Clinical manual for the study of medical cases / edited by James Finlayson.

Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual for the study of medical cases / edited by James Finlayson. 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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    clavicles, or deformity elsewhere of the chest, and any in- equality, or want of symmetry, in the respiratory movements ; any rapid and too easy flushing of the face, and especially that limited flush of the cheek with pallid complexion generally, which denotes fever in an exhausted constitution ; any or all of these may in particular cases be valuable indications of truly morbid emaciation.^ In infants and children, sometimes also in adults, it is not uncommon to observe emaciated limbs and face, with an enlarged abdomen (almost always a sign of grave, often tubercular disease). And in very young infants the presence of emaciation generally, with a retracted abdomen, and a large head, the anterior fontanelle (if still open) being protruded instead of depressed, is a combination of signs of the gravest import, as tending to reveal disease of the meninges of the brain, even should the symptoms otherwise be obscure' or wanting; still more, if these indications are accompanied by peculiarities of expression, or abnormal movements of the eyes (strabismus, nystagmus) or of the pupils; or by the phenomenon described by Trousseau as the '* tache cere^brale, and considered by him to denote fever with a cerebral or meningeal lesion.'^ **a number of little tumours appeared, answering exactly to the number and situation of the points of the fingers, when they had struck the integuments of the chest. These having continued visible for a few moments, subsided, but could be again made to appear on repeating the percussion. [My obser- vations, in very numerous instances, lead me to concur with the original description here given more closely than with the details of fact and of pro- cedure in Mr. Lawson Tait's paper. In particular, I have found that the little tumours of Drs. Graves and Stokes, which are undoubtedly the more imj)ortant part of myoidema, are produced more easily, and with far less risk of fallacy, when the percussion is made, not over a voluntary muscle at all, but over the anterior costal cartilages. The name therefore seems, in a certain sense, a misnomer, if it is intended thereby to suggest that the con- traction of the fibrillse of voluntary muscle has anything to do with the more distinctive phenomena. The little tumours are quite evidently due to a temporary contraction of muscular fibres in the skin itself, similar in kind to those of the dartos on pinching the scrotum. I believe the phenomenon, thus interpreted, to have some, but by no means a pathognomonic, significance.— W. T. G.] 1 These subjects are referred to in detail under the sections on the Nails (Chap, iv.). General signs of Pyrexia (Chap, iii.). Gums (Chap, xi.), and in those dealing with the physical examination of the Chest (Chap. xvi. part 1). ^ On drawing the back of the nail or the blunt end of a pencil along the skin, we find, in the healthy subject, that a momentary whiteness of the part is followed after a time by a distinct red streak. But in certain states this redness is much more easily produced, and is likewise very much more in- tense and persistent; it is to this excessive redness that the term tache cerebrale or meningeal macula is applied, from its being frequently observed in cases of acute meningitis. But it is now quite certain that it may be found equally in cases of enteric fever, and in many other diseased conditions.