. Medical diagnosis for the student and practitioner. red and an orthopneic mitral case, if breath-ing hard and rolling the head listlessly from side to side is almost certainlynearing the portals of the hereafter. All grades of cyanosis must be noted and investigated and, as statedpreviously, but three forms of extreme cyanosis in walking cases are en-countered: That of the child with congenital heart disease, and advancedemphysema or the red cyanosis of erythremia in the adult. In old cases of right heart decompensation of long standing, a subictericfacies is common and underlain by a pallor
. Medical diagnosis for the student and practitioner. red and an orthopneic mitral case, if breath-ing hard and rolling the head listlessly from side to side is almost certainlynearing the portals of the hereafter. All grades of cyanosis must be noted and investigated and, as statedpreviously, but three forms of extreme cyanosis in walking cases are en-countered: That of the child with congenital heart disease, and advancedemphysema or the red cyanosis of erythremia in the adult. In old cases of right heart decompensation of long standing, a subictericfacies is common and underlain by a pallor, contrasting sharply with deeplycyanotic lips. INSPECTION OF THE NECK AND TRUNK.—This should be bothdirect and tangential, general and local. The most important regions andthe conditions to be noted are: i. The valvular areas already described. Important pulsations mayoften be observed and their character may yield information of value. 2. The manubrium and its neighborhood. Here is found most com-monly the expansile pulsation of aortic Fig. 162.—Peculiar orthopneic dyspnea associated with listlessrolling of the head from side to a forerunner of death. Trachealtug. Misleadingcolor. A strikingpicture. Ambulants. Subictericfacies. \ » X 436 MEDICAL DIAGNOSIS Area andposition. Force. Heavingvs. wavyapex beats. Systolicrecession. Extreme type. May deceivethe eye. A misleadingsign. 3. The area lying between the inner edge of the left scapula and thespinal column, in which the heaving pulsation of an aneurysm of the descend-ing thoracic aorta sometimes appears. 4. The Superior Abdominal Quadrants.—In these we may find: Thepresence of manifest enlargement, pulsation, or rhythmic displacement of theliver; ascites; epigastric fulness, pulsation or retraction; pulsation of theabdominal aorta. The fulness and rigidity of vessels and the number, nature and time of pulsa-tions in the veins of the neck must be noted. General or localized edema,
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectdiagnos, bookyear1922
