480 PEDIATRICS 



diagnostic helps are lacking, and the physician is almost entirely 

 dependent on the information derived from objective phenomena. 

 The introduction into pediatrics of percussion and auscultation, so 

 necessary to the knowledge of lung and heart diseases, took place 

 relatively late and slowly. Not until in the forties were they used 

 systematically, especially by German physicians, to whom we must 

 also be thankful for the only book (Sahli) devoted exclusively to 

 percussion of the organs in childhood. 



Of scarcely less importance in diagnosis was the adoption of the 

 thermometer, which, especially in the forms of rectal measurements, 

 can be used so easily in children, even by the laity. This last fact has 

 made it a specially important and reliable instrument. Even though 

 the first thermometric researches were made by Roger, the develop- 

 ment of the technic and the working-out of typic fever curves is 

 a merit of the German school, especially that of the University of 

 Leipsic. Together with inspection and palpation, methods which 

 were always used, percussion, auscultation, and thermometry form 

 the trio which is indispensable in the examination of every child, 

 and makes possible the certain diagnosis of many previously unrecog- 

 nized diseases. The endoscopic methods are used wherever the 

 technical accomplishment in children is possible. By far the most 

 important is the inspection of the throat and mouth, as well as the 

 examination of the ear, all of which are comparatively easy to prac- 

 tice, while the laryngoscopic and opthalmoscopic methods are more 

 rarely used. Electric examination also belongs to the physical 

 methods of examination which are only used under exceptional cir- 

 cumstances, but the importance of which has been increased by the 

 discovery of the frequent increase of electric excitability in early 

 childhood, and radioscopic investigation, which permits a previously 

 unsuspected insight into the conditions of the bony development as 

 well as the changes in the more deeply situated heart and lungs. 



Aspiration of pathologic fluids, introduced by Dieulafoy, is an 

 especially useful and valuable method in childhood, and to it lumbar 

 puncture introduced by Quincke has been added. We may say that 

 the manifold varieties of the processes occurring in the meninges have 

 only been made manifest by the latter. Other methods, especially 

 the graphic, are for evident reasons less used in children, although 

 certain authors (Rauchfuss) have succeeded in overcoming the 

 difficulties. On the other hand the histologic methods of investiga- 

 tion are made of great importance by the number and variety of the 

 anemic states, although our knowledge of the pathogenesis of these 

 diseases has not been very much advanced thereby. 



In contrast to the physical methods whose technic is generally 

 simple, permitting a relatively rapid development of the realms of 

 knowledge opened up by them, are the chemic methods, which are 



