GENERAL CONDITION OF THE PATIENT.
We next proceed to inquire into the general state of the pa tient at the time of observation ; our information being derived from a consideration of all those phenomena which are not con fined specifically to any particular organ.
They are either objective or subjective. Objective phenomena are those changes in the condition of vital functions of which the observer becomes conscious by his own perceptions. They may occasionally point out the ac tual seat of disease, but generally they acknowledge a variety of causes, and therefore only pave the way for further investigation. They are much more trustworthy than subjective phenomena, because to them we can apply the test of experience and comparison, which gives them a certain relative value, in all cases in which they are found. They are independent of the patient's sensations or imagination, and are less under the control of his volition; they are therefore less liable to be simulated or exaggerated.
Subjective phenomena have special reference to the sensations of the pa tient ; they may, to a certain extent, express his consciousness of general derangement of health ; but their more direct tendency is to point out the particular function which is disturbed, and hence the particular organ or por tion of the body where disease is located.
The two classes are in great measure inseparable. They may be divided into the four following groups :— • 1. General symptoms, as pertaining to— a. Temperature and dryness of skin ; b. Fulness and quickness of pulse ; c. Appearance of the tongue ; d State of bowels and kidneys ; e. Desire for food and drink ; It is indispensable to a correct result that the whole of these should be always taken together, as the indications derived from one source serve to correct those drawn from another, and any one of them is valueless as standing alone.
2. The general appearance of the patient :— a. Size, including emaciation, and increase of bulk, whether general or local ; b. Aspect of face, and expression ; c. Changes of color of skin, general and local.
3. His position, or posture : a. In bed ; the manner of lying—on the back, on either side ; quiet, restless, &c.
b. Out of bed ; posture, gait, stiffness or loss of power of limbs.
4. The sensations of the patient.
§ I. The indications of a general condition of system, derived from a comparison of the symptoms exhibited by the skin, pulse, tongue, bowels, thirst, and appetite, serve to determine whether the condition be one associated with febrile disturbance or not ; and in this view the intensity of one symptom is of very much less importance than the complete agreement of all. A mutual relation of some of them points out the opposite conditions of vigor or weakness, on which so much of correct treatment de pends ; while their harmony or inconsistency is one of the very first elements in rational diagnosis.
a. The temperature of the skin may be either colder or hotter than natural, and each of these conditions may be accompanied by moisture or dryness. This relation must always be taken into consideration; heat and dryness generally characterize febrile excitement, coldness and moisture indicate prostration and weak ness ; a hot and moist skin, or a cold and dry one, are each of them less significant than their opposites.
We have also to pay attention to the casual changes in external circum stances by which its condition may be modified ; such as the effects of exer cise or fatigue ; the temperature of the surrounding atmosphere, and the im mediate consequences of exposure; or even the temporary effects of mental excitement. In ordinary changes of temperature, moisture, by a natural law, attends its elevation, dryness its depression; while these again react upon each other, evaporation producing coolness, and vice verse?. In disease this association is sometimes, but not always, broken through ; and hence, while a hot, dry, and pun4it skin indicates a febrile state, a hot and moist skin may, or may not, be the consequence of disease, and its value can only be estimated by determining the causes which have given rise to it. Similarly a cold moist skin, in severe disease, is a most alarming evidence of collapse, and a clammy skin generally indicates debility, while a cold and dry skin is either simply the effect of exposure in perfect health, or is found, as the cutis anserina, at the moment of rigor in fever.