HEALTH COLUMN. Tell-tales of Disease.

Otago Witness, Issue 2817, 4 March 1908, Page 76

HEALTH COLUMN. Tell-tales of Disease.

By Woods Hutchinsox, A.M., M.D. The varying expressions of the face of disease are by no means confined to the countenance. In fact, they extend to every portion of — in Trilby's immortal phrase — "' the altogether." Disca&e can 6peak most eloquently through the hand, the carriage, the gait, and, in a way that the patient may be entirely unconscious of, the voice. These forms of expression are naturally not so frequent as those of the face, on. account of the extraordinary importance of the groat systems whose clockdials and indices form what we term the human countenance. But when they do occur they are fully as graphic, and more definitely and distinctively localising. Next in importance to the face comes the hand, and volumes have been written upon this alone. Containing, as it does, that throbbing little blood-tube, the radial artery, which has furnished us for cen'unes with one of our oldc&t and most reliable guides to health conditions, the pulse, it has played a most important part in surface diagnoses. To this day, in fact, Arabic and Turkish physicians in visiting their patients on the feminine side of the family are allowed to see nothing of them except the hand, which is thrust through an opening in a curtain. How accurate their diagnoses are, based upon this slender clue, I should not like to aver, but a sharp observer might learn much even from thie limited area. We haye — though, of course, in lesser degree — all the colour and line pictures with which we have been dealing upon the face. Though not an index of any special aystem, it has the great advantage of being our one approach to an indication of the general muscular tone of the body, as indicated both in its grasp and in the poses it assumes at rest. The patient with a limp and nerveless handclasp, -wiiose hand is inclined to lie palm upward and open instead of palm downward and half closed, is apt to bo either seriously ill, or not in a position to make ' much of a fight against the attack of disease. — Reading from the Nails. — The nails furnish us one of our best indices of the colour of the blood and condition of the circulation. Our best surface te6t of the vigour of the circulation ie to press upon a nail, or the back of the finger just above it, until the blood is driven out of it, and when our thumb is removed from the whitened area to note the rapidity with which the red freshet of blood will rush back to reoccupy it. In the natural growth outward of the nail, its tissues, at first opaque, andt whitish, and thus forming the little white crescent or lunula at the base of most nails, gradually 'become more and more transparent, and hence pinker in colour, from allowing the blood to show through. During a serious illness the portion of the nail which is then forming suffers in its nutrition, and instead- of going on normally to almost perfect transparency, it remains opaque. ' Amd the patient will, in consequence, carry a white bar across two or three of his nails for from three to nine months after the illness, according to the rate of growth of his nails. Not infrequently this white bar will enable you to ask a patient the question : " Did you not have a serious illness of some sort two, three, or six months ago? " according to the position of the bar. And his fearsome astonishment, if he answers your question in the affirmative, is amusing to ccc. You will be lucky if, in future, he doesn't incline to regard you as something uncanny and little less than a wizard. Another of the score of interesting changes in the hand which. though not very common, is exceedingly sign soant when found is a curious thick* ring or clubbing of the ends of the fingers, with extreme cun=*fe?r* a£ ibo nails, which is associated wfth certain forris: of consumption. So long has it been recognised that it is known as the " Hippocratio finger," on account of the vivid description given of it by the Greek Father of Medicine. Hippocrates. It has lost, however, some of its exclusive significance, as it is .found to be associated al^o with certain diseases of -the heart. It seems to moan obstructed circulation through the lunes. Next after the face and the hand would come the carriage and gait. When a man is seriously sick he is sick all over. Every muscle in his body ha* lost its tone, and those concerned with the maintenance of the erect position, 'being last developed, suffer first and heaviest. The bowed back, the droop of the shoulders, the hanging jaw. and the shufflinc i^ait tell the story of chronic, wastiner disease more graphically than words. We have a ludicrously inverted idea of cause and effect in our minds about " a good carriage." We imagine that a ramrod-like stiffening 1 of the backbone, with the head erect, shoulders thrown back and chest protruded, is a cause of health, instead of simply being an effect, or one of the incidental symptoms thereof. And we often proceed to drill our unfortunate patients into this really cramped and irrational attitude, under the impression that by making them look better we shall cause them actually to become so. The head-erect, chest-out. fingcr= down the-seam-of-vour-trou«ors posii ion of the drillr taster is a pc^e pure and simi-le, intended only for ornament, and

has to be abandoned the moment that j any aittempt at movement or action is begun. So complete is this unconscious muscular relaxation that it is noticeable not only in the standing and sitting position, but also when lying down. When a patient is exceedingly ill, and in the last 6tate of enfeeblement, he cannot even lie straight in bod, but collapses into a curled-up heap in the middle of the bod, the head even dropping from the pillow and falling on the chest. Between this debacle and the slight droop of shoulders and jaw indicative of beginning troubles there are <% thousand shades of expression significant instantly to the experienced eye. More limited in their applicatiDn, but most significant when found, are the alterations of the gait it-self. Even a maker of proverbs can tell at a glance that "tho legs of the lame are not equal." From the limp, coupled with the direction in which the toe or foot is turned, the tilt of the hips, the part of the foot that strikes first, the presence or absence of pain lines on the face, a snap diagnosis can cfton be made as to whether the trouble is paralysis, hip-joint disease, knee or anklo mischief, or flatfoot, as your patient limps aeros your room. Even where both limbs are affected and there is no distinct limp, the form of a shufflo is often "significant. Several of the forms of paralysis have each their significant gait. For instance, if a patient comes in with a firm, rather precise, calculated sort of gait, " clumping " each foot upon the floor as if ho had struck it an inch sooner than he had expected, and clamping it there rather firmly for a moment before he lifts it again, a«> though he were walking on ice, , with rather more knee action than seems- , nocessarv, you would have a strong sus- ' picion that you had to deal with a rn<-e of locomotor ataxia, in which loss of sensation in the soles of the feet is one of the earliest symptoms. Tf so, your natient. on inquiry, will tell you that he feels as if there were a blanket or oven a board between his soles and tho surface on which he is steppinsr. If a ouick glance at the pupils shows both smaller or larger than normal, and on turning his face to tho light they fail to contract, your suspicion is" confirmed : while if. on asking him to bo seated and cross his lees, a tap on the srroat "xten«or tendon of tho knee-joint just below the patella fails to elicit any quick upward ierk of the foot, the socalled "knee-kick," then you may bo almost sure of your diagnosis, and proceed to work it out at your leisure. On the other hand, if an elderly gentlpman enters with a curiously blank and rather melancholy expression of countenance, holding his cane out stiffly in front of Mm, and comes toward you at, a rapid, toddling eait, throwing hk feet forward in auick, short steps, as if he faiWl t.. do so he would fall on his face, while at the same time a vibratin» tremor carries his hoad quickly from side to side, you are iustified in suspoctinsr (hat you have to do with a case of paralysis agitans, or shaking palsy. —"What the Voice Betrays.— Last of all, your physiognomy of disease includes not merely its face, but its voicj, uot only the picture that it draws, but the sound that it makes. For when all j has been allowed and discounted tnat the most hardened cynic or pessimistic agnostic can say about speech being given to man to conceal his thoughts, and the hopeless unreliability of human testimony, twothirds of what your patients tell you about their symptoms will be found to be literally the voice of the disease itself speaking through them. They may tell you much that is chiefly imaginary, but even imagination has got to have some physical basis as a starting point. They may tell you much that is clearly and ludicrously irrelevant, or untrue, •on account of inaccuracy • of observation, confusion of cause and effect, or a mental colour-blindness produced by the disease itself. But these things can all be brushed aside like the chaff from the wheat if checked up by the picture read of the disease in plain sight before you. In the main, the great mass of what patients tell you is of great value and importance, and, with propel deductions, perfectly reliable. In ia,cp, I think it would be safe to say that a sharp observer would be able to make a fairly and approximately accurate diagnosis in seven cases out of ten, simply by what his eye and his touch tell him while listening to symptoms recounted by the patient. Time and again have I seen an examination made of a reasonably intelligent patient, and when the recital had been finished and the hawk-like gaze had travelled from head to foot and back again, from finger-nail to finger-nail, from eye to chest, a symptom which the patient had simply forgotten to mention would be promptly supplied; and the gasp with which the patient would acknowledge the truth of the suggestion was worth travelling miles to see. Of course, you pay no attention to any statement of the patient which flatly contradicts the evidence of your own senses. But even where patients, through some preconceived notion, or from false ideas of shame or discredit attaching to some particular disease, are trying to mislead you, the very vigour of their efforts will often reveal their secret, just as the piteous broken-winged flutterings of the mother partridge reveal instantly to the eye ot the bird-lover the presence of the young which she is trying to lure him away from. Only let a patient talk enough about ms or her symptoms, and the truth will leaK j O1 The attitude of impatient incredulity toward the stories of our patients, typified by the story of that great sur B eon, but greater bear, Dr John -^crnetl y has passed, never to return. When a lads , <* rank came into his consulting roorr. an , havine drawn off her wrap* and comfortably set eel herself in her chair, launched ou^into a luxurious recital of symptoms including most of her family hist °^. a^ adventures, he, after listen.ng about 10 minutes, pulled out his watch and looked at it The lady naturally stopped, openmouthed. "Madam, how long do you thi.iK it will take you to complete the recital of your symptoms?" "Oh, well ''-the lady floundered. embarrassed — 1 hardly know." "Well, do you think you could finish in three-quarters of an hour? V\ell. she supposed she could, probably. Very well, madam. I have an operation at the hospital in the next street. Pray continue with the recital of your symptoms, and I will return in three-quarters of an hour and proceed with the consideration of your case I"

—What the Trained Eye Sees.—

When you can spare the time— and no time is wasted which is spent in getting a thorough and exhaustive knowledge of a serious case — it is as good as a play to let even your hypochondriac patients and those who are suffering chiefly from " nervous prosperity " in its most acute form set forth their agonies and their afflictions in their fullest and most luxurious length, breadth, and thickness, watching meanwhile the come and g-o of the lines about the face dials, the changes of tho colour, the sparkling and dulling of the eye, the droop or pain cramp, or luxurious 101 lof each group of muscles, and quietly draw your own conclusions from it all. Many and many a time, in the full luxury of self-explanation, they will reveal to you a clue which will prove to be the masterkev to your control of the situation, and their restoration to comfort, if not health, which you coyldn't have got in a week of forceps-and-sealpel cross-examination. In only one class of patients is ibis valuable aid to knowledge absent, and that is in very young children, and yet, by what may at first sight seem like a paradox, they are. of all others, the easiest in whom to make not merely a provisional, but a final, diagnosis. They cannot yet talk with their tongues and their lips, but they speak a living language in every line, every curve, every tint of their tiny, translucent bodies,, from their little pink loos to the soft spot on the top of their downy heads. Not only have they all the muscle signs about the face dial of pain or of comfort, but, also, these are ab'^olutely unclouded or uncomplicated by any crosscurrents of what their elders are pleased to term "thought." —The Tales That Babies Tell.— When a baby knits his brows he is not puzzling over his political chances or worrying about his immortal soul. He has got a pain somewhere in his little body. When his vocal organs emit sounds, whether the surglo or coo of comfort, or the yell of dissatisfaction, they are just squeezed out of him by the pressure of his own internal sensations, and heis never talking just to hear himself talk. Further than this, his colour is so exquisitely responsive to every breath of change in his interior mechanism that, watching his face is almost like observing a reaction in a test tube, with its precipitate or change of colour. In addition, not only will he turn pale or flush, and his little muscles contract or relax, but so elastic are the tissues of his surface and so abundant the mesh of blood-vessels iust underneath that, under the stroke of serious illness, he will literally shrivel like a green leaf picked from its «tern. or wilt like a faded flower. A single glance at the tiny face on the cot pillow is Visually enough to tall yon whether or not the litfle morsel is seriously ill. Nothino- could be further from the truth than the prevailing impression that because babies can't talk it is impossible, especially for a young doctor, to find out what is the matter with them. If they can't talk neither can they tell you any lies, and when they yell "Pin!" they mean pin and nothing else.