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.

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    ances, there is sometimes intense redness of the face which may con- ceal the anemia from the physician. For distinction of circumscribed hyperemia from Hemorrhage in the Skin, see under the hitter. 3. The Blue-red Skin, Cyanosis.—This is most plain on the parts that normally are bright red, hence more than elsewhere on the mucous membranes, on the lips, cheeks, etc.; also on the knees, the phalanges of the fingers, and under the finger-nails. A moderate degree of cyanosis, therefore, would only be discovered at these parts. A marked degree, on the other hand, exhibits a blue color spread over the whole body, while those parts, especially the mucous membrane, become black-blue. The cyanosis of the new-born, with heart-failure, is so striking to the experienced observer that it is regarded by him as pathognomonic. This symptom occurs, according to the gravity of the organic changes, either persistently or only after exertion. The popular name for it is blue disease. One only sees anything like it in the death-agony and, exceptionally, in severe spasms with marked interference with breathing. The combination of cyanosis with great paleness is desig- nated as livid skin. Cyanosis arises from the blue-red color of the capillaries, and this, as is well known, is caused by an accumulation of carbonic acid and deficiency of oxygen—that is to say, by the venous or hypervenous character of the capillary contents. Carbonic acid in the blood (serum and red corpuscles) arises from — I. Interference with the exchange of gases in the lungs; 2. From the slowing of the capillary circulation and the consequently dimin- ished gas-exchange in the tissues—that is to say, the diminished giving up of CO2 by the tissues to the blood. Cyanosis arises, therefore—i. In disturbed respiration and circula- tion through the lungs ; 2. In disturbance of the greater circulation, which may be general or circumscribed according as the stoppage may be general or local. The two causes may be combined. Here belong to 1— {a) All conditions which cause a narrowing of the larger air-passages or of a large nnniber of small bro]iclii: inflammation of the neighbor- hood of the pharynx or entrance to the larynx; retropharyngeal abscess, angina Ludovici; very exceptionally a diphtheria of the throat. (In all of these cases the interference with respiration is either direct or dependent on edema of the glottis.) Here belong also those rare, sudden obstructions of the pharynx by foreign bodies, as a piece of meat and the like. The following are enumerated: spasm of the glottis, paralysis of the dilator of the glottis (crico-arytenoideus post.), all acute and chronic inflammations of the larynx, but especially croup ; tumors of the larynx; cicatricial narrowing of the larynx; foreign bodies in the larynx (something swallowed or vomited) and wounds of this organ ; also foreign bodies, croup, and scars in the trachea or one or both primary bronchi; compression of these from without by en- larged glands ; aneurysm of the aorta; mediastinal tumors, etc.; severe diffuse bronchitis, especially the acute croupous form; bronchial asthma.