Now for two of the instances in which it most commonly puzzles us. The
first of these is consumption; for here the flush, both in position and
in delicacy and gentle fading away at the proper margins, is an almost
perfect imitation of health. It, however, usually appears, not as the
normal flush of health does, upon a plump and rounded cheek, but upon a
hollow and wasted one. It rises somewhat higher upon the cheekbones,
throwing the latter out into ghastly prominence. The lips and the eyes
will give us no clew, for the former are red from fever, and the latter
are bright from the gentle, half-dreamy state produced by the toxins of
the disease, the so-called "_spes phthisica_"--the everlasting and
pathetic hopefulness of the consumptive. But here we call for help upon
another of the features of disease--the hand. If, instead of being cool,
and elastic, this is either dry and hot, or clammy and damp, and feels
as if you were grasping a handful of bones and nerves, and the
finger-tips are clubbed and the nails curved like claws, then you have a
strong _prima facie_ case.
The other color condition which is apt to puzzle us is that of the plump
and comfortable middle-aged gentleman with a fine rosy color, but a
watery eye and loose and puffy mouth, a wheezy respiration and apparent
excess of adipose. Here the high color is often due to a paralytic
distention of the blood-vessels of the face and neck, and an examination
of his heart and blood-vessels shows that his prospects are anything but
as rosy as his countenance.
The varying expressions of the face of disease are by no means confined
to the countenance. In fact, they extend to every portion of--in
Trilby's immortal phrase--"the altogether." Disease can speak most
eloquently through the hand, the carriage, the gait, and, in a way that
the patient may be entirely unconscious of, the voice. These forms of
expression are naturally not so frequent as those of the face, on
account of the extraordinary importance of the great systems whose
clock-dials and indices form what we term the human countenance. But
when they do occur they are fully as graphic and more definitely and
distinctively localizing.
Next in importance to the face comes the hand, and volumes have been
written upon this alone. Containing, as it does, that throbbing little
blood-tube, the radial artery, which has furnished us for centuries with
one of our oldest and most reliable guides to health conditions, the
pulse, it has played a most important part in surface diagnoses. To this
day, in fact, Arabic and Turkish physicians in visiting their patients
on the feminine side of the family are allowed to see nothing of them
except the hand, which is thrust through an opening in a curtain. How
accurate their diagnoses are, based upon this slender clew, I should not
like to aver, but a sharp observer might learn much even from this
limited area.
Public-domain text, read in full here on John Shaqi.
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