Palpation

“ On palpation a systolic thrill may be detected, but the presence of a murmur is neither constant nor characteristic. Pain is usually present; it may be neuralgic in character, or may simulate renal colic. ”

“ Habits of Palpation
Every palpater unconsciously forms habits of thought and action. These habits may be good or bad. We deliberately16 form a habit of holding the first three fingers closely together or the habit of using a downward glide, but we should avoid the habit of finding certain subluxations because they are usual and expected rather than because they are actually there. For instance, one may easily form a habit of listing every other vertebra in the spine, his whole record thus depending upon his first choice. ”

“ But if the person is in bad health, excited, or exhausted, the palpitations will be depicted in the most erratic manner, both as regards their occurrence and their force. One very powerful palpitation, for instance, may be followed by a comparatively long interval of quiescence, succeeded by several spasmodic short movements at brief unequal periods. ”

“ Palpitation.—In a certain number of the cases it will be found, indeed, that there is no real disturbance, but that in some way the heart action has been brought above the threshold of consciousness and has become noticeable to the patient. It must not be forgotten that the heart is an intensely active organ. Several gallons of blood are pumped through it every minute and yet it accomplishes its work, as a rule, with such noiseless, frictionless regularity that most people know nothing about it. When the action of the heart becomes conscious, it is usually spoken of as palpitation. ”

“ The shifting of the eye with normal vision is usually not conspicuous, but by direct examination with the opthalmoscope.* When the optic nerve is observed with the ophthalmoscope, movement can be noted that are not apparent when only the exterior of the eye is regarded, it can always be demonstrated. If one eye is examined with this instrument while the other is regarding a small area straight ahead, the eye being examined, which follows the movements of the other, is seen to move in various directions ”

“ The physician is required to note the patient's appearance, eye, tongue, skin, pulse, voice, urine, and faeces. The examination of the pulse is, however, considered the most important of all, as furnishing the best criterion of the phenomena and progress of disease, and it is the one usually depended upon by the native doctors. In order to know the precise character of the pulse, the radial artery at the wrist is usually chosen. In case of a male patient, his right pulse is generally felt, and in case of a female the left. ”

“ Respiration is shallow, and abnormally frequent. The attacks of palpitation recur daily in some patients, in others at intervals of several days; they may occur entirely without exciting cause, or with a cause so trifling that it would not in a normal subject have produced any nervous excitement; the duration of the attacks varies from a few minutes to several hours, and they may occur either by day or by night; in the intervals between the attacks the functions of the heart and the arteries are conducted in a normal manner. ”

“ In those cases in which the palpitation of the heart is a purely subjective sensation, we find no increase either in the frequency or 95in the strength of the pulse, which may indeed be less frequent than normal. With the palpitation is associated a sensation of strong pulsation in the great vessels of the neck, and often there is pain on the left side of the lower part of the chest, with a sensation of shortness of breath, respiratory distress, precordial pain, and a feeling of pressure upon the chest. ”

“ This is exactly what happens in our eye. I have drawn a dotted line c round the lens and the paper on the diagram to represent the eyeball in which the image of the candle-flame would be on the retina instead of on the piece of paper. The first point you will notice is that the candle-flame is upside down on the paper, and if you turn back to Fig. 11 you will see why, for it is plain that the cones of light cross in the lens l, 1 going to 1 ́ and 2 to 2 ́. Every picture made on our retina is upside down. ”

“ The ophthalmoscope has become an instrument of incalculable value to the oculist. Many changes in the retina and interior of the eye, which are due to disease, can be observed and examined by means of the ophthalmoscope ”

“ Patients who are about to undergo a surgical operation are, however, not always in a state for receiving agreeable impressions, and they sometimes complain of palpitation of the heart, and a feeling of fulness in the head. ”

“ The ophthalmoscope has laid bare to our view a living nerve of special sense, the highly-developed end-organ in which it terminates, and the blood-columns circulating in them. In no other part of the body has Nature vouchsafed to us so clear an insight into her mysteries. ”

“ A light, preferably a candle, is placed in front of the eye and moved from side to side, upward and downward, so as to bring its images over all parts of the cornea and lens. In the normal eye there are reflected three images of the light, one large, clear, and upright from the anterior surface of the cornea, one, much smaller but still upright, from the anterior capsule of the lens, and one, small and inverted, from the posterior surface of the lens and capsule. ”

“ He seems to have been well acquainted with the projection of images of objects through small apertures, and to have been the first to show that the arrival of the image of an object at the concave surface of the common nerve—or the retina—corresponds with the passage of light from an object through an aperture in a darkened place, from which it falls upon a surface facing the aperture. ”

“ A gentleman about 65 years of age had for about ten years been subject to an intermittent pulse, and to frequent palpitations of his heart. Lately the palpitations seemed to observe irregular periods, but the intermission of every third or fourth pulsation was almost perpetual. On giving him four drops of a saturated solution of arsenic from a two-ounce phial about every four hours for one day, not only the palpitation did not return, but the intermission ceased entirely, and did not return so long as he took the medicine, which was three or four days. ”

“ The optic nerve being seated at the bottom of the eye, has the images of surrounding objects painted upon it; it looks out through the different humors. The different membranes and humours which compose the eye, and serve for vision, are, the tunica conjunctiva, the tunica sclerotica, the cornea, the iris, the pupil, the choroides, and the retina. ”

“ By holding the lips between the finger and thumb the coronary arteries are felt under the mucous membrane. The facial vein does not accompany the tortuous artery, but runs a straight course from the inner angle of the eye to the front border of the masseter, just behind the artery.
[Pg 8]
14. Eyelids and eyes.—The opening between the eyelids varies in size in different persons; hence more of the eyeball is seen in some than in others, and the eye appears larger. Although human eyes do vary a little in size, yet the actual difference is by no means so great as is generally supposed. ”

“ In most cases of eccentric fixation, on the contrary, the eye quickly tires, and its appearance, with that of the face, is expressive of effort or strain. The ophthalmoscope reveals that the eyeball moves at irregular intervals, from side to side, vertically or in other directions. ”

“ The hand or ear placed against the chest easily detects the unnatural beating. In some cases it is so violent that the motion may be seen at a distance. Palpitation is but a symptom, and in many instances not connected with disease of the structure of the heart or its membranes. A badly frightened animal may have palpitation. ”

“ You grow apprehensive about the palpitation of your heart, which is not at all diseased, but which flutters a little from time to time because the great nerve of the heart is tired, like the other great nerves and nerve-centers of your body. ”

“ The heart being loaded with imperfectly aerated blood, the face is dusky or livid, and the pulse is slow and full. No notice is taken by the man of a loud shout into his ear, and on the surgeon raising his eyelids the pupils are found dilated and fixed, which signifies that the reflex to light is lost — a very grave sign. ”

“ The disturbances of the circulatory system take the form of more or less severe palpitation, pain in the region of the heart, quick pulse, œdema of the eyelids, of the face, of the lower limbs, and even of the whole body. ”

“ The strain that produces an error of refraction is not the same as the strain that produces a squint, or a cataract,2 or glaucoma,3 or amblyopia,4 or inflammation of the conjunctiva5 or of the margin of the lids, or disease of the optic nerve or retina. ”

“ Central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends on angular distance no greater than twenty degrees in the better eye. ”

“ The nerve which goes to the eye is called the optic nerve, and it is connected with each square by pretty rods and cones, which look like those in your own eye (Fig. 27) . The rods and cones are covered with coloring-matter or pigment, which turns red when it is boiled. ”

“ Soon there is an adaptation to the change—the functions regain their accustomed office—the palpitation of the heart subsides—the pulse, which might have been fluttering and intermitting, becomes regular, though still quick and full. ”

“ The best of us learn to use the ophthalmoscope to look into the eye, to use the laryngoscope for the larynx, and can at need examine the urine and the blood, but the men must be rare who are as competent to use each and all of these means as persons who devote themselves to single branches of our work. ”

“ This nerve accompanies the external ophthalmic artery forming around it a network of fibers, called the external ophthalmic plexus. It lies outside and downward from the optic nerve, sends fine branches to the external ophthalmic artery and to the masseter artery, and extends along with a small branch of the superior maxillary nerve to the skin of the outside rim of the eye cavity. ”

“ The vena ophthalmica lies close to the point where the olfactory nerve passes out of the cranial cavity. The largest branch it receives is the recurrent ophthalmo-temporalis, which accompanies the lateral side of the optic nerve. It collects the blood from the base of the brain, from Harder’s gland, from the eye muscles, from the 237inner eye, the nose, the lacrimal gland, the skin of the frontal region, and the comb. ”

“ The optic nerve enters the eyeball from the back and spreads its fibers out in a thin membrane called the retina, which corresponds to the sensitive plate in a camera. The lens focuses on the retina the image of any object you look at. The impression made on the minute nerve endings in the retina is carried by the optic nerve fibers to the brain. ”

“ Nervous and purely functional palpitations are probably confined to cases in which they are manifested at intervals appearing under the influence of some transient excitement, and continuing only for a few minutes at a time. ”

“ The positions having been taken, the observer places the head reflector upon his forehead a little above the left eye, and by rotating it upon its ball-and-socket joint reflects the light from the lamp- or gas-flame upon the patient's face so that the circle of light is bounded above by the tip of the nose and below by the tip of the chin. ”

“ The lens of the eye acts just like a glass lens. It makes a picture of everything we see, upon the ends of the nerves of sight which are spread out at the back of the eyeball. The nerves of sight tell their nerves in the brain about the picture, just as the nerves of feeling tell their cells when they are touched with a pin ”

“ If we watch carefully at the distal end of the backbone, upon either side of it, it will be seen that the skin pulsates at those points with sufficient force to make it apparent to the eye. These pulsations are performed by the posterior pair of lymph hearts. ”

“ The countenance is brilliantly illuminated by the oxy-hydrogen light, and being placed near the lenses, the rays are reflected from the face into the physioscope, and being properly focused, and the inversion of the image corrected, the perfect representation of the human countenance is apparent on the disc. The lenses and concave reflectors required are shown in the section of the physioscope. ”

“ When the cavity within the optic nerve vanishes, and the fibres of the optic nerve appear, all connection is ruptured between the outer wall of the optic cup and the optic nerve, and the optic nerve simply perforates the outer wall, and becomes continuous with the inner one. ”

“ It must be too obvious that the evidence adduced as to the nature of the proximate and occasional causes of this disease, is by no means conclusive. A reference to the test therefore which will be yielded by an examination of some of the more prominent symptoms, especially as to their agreement [53] with the supposed proximate cause, is more particularly demanded. Satisfied as to the importance of this part of the present undertaking, no apology is offered for the extent to which the examination is carried on.
If the palpitation and the attendant weakness of the limbs, &c. ”