Lectures on the diseases of infancy and childhood / by Charles West.

  • West, Charles, 1816-1898.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the diseases of infancy and childhood / by Charles West. 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.

    18/716 (page 20)
    feel its pulse. This must always bo done at as early a period in your visit as possible, in order that you may count it while the child is undisturbed, since the pulsations of the heart vary in young chil- dren, as much as twenty in a minute under comparatively slight dis- turbing causes ; and any inferences that you might draw from the pulse of the child, when frightened or excited, would almost certainly be erroneous. Here, as throughout when children are your patients, your difficulties will be great or small exactly in proportion to your tact. If you grasp the hand, however gently, and try to feel the pulse, the little one will struggle to be free. If you place your hand as if accidentally on its arm, and gradually move your fingers downward to the wrist, you will often unobserved and unsuspected count the pulse. Or if the nurse or mother takes the babe's hand in hers it will leave it there with confidence, and will not heed the pressure of your fingers. Besides the pulse, the' frequency of the respiration should, if possible, be noticed, since the results obtained by a comparison of the two are always more valuable than those of either taken alone. But if this is your first visit to the child, do not, for the sake of ascertain- ing either of these points exactly, persevere in attempts which irritate or frighten it: probably you would, after all, be unsuccessful; and even though you were to succeed, the knowledge would not repay you for the loss of the child's confidence, which it must be your grand object to acquire and to keep. With management and gentleness, however, you will comparatively seldom fail ; and while yon are feeling the pulse, or with the hand on the abdomen are counting the frequency of the inspirations, von will also learn the temperature of the body and the condition of the skin. Supposing your examination has thus far been pretty well borne, you may now probably, venture to talk to the child, or to show it some- thing to amuse it—as your watch or stethoscope ; and while thus testing the state of it.s mental powers, you may pass your hand over the head, and note the state of the ibntanelle, and the presence or absence of heat of the scalp. Often, though not always, it is important to ascertain the tempera- ture with greater exactness than is possible without the aid of the ther- mometer; and its neglect would then beat least as culpable as the omission of auscultation, and would lead to just as grave mistakes. When practicable it is best to take the temperature in the axilla, but where the restlessness of the patient, as is often the case with infants and very young children, renders this impossible, the thermometer can almost always be placed in the fold of the groin without exciting resist- ance, and the results thus obtained are very little less accurate. The examination of the state of the abdomen, though too important to allow of its ever being omitted, will often lead to no satisfactory result unless carefully managed. If you allow the nurse to change the child's posture and to lay it back in her lap, in order that you may pass your hand over its stomach, the child will often be alarmed, and begin to cry. Its abdomen then becomes perfectly tense, and you cannot tell whether pressure on it causes pain, or whether the cries are not altogether the consequence of fear. It is therefore the best plan to pass