General discussion about manifestations and signs

The manifestations and signs indicating the presence of one of the three health conditions mentioned are included in one of three varieties. First, these are signs indicating a circumstance that currently exists. Galen said: “Only the sick person benefits from such a sign, for he knows what he should do.” Secondly, it is a sign indicating a circumstance that existed before. Galen said: “Only the doctor benefits from this, for it indicates the doctor’s advanced position in his craft and increases confidence in his advice.” Thirdly, it is a sign indicating a circumstance that will occur in the future. Galen said: “Both benefit from this: the doctor because it indicates his advanced position in recognizing the disease, and the patient because he learns from this what his regimen should be.”

Of the signs of health, some indicate a balanced nature - we will talk about this in its place - and some indicate an evenness of combination. The latter include signs related to the essence, for example, an indication that the addition, position, size and quantity of a given organ are as expected - the meaning of these expressions has already been discussed in detail - as well as signs related to secondary qualities , in relation to the degree of goodness and beauty, and, finally, signs related to completeness, that is, indicating the completeness of actions and the fact that they constantly remain perfect. After all, every organ whose action is completed is healthy.

As for the way to draw a conclusion on the functions of the dominant organs, you can find out about the state of the brain | by the state of voluntary actions, by the actions of feelings and by the action of thought: about the heart - by pulse and breathing, about the liver - by feces and urine; the fact is that due to the weakness of the liver, feces and urine become similar to the water in which fresh meat was washed.

As for the manifestations that indicate disease, some of them indicate the disease itself, such as the variability of the pulse rate during fever indicates the fever itself, and some indicate the place affected by the disease. So, for example, a “sawtooth” pulse, when pain is felt in the chest area, indicates that the tumor is located in the membrane and in the thoraco-abdominal obstruction, and a wave-like pulse under similar circumstances indicates that the tumor is located in the body of the lung. Some signs indicate the cause of the disease. These are the various signs of overflow, each variety indicating some kind of overflow.

Manifestations. Some manifestations of diseases are temporary: they begin and end with the disease - such as acute fever, shooting pains, shortness of breath, cough and “sawtooth” pulse with pleurisy - and for some there is no specific time: they sometimes accompany the disease, and sometimes not accompany, for example, headache with fever. Some manifestations occur at the end of the disease, such as signs of crisis.

This also includes signs of juice maturity, as well as signs of lack of maturity and signs of death of the patient.

Most of these manifestations occur in acute diseases.

Signs. Some of them indicate illness in external organs and are drawn either from specific feelings, such as the nature of the complexion and the condition of the skin to the touch in terms of hardness, softness, warmth, coldness, etc., or from general feelings. Signs of this latter kind are drawn from the composition of the organs, their position, their presence in motion and at rest, and all this often indicates the state of the internal organs, such as trembling of the lips - vomiting, as well as their size - is it larger or smaller than it should be - and quantity. Sometimes this also indicates the condition of the internal organs; Thus, the shortness of the fingers indicates a small size of the liver.

The conclusion on the quality of the stool: it is black, white or yellow and what this indicates is a visual conclusion, and the conclusion on rumbling in the stomach about bloating and poor digestion is auditory. This also includes a conclusion based on smells, taste in the mouth and other similar signs.

The conclusion about consumption and tabes from the convexity of the nails is visual, but it falls into the realm of general feelings. Sometimes external perception by these signs indicates an internal state; Thus, blush on the face indicates pneumonia, and bulging nails indicate pulmonary tubercle.

The conclusion on the movement of organs and their immobility is one of the issues that needs to be discussed more. As for the manifestations visible from immobility, these are, for example, sickness, epilepsy, fainting, paralysis, and the signs visible from movements are goose bumps, chills, hiccups, sneezing, yawning, stretching, coughing, twitching and spasms for diseases that begin with spasms. Some of these movements arise from the action of the basic nature, such as hiccups; some come from the action of a secondary nature, for example, spasms and shaking; some are purely voluntary, as, say, when a person tosses and turns from side to side in bed; some are complex, natural and voluntary - such as coughing and urination. In some movements of the last category, the will precedes the nature, as, for example, when coughing, and in other cases, the nature precedes the will, unless the will rushes to the rescue, as, for example, when urinating and defecating.

A number of movements arise from nature without the participation of will. Some of them are warned by a feeling - such as “goose bumps”, but others are not warned by a feeling, since they are not felt, such as twitching.

These types of movements differ from each other either due to the difference in their essence - coughing in itself is stronger than twitching - or due to the difference in the number of movable organs - for example, when sneezing, the number of movable organs is greater than when coughing, because coughing occurs as a result of the movement of the chest organs, and sneezing is accomplished by the combined movement of the organs of the chest and head together. They also differ in the degree of danger: movements during dry hiccups are more dangerous than during coughing, although the cough moves stronger than hiccups, and according to which organ is attracted by nature to help. Sometimes it uses the help of an essential, main instrument - for example, when erupting feces, it is helped by the abdominal muscles, and sometimes with the help of an extraneous instrument, such as when coughing - with the help of air.

These movements also differ according to the difference in the organs that are their source - this is how cough and retching differ - or according to the difference in the acting forces - for example, the cause of twitching is physical, and cough is mental, or by matter - cough arises from phlegm, and twitching - from the internal wind.

These are the signs drawn from the state of the external organs. Most often they indicate external circumstances, but sometimes they also indicate the condition of internal organs, such as a blush on the face, indicating pneumonia.

Signs of illness also include signs indicating internal diseases, but anyone who makes a conclusion about internal diseases from them must first study anatomy. It gives information about the substance of each organ - whether it is fleshy or not, and about its appearance, in order, for example, to know whether a tumor of such and such a shape is located in a given organ or in another, that is, whether it corresponds to the outlines of this organ or not.

It is also necessary to study anatomy in order to know whether it is possible to assume that something is retained in an organ, or not, for the reason that everything that enters this organ slips through it, and it remains as if fasting, and If it can be assumed that something is retained in an organ or something is slipping through it, then knowledge of anatomy makes it possible to establish what exactly can be considered retained in the organ and what is slipping through it, as well as to find out the location of the diseased organ and judge by pain or tumor, whether it is located on the organ or at a distance from it, and establish with whom the organ participates in function, in order to judge whether it hurts on its own or through complicity and whether matter is released from itself or enters it from a participating organ , and also whether what is separated from this organ comes from its own substance, or whether it is a passage through which the matter separates from another organ passes.

The study of anatomy is necessary to know what is contained in a given organ, and whether it can be assumed that this emptying takes place precisely from this organ, as well as to know the function of the organ and conclude about its disease based on the occurrence of a dysfunction.

All this relates to what is learned through anatomy, and we are talking about this so that it is known that a doctor who is trying to treat diseases of the internal organs needs to know anatomy.

When he acquires knowledge of anatomy, he should rely on the following six rules when recognizing internal diseases.

Firstly, he must judge by the violation of certain organ functions; dysfunctions of functions are recognized by their quality and by their quantity, and the instructions given by the functions are primary and constant.

Secondly, the doctor must judge by the nature of the bowel movements. Their indications are constant, but not primary: constant - because they always provide confirmation of the disease, and not primary - because they serve as an indication not by themselves, but by an intermediary sign of the maturity or immaturity of the ejected substance.

Thirdly, the doctor must judge by pain, fourthly, by swelling, fifthly, by the position of the organ, and sixthly, by the corresponding external manifestations of the disease, but their instructions are neither primary nor permanent.

Now let's talk in detail about each of these rules.

As for recognition by function, the point here is that if the function of an organ does not proceed in its natural way, this indicates that the corresponding force is affected by damage, and damage to the force is followed by a disease of the organ in which the force operates.

There are three types of dysfunction. The functions either weaken, as in the eye, whose ability to see becomes less, so that it sees things less clearly and at a closer distance, or in the stomach, which digests food more difficult, slower and in smaller quantities, or they change, as in the eye, which sees something that is not there or sees a thing not as it is, or like the stomach, which spoils food and digests it poorly, or stops, like the eye, which does not see at all, or the stomach, which does not digest at all.

As for the signs of emptying and retention, these are multifaceted signs. They indicate the disease by the very factor of unnatural retention, for example, the retention of that which is supposed to be ejected, as in a person suffering from retention of urine or feces, or the fact of unnatural evacuation. It is a sign of disease, either because the discharge belongs to the substance of the organ, or not for this reason. That which belongs to the substance of the organ indicates disease in three ways.

Firstly, it can indicate by its very substance - so the throat from which blood comes indicates a corroding ulcer in the pulmonary tube.

Secondly, the amount of release; These are the films that come out during abrasions: if they are thick, this indicates that the ulcer is in the large intestines, and thin films indicate that it is in the small intestines.

Thirdly, the discharge indicates illness by its color; This is the red sediment with films in the stool.

Red color indicates that the discharge is coming from fleshy organs, such as the kidneys, or white, which indicates that the discharge is coming from organs rich in nerves, such as the bladder.

And secretions, which show that they do not belong to the substance of the organ, indicate a disease either because their output is not natural, such as when healthy juices and blood come out, or because their quality is unnatural, for example, spoiled blood , it doesn’t matter whether its appearance is usual or not; or because they are generally unnatural in substance, for example, stones. Or they may be unnatural in quantity, although their output is natural; at the same time, there are either few of them, or too many, as with scanty or too abundant bowel movements and urination, or unnatural in quality, although their output is normal; These are black stool and urine. They can also be unnatural in the place of their exit, although their very exit is common; This is the feces when it comes out from above during ileus.

As for the signs given by pain, they are reduced into two categories. The fact is that pain indicates a disease either by its location - for example, if the pain is on the right, then it is in the liver, and if on the left, then in the spleen, and sometimes by its nature indicates the cause of the pain, as we discussed in detail in department about the reasons. For example, if the pain is severe, this indicates a tumor in an organ that is insensitive or has lost sensitivity; nagging pain indicates an abundance of matter; burning pain indicates sharp matter.

The signs given by a tumor are of three kinds: the disease is visible either in the essence of the tumor - thus, erysipelas indicates the presence of yellow bile, hardness - black bile - or in its place: swelling on the right indicates that the tumor is in the liver area, swelling on the left indicates that the tumor is in the area of ​​the spleen, or by its outline: if the swelling is on the right side and looks like a crescent, this indicates that the tumor is in the liver itself, but if it is oblong, this indicates that the tumor is in the muscle located above liver

As for the signs given by location, they indicate a disease either by location or by the organs involved in the disease. As regards the location, this is clear, and as regards the organs involved, the sign is pain in the fingers from some previous cause, indicating that its source is damage to the sixth pair of cervical nerves.