In Ague, several hours before the paroxysm, the temperature of the patient’s body rises considerably.
In Acute Rheumatism, a temperature of 104* is always an alarming symptom, grave complication, such as involvement of the valves of the heart. In short, a temperature of 104* to 105* in any disease indicates that its progress is not checked, and tat complications are liable to arise.
In all cases of convalescence, so long as the decreases of temperature proceeds regularly, as measured by the thermometer, no relapses need be feared; on the other thermometer, no relapses need be feared; on the other hand, delayed decrease of temperature in Pneumonia, the persistence of a high evening temperature in Typhus or Enteric fever, or in the eruptive diseases, and the incomplete attainment of normal temperature in convalescence, are of great significance. They indicate convalescence, are of great significance. They indicate incomplete recovery, approach of other diseases, unfavourable changes in the products of disease, or the continuance of other sources of disturbance requiring careful examination. The onset of even a slight elevation of temperature during convalescence is a warning to exercise careful watching over the patient, and especially for the maintenance of a due control over hid diet and action (Aitken).
These remarks might easily be extended, and illustrations multiplied of the value of the thermometer as an aid to diagnosis; but beyond recommending a small, straight instrument, with a correct scale, self-registering, and taking the observations regularly at the same hours daily throughout the disease, noting at the same time the pulse and the breathing, we have only space for the following directions –
The best way to take a temperature is to place the bulb of the thermometer under the tongue, by the side of the last molar- wisdom tooth-and request the patient to close the lips around the stem. The time required to ascertain the temperature correctly is from three of five minutes. Another way is to place the bulb under the armpit; but the former plan is better wen practicable.
15.- Breathing.
Healthy inspiration is performed with great ease by a nearly equal elevation of the ribs and enlargement of the chest, and by descent of the diaphragm. Expiration is the natural return of the chest to its proportions during rest, which is produced by the pressure of the external air, the ascent of the diaphragm, and contraction of the abdominal muscles. An adult breathes about twenty in a minute. Disease and exertion quicken the rate of breathing.
Dyspnoea, or difficult breathing, may result from wasting disease of the lung substance; adventitious deposits in these organs (these conditions necessarily lessening the amount of breathing surface); formations of false membranes in the air passages, as in Diphtheria and inflammation and swelling of the tonsils or tongue – all of which conditions obstruct t he entrance of air into the lungs, and thus cause Dyspnoea, as does also Asthma, which seems to be a spasm of the muscular coat at the air-tubes, or a swelling of the mucous membrane.
Effusions into the pleurae or pericardium, the serous membranes surrounding the lungs and heart, also induce Dyspnoea by causing compression of the lungs, and fracture of the ribs may naturally impede the respiratory movements. Intrinsic organic and functional diseases of the heart also cause Dyspnoea. Disease of the nerves which preside over the respiratory movements, or in that part of the nervous centres from which they proceed, may also produced serious and even fatal difficulty of breathing. In Apoplexy, and cases of great exhaustion, when an insufficient supply of blood is sent to the great nervous centre-the brain-the respiratory movements are deranged, and otherwise greatly or even fatally obstructed.
16.- The Tongue.
This organ affords important indications – Dryness points to diminished secretion, and is common in acute and febrile diseases; moisture is generally a favourable sign, particularly when it succeeds a dry or furred condition. A preternaturally red tongue is common in the course of the eruptive fevers; in Gastric and Bilious fevers, and in bad cases of Indigestion, the redness is often limited to the edges and tip. The Strawberry tongue is a symptom of Scarlet fever; the fissured tongue of Typhus and Enteric fevers. When the tongue is livid or purple, there is defective oxygenation of the blood. The furred tongue is the most marked, and is common in inflammation and irritation of the mucous membranes, in diseases of the brain, in all varieties of fever, and in almost all acute and dangerous maladies. Some persons have usually a coated tongue on rising, without any other symptom of disease. This is especially the case with tobacco smokers. A uniformly white-coated tongue indicates gastric or intestinal disorder, but not as a rule of a serious kind; a yellow coat is indicative of disordered action of the liver, or more profound alimentary disorder; a brown or black, of a low state of the vital powers, and contamination of the blood. The gradual cleaning of the tongue, first from the tip, and edges, shows a tendency to health, and indicates the cleaning of the whole intestinal tract; in less fortunate cases, as the tongue gets browner, dirtier, and drier each day, the nervous and muscular systems get weaker, and hope is gradually extinguished; when the fur separates in patches, leaving a red, glossy surface, it is also unfavourable; when the crust is rapidly removed, leaving a raw or dark-colored appearance, the prognosis must still be unfavorable.
17.- Pain.
This is often a most important indication of the nature and seat of disease, pointing to an interruption of the harmony of the bodily organs. When attended with a throbbing sensation, consequent upon the heart’s action, it is called pulsating pain; when with a feeling of tightness, tensive; when with heat, burning. Nervous Neuralgic pain may be recognized by its disposition to follow a certain course, without being rigidly limited to one particular part; by its being subject to perfect intermissions; and by the suddenness with which it comes and goes. Spasmodic pain is mitigated by pressure, by frictions, and by applications of heat; it comes on suddenly with greater or less severity, terminating abruptly. Inflammation pain is constant, attended by heat and quickened pulse, is increased by movement of the affected part, by touch or pressure, and usually mitigated by rest. Frequently pain occurs, not in the part diseased, but in a distant one. Inflammation of the liver often first shows itself by pain in the right shoulder; inflammation of the hip-joint, by pain in the knee; stone in the bladder, by pain at the end of the penis; disease of the heart, by pain down the left arm, etc.
18.- The Skin.
In health the skin imparts to the touch the sensation of an agreeable temperature, with just sufficient moisture to preserve its softness; it is also elastic, smooth, and neither too tense nor loose. A harsh, dry, burning heat of the skin is indicative of fever, and must ever be regarded as unfavorable, especially in inflammatory conditions of internal organs. If this condition be followed by perspiration, coincident with general improvement, it is a favourable indication. Great relief is usually experienced on the occurrence of the sweating stage in Ague, Inflammatory fevers, etc. On the other hand, complications may be feared if perspiration ensue without any amelioration of other symptoms.
Partial or local symptoms indicate a deranged condition of the nervous system, or an affection of the organs beneath the perspiring surface. If perspirations occur after trifling exertion, they point to excessive weakness. Night sweats, of frequent occurrence, not only show debility, but when preceded by chills and fever, may indicate Tuberculosis.
The colour of the skin is also diagnostic. A bluish tint of the skin indicates structural disease of the heart. A yellow colour points to biliary affections. A rich blush of the cheeks, especially if it be circumscribed, and the surrounding parts pale, may indicate an irritable condition of the nervous system, or a diseased state of the lungs.
19.- The Urine.
The urinary organs are, the kidneys and bladder, with their appendages. The kidneys secrete the urine from the blood, and by this process the blood is relieved of many impurities, which if retained, would give rise to decease in the whole system. The secretion of the kidneys reaches the bladder through the channels (ureters), and the urine is ultimately discharged through the urinary canal (urethra).
Healthy urine is of a brightish yellow or amber colour, a tint darker in the morning than in the afternoon, yielding a slight ammoniacal smell, devoid of unpleasant odour, and precipitating no deposit on standing, or only the merest trace of mucus, or of urates from a low temperature. In advanced age the urine becomes darker and slightly offensive; it is darker in persons who lead a very active life; different varieties of food also produce a marked effect both on the colour and odour of urine. The stream of urine should be round and large, and it should be passed about four to six times in twenty-four hours without any pain or straining.
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."