An American text-book of the diseases of children / By American teachers. Ed. by Louis Starr ... assisted by Thompson S. Westcott.

  • Starr, Louis, 1849-1925.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of the diseases of children / By American teachers. Ed. by Louis Starr ... assisted by Thompson S. Westcott. 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.

    29/1302 (page 13)
    to the sacrum forming ■ continuous curve, with the convexity directed back- . d the end of the eighth month the - begins to b more erect, and in a fen weeks is perfectly bo, the spine assuming an almost perpendicular line. Any marked delay in this change ind. a _ debility. At the end of the fourteenth month the child should be able to walk alone. The spine then assumes the S-like curve seen in healthy adults. A delay in walking may be due to systemic weakness or infantile paralysis affecting one or both legs. If the walking be done on the toes chiefly, if the £ait be limping, and especially if knee-pain be complained of and manipulation of the limbs causes Buffering, the chances are that hip-joint dif - coin- mencing. The anterior fontanelle should be i • mpletely clos* some period between the fifteenth and twentieth months. The closure is much retarded in rickets, which is pre-eminently a disease of malnutrition. Hydro- cephalus has a like effect In a state of health the opening, while still mem- branous, is level with the cranial bones or very slightly depressed. Conditions Btemic exhaustion cause marked sinking, and this depression is one of the best indications of the necessity of stimulation. Bulging of the fontanelle is a symptom of chronic hydrocephalus. BTDITION8 Of the Skix.—In addition to the characters already described, the skin of a healthy child has a velvety smoothness and softness, a scarcely perceptible moisture, and a great ; _ :' elasticity. MMucous disease is attended with a dry. harsh skin, which is muddy in color, and covered, especially on the extensor surfaces of the arms and legs, by a more or less thick layer of exfoliating epidermis. Chronic abdominal affections, particularly tuberculosis of the intestines and mesenteric glands, lead to harshness, acridity. scurfiness. and a wrinkled appearance of the skin covering the abdomen and thorax, with enlargement of the superficial abdom- inal veins. Protracted diarrhoea, and. still more, vomiting combined with diarrhoea, cause absorption of the subcutaneous flit and wasting of the mus- cles. The skin becomes too large for the body, is dry, harsh, discolored, and so inelastic that it falls into wrinkles over the joints when the limbs are moved, and if pinched up retains the fold for a long time. The condition of general atrophy popularly known as •• marasmus *? presents these features most strik- ingly. Dryness is a concomitant of the febrile state : excessive moisture, of prostration and collapse. Eruptions appear upon the integument in the skin diseases proper, in the exanthemata, in constitutional syphilis, and in certain digestive disorders. (Edema of the subcutaneous connective tissue may be due to affections of the heart, liver, or kidneys. The cardiac variety usually shows itself first in the feet: the renal, in the eyelids : the hepatic, in the feet and legs, secondarily to ascites. While examining the surface it is well to look for enlargement of the super- ficial lymphatic glands and swelling of the joints. The former occurs in tuber- culosis and syphilis : the latter, in rheumatism. Examination of the Abdomen.—To examine this portion of the body, the child, still stripped, must be placed on its back and kept as quiet as possi- ble. Palpation or percussion should never be made with cold hands. The abdomen of a healthy child is prominent, uniformly soft, yielding, and painless to the touch, and to percussion gives a tympanitic sound, varying in tone according to the region percussed. The tympanitic note is lowest in pitch over the epigastric and left hypochondriac regions, the seat of the stomach : highest over the umbilical region, the position of the small intestine. In disease inspection reveals any disproportion in the size or form of the abdomen, the state of the integuments, of the superficial veins, and of the