Case histories in pediatrics : a collection of histories of actual patients selected to illustrate the diagnosis, prognosis and treatment of the diseases of infancy and childhood, with an introductory section on the normal development and physical examination of infants and children / by John Lovett Morse.

  • Morse, John Lovett, 1865-1940.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Case histories in pediatrics : a collection of histories of actual patients selected to illustrate the diagnosis, prognosis and treatment of the diseases of infancy and childhood, with an introductory section on the normal development and physical examination of infants and children / by John Lovett Morse. Source: Wellcome Collection.

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    CASE 197. Paul K., nine months old, was the second child of healthy parents. There had been no deaths or mis¬ carriages and no known exposure to tuberculosis. He was born at full term, after a normal labor, and was normal at birth. He was not nursed and some difficulty was experienced in feeding him up to the time he was three months old, since when he had thrived in every way. He began to be sick about August i. He was fussy and evidently in pain. He vomited a little at first, but this stopped when his food was weakened. He had had no disturbance of the bowels. His mother noticed August 16 that he '‘favored” his left leg a little. He was first seen by his physician, August 19. He found a temperature of lOo F., but nothing abnormal on physical examination. The temperature had ranged be¬ tween 99° F. and 101° F. since then. He was very fussy and it was evident that he was in pain. The physician was, how¬ ever, unable to locate its seat. He slept much better than usual the night of August 22, and the next morning his mother found that his left thigh was much swollen. Both she and the physician were sure that it was not swollen the day before. In spite of the swelling, he seemed more comfortable than for several days. He was seen in consultation at 4 P.M., August 23. Physical Examination. He was pale and feeble and had evidently lost much weight. He was evidently in consider¬ able pain. The anterior fontanelle was four cm. in diameter and depressed. The pupils were equal and reacted to light. There was no rigidity of the neck or neck sign. The ear¬ drums were normal. He had two teeth. The mouth, gums and throat were normal. There was no rosary. The heart, lungs and abdomen were normal. The spine was flexible. The lower border of the liver was palpable two cm. below the costal border in the nipple line. The spleen was not palpable. The arms and right leg were normal. He lay with the left thigh flexed on the body and rotated outward and the leg flexed on the thigh. The left thigh was much and somewhat irregularly swollen. The swelling was most marked in the upper portion and did not extend on to the abdomen or leg. It was not in the superficial tissues and did not pit on pressure. It was moderately tender, but not red or hot. The whole left lower extremity was mottled, but the