Medical diagnosis : a manual of clinical diagnosis / J.J. Graham Brown.

  • Brown, J. J. Graham (John James Graham), 1853-1925.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis : a manual of clinical diagnosis / J.J. Graham Brown. Source: Wellcome Collection.

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    is common in febrile conditions (particularly in typhus), and in neuralgia of the ophthalmic branch of the fifth nerve. In chlorosis and anaemia generally, the sclerotic has a peculiar white pearl-like lustre. Prominent eyeballs are met with in cases of exophthalmic goitre, and in connection with tumours of the orbit. Sunken eyeballs are seen in all wasting disorders, due to the atrophy of the fat which lies in the posterior part of the orbit. In regard to the muscles of the face, we may meet with spasmodic contraction in tic-douloureux, tetanus, hysteria, epilepsy, and chorea. In facial paralysis the muscles are paralysed, and the expression on the diseased side is therefore lost. While many diseases have expressions of the face which are more or less characteristic of them, there are one or two facies which stand out more prominently than the rest, and which deserve special attention. The Typhoid Facies^ that, namely, which is met with in the typhoid or adynamic state, is characterised by the following symptoms :—The patient lies on his back, dull, expressionless, and somnolent, his eyes half shut, with the pupils dilated. The face is usually emaciated, the lips black at the edges and trem- bhng, and wide enough apart to show the teeth, which are covered with sordes. Facies of Heart Disease.—In mitral disease, after compensation has been lost, the face is swollen and pale, except the lips and cheeks which are blue, the veins of the neck are engorged, and the mouth is usually half open on account of the dyspncea. In aortic insufficiency, on the other hand, the chief characteristic is extreme pallor. Facies of Inspiratory Dyspncea.—Eyes wide, head thrown back, nostrils dilated but not working, mouth half open, face pale. Seen in croup, oedema glottidis, paralysis of the posterior crico- arytenoid muscles, &c. Facies of Expiratory Dyspnoea. — The face is swollen, dark reddish blue, nostrils working powerfully, the eyes injected, and the mouth open. The patient is sitting up with the arms fixed to some support so as to allow the extraordinary muscles of respiration to come into play.