On the wasting diseases of infants and children / by Eustace Smith, M.D.

  • Smith, Eustace, 1835-1914.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: On the wasting diseases of infants and children / by Eustace Smith, M.D. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    groove reaches downwards to a less distance on the right side than on the left, on account of the liver ; and at the level of the fourth and fifth ribs it is shallower on the left side than the right, on account of the heart. The enlarge- ment of the ends of the ribs gives a peculiar appearance to the surface of the chest; a line of nodules is seen, on the inner side of the groove, looking like a row of large beads under the skin. Below the sixth rib the chest widens, as the walls are forced outwards by the underlying liver, stomach, and spleen. If we strip a rickety child and watch his breathing, we see that in inspiration there is sinking in of the chest walls. The lateral depressions deepen; the sternum moves forwards; the abdomen expands; and a deep horizontal groove furrows the surface, dividing the chest from the belly, and marking the upper borders of the abdominal viscera. This recession of the chest walls shows the mechanism by which the deformity is produced. In the healthy subject when the diaphragm contracts, and the ribs are elevated in the act of inspiration, air rushes in through the glottis to expand the lungs, and to enable them to follow and remain in contact with the expanding chest walls. The atmospheric pressure is, therefore, overcome by the power of the osseous and muscular walls, aided by the pressure of the inspired air. In the rickety child, however, one of these agents is com- paratively powerless. The softened ribs can afford little assistance to the air within the chest in resisting the pressure outside: they therefore sink in at their least supported parts, and produce the lateral furrows which have been described, while at the same time the sternum is carried forwards in proportion to the recession of the ribs. Rokitansky held that chest deformity was due to want <>l power in the inspiratory muscles. Sir W. Jcnner, however, has shown that the points of insertion of the 9