To recognize fully the various evidences of an unhealthy action of the system, a long course of study, including both healthy and morbid anatomy, is necessary. If, however, the several points referred to in this chapter be carefully studied, they will aid us in arriving at a tolerably accurate idea of the nature and severity of the disease we have to treat. The following are common and well-known diagnostic signs.
13.- The Pulse.
The pulse is produced partly by the forcible expulsion of blood from the heart, through the aorta (the great arterial trunk), and thence into the a various arteries of the body, by each contraction of the left ventricle of the heart; and partly by the innate contractility of the arterial walls. Its character will consequently be modified by the condition of the heart and the blood vessels.
In feeling the pulse, great gentleness should be observed, so as not to excite the action of the heart, which would defeat the object tin view. The pulse may be examined in any part where an artery is so close to the surface that its throb can be plainly felt; but in general the most convenient locality is at the wrist. While examining the pulse, there must be no pressure exerted upon the artery in any part of its course, by tight sleeves, ligatures, etc. The examiner should place three fingers just above the root of the thumb and the joint of the wrist, with his thumb on the opposite side, so as to be able to regulate the pressure at will. Its frequency may thus be measure by the seconds-hand of a watch; but its peculiar characteristics, as indicative of various phases of disease, can only be appreciated by the educated hand of a medical man. By this method we can detect its rhythm, its fulness, or softness; whether by compression it may be rendered less perceptible; whether it is strong and bounding, forcing the fingers almost from the arm, or hard, or small and wiry, like the vibration of a string; or intermittent, striking a few beats, or whether the pulsations flow into each others, small and almost imperceptible.
HEALTHY PULSE.- The healthy pulse may be described as uniform, equal, moderately full, and swelling slowly under the fingers;it is smaller and quicker in women and children. In old age the pulse becomes hard, owing to increased firmness or to structural change in the arterial coats. The average number of beats in the healthy pulse in the minute, at different ages, is as follows- At birth, 140; during infancy, 120 to 130; in childhood, 100; in youth, 90; in adult age, 75; in old age; 65 to 70; decrepitude 75 to 80.
The pulse is influenced, however, by the following and other conditions, which should be considered in estimating the character of the pulse as a diagnostic sign. It is faster in the female than the male, by from six to fourteen beats; but this difference only occurs after about the eighth year. It is quickened by exertion or excitement; it is more quickened by exertion or excitement; it is more frequent in the morning, nd after taking food; it beats faster standing by cold, step, fatigue, want of food, and by certain drugs, especially Digitalis.
PULSE IN DISEASE.- In estimating the differences of the pulse as signs of disease, allowances must be made for those sudden irregularities which are often observable under transient excitement or temporary depression, especially of nervous persons.
The rapid pulse, especially if strong, full and and hard, indicates inflammation or fever; if small and very rapid, it points to a stage of great debility, such as is often present in the last stage of Enteric fever.
The jerking pulse is marked by a quick and rather forcible beat, followed by a sudden, abrupt cessation, as if the direction of the wave of blood had been reversed, and excites suspicion that structural disease of the valves of the hear may be present.
The intermittent pulse is that in which a pulsation is occasionally omitted, and is frequently owing to some obstruction in the heart or lungs, or Inflammation or softening of the brain, Apoplexy, etc.; also in some forms of valvular disease of the heart. Prolonged over-exertion, watching, want of rest, anxiety, etc., may produce it. In minor degrees, Indigestion with flatulence may produce it. It is often a symptom of the gouty constitution without indicating the presence of any organic disease.
The full pulse occurs in general plethora, or in the early stages of acute disease; while the weak pulse denotes impoverished blood and an enfeebled condition of the system.
When the pulse resists compression, it is said to be hard, firm or resistant; if it is small as well as hard-it is said to be weak. Of late years much attention has been paid to the condition known as the blood-tension. This depends on a variety of factors in the action of the heart and the condition of the arteries. It can be to some extent estimated by the fingers, but instruments have been devised for its more exact measurement. These require the expert, however, both to apply them and to estimate the value of the readings obtained.
14.- Temperature and the Clinical Thermometer.
For many years now considerable help has been derived in the diagnosis and treatment of disease from the use of the clinical thermometer. In all cases of illness, to count the pulse and the respirations is not more important than to measure the heat. The thermometer aids the physician in arriving at definite conclusions, and relieves him of much mental anxiety, and in many cases gives him a clue to the disease even before characteristic symptoms have made their appearance. In temperate regions the normal heat of the human body, at sheltered parts of its surface, is 98.4* Fahr., or a few tenths more or less; and a persistent rising above 99.5*, or d a persistent depression below 97.3* are signs of some kind of disease. The maintenance of a normal temperature, within the limits above stated, gives a complete assurance of the substance of anything beyond local and trifling disturbances; but any acute disease unnaturally elevates the temperature or animal heat, and many diseases are thus indicated some time before they could be detected by any other means.
The thermometer enables us to diagnose decisively between an inflammatory and a non-inflammatory disease; it also helps us to determine the severity of the inflammation by the number of degrees to which the thermometer is raised. Hysteria, it is well known, often simulates inflammatory disease; but the temperature of hysterical persons is normal, whereas that of persons really suffering from inflammation is always raised. A case is recovered of a girl supposed to be suffering from Hysteria presenting symptoms indicative of inflammation of the membranes of the brain. The hysterical tendency of the patient led to the supposition that there was only an apparent symptom of inflammation; the thermometer determined the genuineness of the symptoms; for it showed a temperature of 103.5* F., proving the actual existence of grave inflammation, afterwards confirmed by the fatality of the disease. Hysterical patients sometimes become very skilful l in manipulating the thermometer and apparently recording high temperatures. Therefore if there is any suspicion of hysteria or malignering the temperature should be taken by the physician with the utmost care.
In acute fevers, the thermometer affords the best means of deciding in doubtful cases; it is often the best corrective of a too hasty conclusion, and is indispensable for prognosis. Thus, a Typhoid fever, the rise of temperature, or its abnormal fall, often indicates, what is about to happen some time before any change in the pulse, or other sigh of mischief, may be observed.
In Tuberculosis, the thermometer affords us most valuable diagnostic information. The symptoms and signs are often obscure, or their true cause may be doubtful; especially in the early stage of the disease, when treatment is likely to be greatest avail. The importance of the aid of the thermometer in this case will be recognized by the fact that during the deposit of tubercle in the lungs, or in any organ of the body, the temperature of the patient is always raised from 98*, the normal temperature, to 102.3*, or even higher; the temperature increasing in proportion to the rapidity of the tubercular deposit. A persistent elevation of the general temperature of the body has often been found general temperature of the body has often been found to exist for several weeks before less of weight of physical signs indicating tubercle in the lungs could be appreciated. Hence an elevated temperature not only affords us certain information as to the existence of Phthisis, but the degree of that elevation enables us to estimate the extent and progress of the disease; for a persistent rise shows that the disease is progressing, or that unfavorable complications are setting in.
In Measles, the thermometer is almost the only means of learning at an early stage the invasion of Pneumonia.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."