This is the proper period of the examination at which to in quire what the patient has to complain of. We are preparing to enter into the investigation of the special phenomena of disease, and it is a good plan to ascertain, first, in what direction the sen sations of the patient point. But it must be remembered that every person has a tendency to express a theory of his malady, rather than to relate the simple facts of which his sensations have made him conscious ; not satisfied with the knowledge that such and such effects have followed, he always fixes his mind on what he assumes to be their cause, and when asked what he has to complain of, his answer is commonly framed in the language of this theory. The French physicians have a form of question which seems to me very well suited to avoid this evil ; they ask, " Oti avez vous mall" and it would be well to adopt something of the same kind among ourselves, rather to ask where is the complaint, than what it is.
In making the observations which have just been detailed, it not unfre quently happens that some particular or unusual condition is present, which has a more direct bearing upon the diagnosis of the disease; not, let it be understood, as a distinctive mark, or special diagnostic sign, but as a pheno menon which, in the majority of instances, has been found associated with only one form of disease, or at least with a comparatively small variety of cases. Some of these are very distinct and unmistakable, while others scarcely admit of description, and are only learned by repeated observation. Even to the most practised eye, such signs are more or less uncertain, and the student should never place reliance on them : they are but solitary indica tions, and his object should be to acquire accurate knowledge, which is only to be obtained by testing conclusions drawn from one series of observations, by others which are as distinct from them as possible. The sources of fallacy which especially affect all these special indications have been already noticed, and it is most essential to remember that they have no necessary or absolutely inseparable connection with any one single morbid state, to the exclusion of all others. The deeper seated the lesion in all these cases, the more liable are we to fall into error. It surely needs no argument to prove that instead of trusting to such special signs, a systematic examination of the whole symptoms of the case may not only lead to the discovery of some other dis ease in addition to that which the particular sign, however truthful, may have indicated, but it may also point out peculiarities in the case under observation which a more cursory view must overlook; and with reference to treatment, both of these circumstances are of much importance. A few of the indica
tions just referred to, are here ranged under the four groups, into which the general symptoms have been divided, several of them having been already incidentally mentioned.
Particular indications derived from GROUP I.
a. The skin.
a. The skin feels peculiarly thin and detached from the subcutaneous tures in phthisis ; and to a less degree also in similar wasting diseases.
S. A. feeling of fulness and tension exists in the eruptive fevers, amounting to a sense of hardness in erysipelas, and of grittiness in smallpox.
7. The nails become clubbed and the hair falls off in tubercular disease, but these circumstances are not limited to such cases : in secondary syphilis the hair also falls, and during recovery from fever.
A. Disease of the abdomen, especially of a tubercular character, is often accompanied by a dry, harsh state of skin, which is most marked in child hood.
The skin is remarkably moist and soft in delirium tremens.
1. The perspiration are profuse and sour smelling in acute rheumatism. but this is not specifically diagnostic as has been supposed ; in some of the most intractable forms of the disease, the odor is peculiarly rancid and disagreeable. Excessive perspiration of any kind is frequently at tended with an eruption of mihary sudamina.
q. CoUiquative sweats are constant attendants on the latter stages of phthisia and on profuse suppuration, such as lumbar abscess.
O. Rigor, as indicated by the cutis alumina, is the common precursor of fever; its recurrence at intervals, if not from the presence of ague, or its sudden supervention daring any existing illness, is indicative of the for mation of pus.
s. The crackling feeling of emphysema, and the doughy character and pit ting under pressure of anasarca, are each very characteristic.
(See also changes of color.) b. The pulse.
a. When frequent, the pulse is observed to be remarkably full in acute rheumatism, and generally firm in all acute inflammatory diseases.
0. It is hard and wiry in abdominal inflammations especially.
7. It is weak in fevers, properly so called; either large and soft, or small and feeble.
E. It is rapid and jerking in hemorrhage.