A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt.

  • Oswald Vierordt
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt. 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.

    42/642 (page 36)
    in syncope or faintini(; in the chill of fever, which ordinarily accompanies a rapid, considerable elevation of temperature ; in spasm of the capillary vessels; in vascular spasm which occurs spasmodically, particularly in the extremities. This spasm is observed either as a simple vaso-motor neurosis or in connection with certain phenomena in the heart.^ [b) Paloicss lasting a lojiger or shorter time. This comes on sometimes quite rapidly, at least in the course of a few moments, during profuse hemorrhage and in sudden collapse—that is to say, in sudden failure of the heart as it occurs in acute, and sometimes chronic, diseases, and in acute poisoning. The sudden paleness in consequence of the loss of blood or collapse is accompanied by acceleration and attenuation of the pulse, great weakness, and sometimes with disturbance of con- sciousness. External hemorrhages make themselves evident. But cases of severe internal hemorrhage, especially of the stomach or bowels, of ruptured aneurysm, hemorrhage from internal wounds of any kind, are declared only by this sudden paleness, sometimes even before the patients themselves, if quiet in bed, complain of weakness. In a case of endocarditis which I saw the patient became pale, as one does from an internal hemorrhage, with increased frequency of pulse and stupor, within less than ten minutes. At the autopsy there was found a recent total rupture of an aortic valve. This paleness, spoken of under {b) above, can develop more slowly within a few hours or days by considerable repeated hemorrhages. In such a case the examination of the blood always shows it to be watery, deficient in hemoglobin, and often also in red corpuscles, because after losses of blood the watery constituent is always restored first. [This condition is called hydremia^ It develops as a symptom of weakening of the heart's activity in all acute and chronic diseases of the heart and pericardium; also in diseases of parts adjacent to the heart, as pleurisy and abdominal affections, with much pressure upon the diaphragm in case they interfere with the action of the heart; finally, in many acute diseases, especially in diphtheria, in heart-failure from diseases affecting the muscular structure of the heart, and very often and very quickly in acute catarrh of the stomach (acute dyspep- sia). Here hydremia is connected with imperfect fulness of the blood- vessels. Finally, paleness of the skin comes on in certain conditions gener- ally unnoticeable, insidious, and is a chronic condition; in the so-called special diseases of the blood and of the blood-making organs—indeed, most unfortunately, from a diminution of the hemoglobin, hence in chlorosis, also in pernicious anemia, leukemia, pseudo-leukemia. In this list also probably belongs malarial cachexia. Paleness is a symptom of all slowly-developing secondary anemias {cachexia) as they occur in a large number of diseases, such as all chronic febrile diseases, especially tuberculosis; in suppurations without fever; in continuing slight hemorrhages, as in many tumors and in ankylosto- miasis [Egyptian chlorosis] ; in all chronic diseases of the digestive tract; in most diseases of the female generative organs; in the dif- ferent forms of chronic nephritis, especially the large white kidney; in ' Compare seclion on Circulatory Apparatus.