Volume 1

The household physician : a family guide to the preservation of health and to the domestic treatment of ailments and disease, with chapters on food and drugs and first aid in accidents and injuries / by J. McGregor-Robertson ; with an introduction by John G. McKendrick.

M'Gregor-Robertson, J. (Joseph), 1858-1925

Date:: 1899

Credit: The household physician : a family guide to the preservation of health and to the domestic treatment of ailments and disease, with chapters on food and drugs and first aid in accidents and injuries / by J. McGregor-Robertson ; with an introduction by John G. McKendrick. Source: Wellcome Collection.

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$THE PULSE. lead to a corisultatiou with a physician at once. The “ collapse temperature,” below 96’8 , par- ticulai’ly if previously the temperature has been high and has suddenly fallen so low as this, forebodes death. The temperature may be made to vary a good deal by the use of hot or cold baths, but the in- crease or diminution is only for a short time. Ihe administration of alcohol lowcvs the temperature. The temperature should be taken twice daily, morning and evening, and every day at the same hour in the morning and the same hour in the evening, so that any comparison between differ- ent days may be accurate. It would be well, therefore, for a nurse or other person attending an invalid and observing the temperature to note it down regularly at the par- ticular hour, and, alongside, to place a note of the rapidity of the pulse and the breathing. Thus, T. p. R. 9 A.M 102-8° ... ... no ... ... 27 10 P..M 103° . . 115 ... ... 29 where T. stands for temperature, P. for pulse, and R. for respirations, both of the latter being the number per minute. 9. Next to the temperature stands the pulse. The pulse is usually felt at the wrist, and may be found in a straight line drawn parallel from the inside edge of the forefinger aeross the ball of the thumb to the wrist. It is due to the movement of the waves of blood driven along the blood-vessel by the contractions of the heart. The things to be noticed about the pulse are:— (1) Rapidity, (2) Regularity, (3) Fulness and firmness. (1) Rapidity.—{a) In the young the pulse is more rapid tlian in the old. At birth it is from 100 to 120 times a minute ; at six or eight years of age from 90 to 100; then it givadually declines till in the adult its rate is between G5 and 75; and in the aged it is even slower, though in the very infirm it may become faster, (b) The number of beats is increased by food, exercise, by rising from the sitting to the standing posi- tion, by heat, (c) In women, as an average, it is five beats faster per minute than in men. (d) It is increased in debility and fever, (e) It is slower—sometimes very slow—in brain op- pression, for example, apoplexy, opium poison- ing, fracture of the skull, unconsciousness from drunkenness. (2) Regularity.—Irregularity, that is, missing a beat, or two or three beats occurring fast after one another and then slower, is not uncommon. It is sometimes due to actual disease of the structure of the heart, but is also very often of nervous oi’igin, and very frequently is due to flatulence or indigestion. Great smokers have sometimes irregular pulse. (3) Fulness.—It should be noted whether the pulse is lai-ge and soft—easily compressed—or small and hard. When the former the pressure of blood in the vessel is little, when the latter great. In some diseases of the heart the pulse gives the sensation of small shot passing under the finger. 10. The breathing should next engage the attention in the search for disease. The following table gives the average number of respirations per minute at different ages:— NumVjer of Respirations Age. per minute. Newly-born child 44 1-5 years 26 15-20 „ 20 20-25 „ 13 25-30 „ 10 30-50 „ 18 In very old people the number may fall to 12 per minute. There should be one respiration to 4 or 4-| beats of the pulse. If this pro]3ortion is seriously disturbed it points to some affection of the chest. In disease the breathing may be in- creased, as in fever and disease of the lungs, or seriously diminished and laboured, as in apo- plexy and other diseases of the brain. In o]jium poisoning the number of respirations is greatly reduced. In fact this is the seriousness of the case, the difficulty of maintaining the breathing. The writer had a case in which the number w^as reduced to four per minute, and yet the person was restored. Stertorous breathing is breath- ing accompanied with noise in ex]iiration, and is common where the brain is affected. Another kind of breathing in disease of the brain is when the cheeks are sucked in with each inspiration, and blown out with expiration. Breathlessness is common in diseases of heart and kidneys as well as in diseases of the lungs themselves. II. SPECIAL EXAMINATION OF THE BODY. These more or less general points having been noticed, it is necessary to proceed to a more detailed examination with the hope of finding symptoms which will point definitely to the seat and character of the disease. For this pur- pose it is advisable to proceed in a regular and systematic order, examining, one by one, each organ or set of organs, and noting anything cal- culated to aid in the search. 1. The eye gives information not only by its colour (see Colour, p. 9), but by the size of the$