4



CHAP. 1 ANAMNESIS AND GENERAL CONDITION 5

The state of the nutrition leads the diagnosis to a particu-
lar group of diseases. A poorly nourished condition is indic-
ative of the so-called cachectic diseases (phthisis, carcinoma,
leucsemia, ansemia, the severer form of diabetes). A patient
who maintains a well-nourished condition in spite of long-
continued illness is not a victim of cachectic disease. Be-
cause of their short duration, the acute febrile diseases do
not essentially disturb the nutrition ; the sub-acute diseases
(typhoid fever, meningitis), on the other hand, lead to marked
emaciation.
The nutritive state is of particular importance in the dif-
ferential diagnosis of the diseases of the lungs and stomach.
Phthisis and carcinoma of the stomach are suspected in
cachectic individuals ; bronchitis, ulcer, and neurotic disturb-
ances of the stomach appear more often in healthy-looking
persons.
3. Constitution and habitus. — Through the repeated obser-
vation of the sick, the physician secures certain impressions
of single forms of disease, by means of which, on seeing
similar cases, he at once suspects the nature of the illness.
These impressions are a composite of the nutrition, com-
plexion, appearance, position, speech, etc. The judgment as
to the habitus is of unquestionable worth, but must not
preclude a careful examination.
Habitus phthisicus is seen in tubercular subjects. It is character-
ized by a pale, often spiritual countenance, with a fine skin and
circumscribed redness of cheeks ; the neck is slender, the thorax
weakly acting. The figure is thin and wasted, the hands are small
and white.
