A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
Coldness of the surface attends prostration, either from temporary
collapse or from positive exhaustion. The skin is perceptibly cold in
the algid stage of cholera. It may be so in very severe cases of
sporadic cholera morbus. In the chill of intermittent, while the
patient has the subjective sensation of coldness, his temperature is
seldom reduced, and is often higher than natural, although lower than
during the febrile exacerbation.
The color of the skin is pallid in anæmia, phthisis, dropsy, etc., and
in syncope; ashen or livid in cholera collapse and in the cold stage
of pernicious malarial fever; yellow in jaundice, remittent, and
yellow fever; sallow in chlorosis, cancer, and chronic dyspepsia;
purple, almost black (especially the lips and ends of the fingers), in
asphyxia; dark, as if stained with ink, after long use of nitrate of
silver; bronzed in Addison's disease; bright red in scarlet fever,
etc. The eruptions of this and other exanthemata, and of the different
cutaneous diseases, will be best considered in the special articles
treating them of in this work.
Odor is perceptible and peculiar (though not easily described) in some
bad cases of typhus fever and of small-pox; less often in aggravated
chlorosis. Lunatics and paralytics (especially when assembled together
in institutions) often give off a noticeable smell. Most distinct,
however, is the cadaverous odor, sometimes perceptible for hours
before death. Corroborative of this, in summer, is the flocking of
flies around the bed of a dying patient. In a hospital ward this
selection amongst a number of patients may be quite observable.
Emphysema, from the presence of air in the connective tissue under the
skin, is rarely met with except as the consequence of an injury or of
local gangrene.
Oedema is local watery effusion, which may have various causes and
significance. Anasarca must have a general causation, either connected
with the state of the blood or with disorder of the heart, kidneys, or
liver, or of more than one of those organs at once. Pitting on
pressure is the sign of watery effusion. Soft crackling under the
touch distinguishes emphysema. A firm enlargement of the surface of
the face and upper part of the body occurs in myxoedema.
Swellings of all kind must be carefully observed, and their nature
inquired into--whether they be inflammatory or other chronic
enlargements of joints, tumors, fibrous, fatty, or cancerous,
aneurisms, hernial protrusions, or of any other character. In
protracted disease of the liver (cirrhosis) it is not uncommon to find
the superficial abdominal veins dilated and tortuous.
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