions which make it difficult, in the young infant, to perceive and appre- ciate any minute change from the healthy sounds. After the age of one or two years, however, when the circulation lias become slower and more steady, the signs yielded by the physical examination of the heart become much more valuable and positive; so much so, indeed, as to yield results almost as important as in the adult. The first sound is almost always duller than the second. They succeed each other commonly with perfect regularity, and have the same interval between each in the same child. The cardiac sounds are readily heard by placing the ear over the prascor- dial region. The extent of surface over which they may be heard will depend on several conditions: particularly the state of quiet or agitation of the child, the presence or absence of fever, the state of the lung as to its consistence (constituting it a better or worse conducting medium of sounds), and the condition of the heart itself as to health or disease. In a healthy child, who is undisturbed by any cause of irritation, and particularly in one sleeping, the sounds are distinctly audible over the whole prajcordial region and under the left clavicle. In many subjects they can be heard over the wliole front of the thorax, but become, of course, feebler in proportion as we recede from the precordial region. Usually they are heard quite as distinctly under the right clavicle as over the nipple of that side, in consequence, no doubt, of their transmission in an upward direction by the aorta. They are never heard over the posterior walls of the chest in children in perfect health, and whose circulation is entirely undisturbed. In those who are awake and agitated, and in those who have been making severe muscular exertions, the cardiac sounds are very loudly audible over the whole front of the tliorax, and even through to the back of the cliest. When the lungs are indurated by inflammation, as in pneumonia, they transmit with great distinctness, from having become better conducting media, the cardiac sounds to the back. This circumstance sometimes becomes a valuable aid in the diagnosis of pneumonia. We have been enabled to satisfy ourselves of the existence of pneumonia in the lower lobe of the right lung, in a doubt»\il case, from the fact that the sounds of the heart were much more clear and distinct over the right inferior, than over the left inferior dorsal region. The pra:cordial region is decidedly less sonorous on percussion than the parts of the thorax directly over the lungs. This diminution of sound is distinct enough to be evident to any ordinary ear, but it rarely amounts