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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    tract with sufficient force to adequately fill the arteries and capillaries. Of the many varieties of pallor which come under this category, the following may be mentioned :—that which is connected with emotional influences such as fear or r nxiety, and which is immediatel}r produced by contraction of the arterioles from irritation of the vasomotor nerves ; that of syncope, which is due to sudden enfeeblement or even momentary cessation of the heart's action ; that which appears in fatty degeneration of the heart, and in those cardiac diseases in which, from engorgement of the pulmonary vessels, the left ventricle contains less blood than nor- mally (e. g., mitral disease). It should be remarked that while it is true that blanching may arise from any one of the above-named causes, it most frequently happens that two or more of them co-operate in pro- ducing it. The skin is sometimes simply white, as in chlorosis, when the patient, provided there be no disturbance of nutrition, has otherwise the appear- ance of health. At other times it is of a dull earthy color, at once giving the impression of serious organic disease associated with disordered nu- trition and emaciation ; this is found chiefly in cases of malarial cachexia of old standing, leukaemia, amyloid and carcinomatous degenerations, and many other diseases of the abdominal organs. The absolute colorless- ness of the skin is occasionally varied by the presence of slight cyanosis; this occurs most often with those cardiac affections in which there is a tendency to overloading of the pulmonary circulation, and in various dis- eases of the respiratory apparatus. Caseous pneumonic infiltration, even in its early stages, is marked by pallor of the face, partly from repeated haemoptyses, but principally from the remittent fever which accompanies it ; the whole countenance may be uniformly pale, or certain spots may be of a bright red color,—the well-known hectic flush of consump- tives. In these cases, also, the color comes and goes rapidly under slight physical or mental excitement, the face being suddenly overspread by a fiery blush, which just as suddenly disappears. These symptoms are most pronounced in young persons with a delicate skin and in whom the disease runs a subacute course. Another common change in the color of the skin is Cyanosis. It varies much in intensity, from a light bluish tint to a dark bluish- black coloration. In the extremities, and wherever the skin is most delicate and most vascular,—in the lips, the point of the nose, the eye- lids, ears, nails, tips of the elbows, and fronts of the knees,—it is earliest and most distinctly seen ; even when the cyanosis is extreme, and the whole surface of the body is discolored, it is most marked in the parts mentioned. The mucous membranes have the same bluish hue as the skin. Together with the lividity the superficial veins (in the arm, neck, &c.) are seen to be so overloaded with blood as to stand out like bluish knotted cords. Those cases must be distinguished from others in which the change of color is merely local, and which will subsequently be dis- cussed. Cyanosis is always an indication that the blood is deficient in oxygen, and surcharged with carbonic acid,—that it is either not com- pletely oxidized in the lungs, or that, on account of passing slowly through the capillaries, it gives off too much oxygen to the tissues and absorbs an excess of carbonic acid from them. It arises from one or both