A handbook of physical diagnosis : comprising the throat, thorax, and abdomen / by Paul Guttman ; tr. from the 3rd German ed. by Alex. Napier.

  • Guttmann, Paul, 1834-1893.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of physical diagnosis : comprising the throat, thorax, and abdomen / by Paul Guttman ; tr. from the 3rd German ed. by Alex. Napier. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    INSPECTION. Many diseases of the chest and abdomen, acute as well as chronic, are recognizable at the first glance by a change in the color of the skin. The most common of these changes is Blanching. A high degree of pallor has always a pathological significance ; in a less marked form, however (as it is often seen in perfectly healthy per- sons), it can be so regarded only when the symptoms of the disease, sub- jective and objective, offer a satisfactory explanation of its presence. It attracts attention most readily on those exposed parts which are nor- mally of a red color, the face, the mucous membrane of the lips, and the conjunctivae. It is caused, in every case, either by a diminution of the volume of blood in circulation, by deficiency in the number of red blood-corpuscles, or by an unfilled condition of the capillaries. The decrease in the quantity of blood may be direct, the result of haemorrhage from the lungs, stomach, bowels, or urogenital apparatus, or of the effusion of blood or blood-tinged exudation into the serous cavities. Or it may be indirect, caused by a deficient supply or malassi- milation of food,—as in all febrile affections, in convalescence from se- vere acute disease, and in many chronic diseases of the alimentary canal and the organs connected with it. Further, we have the same condition produced when the system, through loss of albumen, is deprived of much blood-forming material; instances of this are seen in cases in which there is copious effusion into the pleurae, pericardium, and peritoneum, in gen- eral anasarca and in albuminuria. Blanching from a deficiency in the number of the red blood-corpuscles comes under our notice chiefly in chlorosis and other anaemic conditions (anaemia splenica, pernicious anaemia) and in leukaemia. In chlorosis not only is the total quantity of blood in circulation probably diminished, but the red corpuscles may be reduced to one-half their normal relative number, giving rise to such an extreme degree of pallor as is rarely ob- served in any other affection ; in leukaemia the alteration of the propor- tion of white corpuscles to red is due both to increase of the former and decrease of the latter. In these diseases, also, owing to the fewness of the red corpuscles, the blood is markedly wanting in haemoglobin, which may be reduced to one-third the normal quantity ; this is especially char- acteristic of some cases of chlorosis in which, not the number of the red corpuscles, but their haemoglobin, seems to be lessened. Independently of any change in the blood, however, extreme paleness of the skin may show itself when, from any cause, the heart does not con-