The condition of disease approaching illness can be well understood by the general appearance of the patient.  The eye, tongue, pulse, gums, and lips, the stomach and bowels.

    The countenance is the great barometer of the condition of the weather within the human system.

    When the countenance is flushed and full of blood, there is impeded respiration and circulation and very likely congestion of the brain.  This is the case in apoplexy, diseases of the heart, effusion of the lungs, etc.

    A pale countenance is a sign of fainting, of anaemia, and hemorrhage, external or internal.  When the expression is violent and excited, there is probably the delirium of fever, inflammation of the brain, mania, or delirium tremens.  In paralysis, convulsions, epilepsy, hysteria, chorea, etc., we have a distorted countenance, and a flushed one is symptomatic of fever in general and of the early stage of delirium tremens.  Some times in an incurable disease, the face becomes what nurses call “struck with death”and to this hopeless corpse-like expression has been applied the term “Facies Hippocratica,” because it has been vividly pictured by Hippocrates himself.  Here is his picture:   “The forehead wrinkled and dry, the eye sunken, the nose pointed and bordered with a dark or violet circle; the temples sunken, hollow, and retired; the ears sticking up, the lips hanging down, the checks sunken, the chin wrinkled and hard, the color of the skin leaden or violet, the hair of the nose and eye-lashes sprinkled with a yellowish or white dust.”

    The expression of the eye, and of the whole countenance, affords an excellent index to the state of health or disease.  When the eye is bright, but not too much so, high health is generally present; if languid, there is want of tone; and on the other hand, if excited and wandering, some affection of the brain may be predicted.

    The tongue is a certain indicator of the state of the system, and always consulted by the physician as reliable authority.  Florid redness is the sign of dyspepsia; a livid or purple tongue shows that there is obstruction in the circulation, or lungs; a pale or white tongue denotes a weak or impoverished condition of the blood; a furred tongue is common with some people even when in health, but when there are bright red points perceptible beneath the fur, there is a scarlet fever present; a tongue with red edges and furred in the middle is a sign of intemperance, or brain disorder.

    In feverish conditions of the system the tongue becomes very dry and hot, parched as it is called.  If clammy and viscid, there is usually derangement of the digestive functions.  A yellow tinge on the coating of the tongue indicates a biliary disorder.  A thin creamy white, an inflammatory disease in the abdomen.  In sore throat we often find it of a dingy whitish color.  In scarlatina, we have elongated papillae, presenting bright red spots; and in some form of intestinal irritation and hemorrhage, it is morbidly clean and red.  In anaemic patients we find this organ partaking of the general condition of the system, being pale and flaccid.  In paralysis it is drawn to one side.  In delirium tremens and nervous affections, it is tremulous.  And in low stages of fever it becomes almost black and cannot be protruded.

    The Pulse is one of the chief indications of disease.  Walsh, in his Domestic Economy, gives the following on the pulse, gums, lips and stomach.  When the pulse is frequent, large and soft, it indicates the early stage of fever, or of acute inflammation of the lungs, etc.

    When very frequent, large and hard, it accompanies the full onset of fever, of an inflammatory kind, such as rheumatic fever, small-pox, etc.

    A moderately frequent, large and hard pulse may be that of mere fullness of blood.

    When frequent, large, hard and thrilling, there is generally some disease of the artery, or in its close neighborhood, such as aneurism or tumor.

    A frequent and small pulse is often met with in consumption, in which the quantity of blood is diminished, and is equally impaired.

    A slow, laboring, large and hard pulse is often attendant upon apoplexy, or other forms of pressure on the brain.

    The gums and lips are also useful as indicative of certain conditions of the system.

    When the gums are swollen, and bleed at the lightest touch, there is reason to believe that the system is generally out of sorts, in a state commonly called scrobutic.

    A pale bluish-red gum, with a marked line of blue at the edge, is a sign that lead has been taken into the system in some way.

    When the lips are parched and cracked, with foetid breath, there is reason to suppose that fever is present in a typhoid type, though this is by no means a certain sign by itself.

    The Stomach -- The symptoms affecting the stomach are vomiting or nausea, flatulence, pain after eating, and in some cases eructations of a watery fluid in large quantities.

    Flatulency is a symptom of a disordered stomach of a chronic character.

    Pain after eating is also a sign of disordered stomach, but there is generally inflammation accompanying it.

    The bowels present the following symptoms when disordered:

    Constipation may arise from torpor of the bowels, owing to long continued neglect, or the absence of the necesssary lubrications, or other causes, or from a defective secretion of the natural stimulus, the bile.

    Diarrhoea consists of an increased discharge of liquid faeces, either caused by the irritation of food or medicine, or the presence of hardened faeces; or some form of poison, such as cholera.

    The Faeces -- The faeces are the rejected residue of the food passed into the stomach after it has served the purpose of nutrition.  According to Berzelius, the normal constituents of the human faeces are as follows:

    Water. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  73.3
    Vegetable and animal remains . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . .   7.0
    Bile   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   0.9
    Albumen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   0.9
    Balusciar extractive matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   2.7
    Salts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . .   1.2
    Slimy matter, consisting of pecromel, peculiar animal matter and
    Insoluble residue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  14.0
                                                                                                                 ------
                                                                                                                 100.0

    This is the condition of the faeces when the health is perfect and there is nothing very peculiar in the diet to render it otherwise.

    In diseases great changes take place, not only in the proportions, but even in the ingredients of which the faeces are composed.  By their peculiarities of substance, smell, and color, the operator is enabled in a great measure to judge of the nature and progress of the mischief going on within.  Therefore, it is of great importance that they should be preserved for his inspection.

    The following are a few of their most obvious indications:

    Natural motions are of a ginger-bread color, slightly varying in tint and hue, and of tolerable solidity of consistency, although perfectly impressible.  The smell is offensive, but has not that peculiar foetidity which is observed in some diseased conditions of the system.  The evacuations should be daily, and at or near a certain hour, but a deviation from this rule is no proof of ill health.  We have known persons in a perfectly healthy state who went to stool once in every two or three days.

    It depends greatly on habit, but such a habit is not good.  Children should be taught to go to stool every day, at a certain hour, and a habit of a daily evacuation of the bowels once fixed, will probably remain through life, except when it is interfered with by sickness, or the failing powers which are often a consequence of old age.

    Mucous evacuations have a semi-transparent, jelly-like appearance.

    They may be tinged with brown, green or yellow, all indicating the presence of bile, or red with blood, when there is inflammation or congestion of the mucous membrane, as in mucous diarrhoea and dysentery.

    Lymphatic evacuations have a rough, shreddy, or spotty appearance.

    There may be irregular or little round specks, like dirty white of egg, scattered through the faeces, or long pieces like shreds of lymph or dingy-colored parchment.  In this case it is likely there may be acute inflammation of the mucous membrane of the intestines, the seat of which may be in any of the bowels, or merely the rectum.  This, like the above, is a symptom of diarrhoea and dysentery.

    Pus in the faeces indicates either ulceration of the bowels, or the breaking of an internal abscess into the alimentary passages.  If there is much of it, the latter is most likely the case.  This is a dangerous symptom.

    Bile in the faeces indicates excessive action of the liver, the cause of which may be excessive irritation or active congestion, -- in which case the color is generally of a bright yellowish brown, but sometimes, especially in children, it is of a decided green color.  This, too, is often the case with grown persons when the liver is just recovering from a torpid state and beginning to act violently.  This is commonly the case, too, in hydrocephalus, when the color is a peculiarly deep green.

    Bilious motions may or may not be loose, although they are generally so, from the bile acting as an irritant in the lining of the bowels.

    Absence of bile in the faeces is shown in the absence of color.  The motions are clayey, sometimes as pale as pipe clay, and ranging from that shade up to the natural hue, occasionally assuming a grayish tint.  They vary in substance, and when liquid are usually frothy, and float on water on account of the quantity of gas they contain.

    Loose motions proceed from so many causes that we cannot take them as clear indications of any particular diseases.  They are always present where there is an inflamed state of the mucous membrane, as a diarrhoea.  In some stages they become altogether watery.  If when in this state, they exhibit rice-like particles, they indicate Asiatic cholera, or the too powerful action of saline or drastic purgatives.

    Solid motions, when too much so, indicate constipation.

    Offensive motions occur in dyspepsia, especially those forms of it which are associated with hypocondriasis.  The foetor is excessive in low fevers, when the poison is introduced into the system seems to render the whole of the solids and fluids thereof peculiarly liable to decomposition.

    Expectoration -- This is, first, the act of discharging mucous or other matter from the lungs or trachea, and, second, the substance so discharged.

    The term in its first meaning is synonymous with coughing, and need not further occupy our attention, but in its second, we find so many important considerations connected with the diagnosis of diseases, that we must pause awhile to consider it.  It is by the nature of the expectoration that the operator is enabled to judge of the character and progress of the malady with which he has to contend.  If this is frothy, it indicates active bronchitis, catarrh, or influenza.  If stringy, and of a whitish or yellowish color, the bronchitis has become chronic, or spasmodic, or there may be whooping-cough present or impending.  If purulent, it may indicate the latter stages of catarrh or influenza, especially if the sputa, or matter spat up, is mixed more or less with a tenacious mucous, genuine pus, capable of being poured from one vessel to another, indicates the bursting of a vomica on the lungs, or of the matter of the empyema, having found its way into the bronchial passages. The yellow matter often expectorated in humoral asthma is not truly purulent, but to a large extent mucous.  If lumpy, there can be no mistake as to the nature of the disease.  Pulmonary consumption has fairly set in and made considerable advances.  There is surely to be a softening and breaking up of the tubercles, where there are small whitish or yellowish lumps expectorated along with the clear fluid on which they float, perfectly distinct.  If membranous, the sputa indicates inflammatory action of a chronic, most likely of a croupy character.  If stringy and of a rusty-color, there is certainly pneumonia.  If bloody, there is hemoptytis,--either a blood vessel on the lungs has broken, or the blood has oozed through the membrane of the bronchial tubes, both of which are symptoms of a very diseased state of the tissues, and indicative of very great danger to the patient.  If offensive and putrid, there may be gangrene of the lungs, but this is only a single sign, and not to be relied on alone.

    These are the chief distinctive characters which expectoration assumes.  Its increase or decrease in bulk or density, its varieties of tint, and other particular changes, tell to the operator of experience how the case progresses and whether it is likely to terminate in convalescence or death.

    The Temperaments -- In physiology temperament has been defined as a peculiar organization of the system common to several individuals, which to a certain extent influences the thoughts and actions.  There is besides in each individual a further peculiarity of organization which serves to distinguish his temperament from that of another person, to whom, however, he may in other respects bear a great resemblance.  This individual temperament is called IDIOSYNCRASY.

    Four temperaments were distinguished by the old schools, founded on the notion of four qualities which entered into the constitution of man and were supposed to temper each other and influence the character, according as one or other prevailed over the rest.  These qualities were, in the abstract--hot, cold, dry, moist.  In the concrete--fire, air, earth, water, and their highest point of development was:

    1.  The Sanguine, or Sanguineous Temperament, suppossed to be characterized by a full habit, soft skin, ruddy complexion, blue eyes, red or auburn hair, frequent pulse, large veins, and vivid sensations.

    2.  The Atrabilious, or Melancholic Temperament, described as existing in a thinner but firmer frame than the preceding, with a dark complexion, black hair, and a slower circulation, a nervous system less easily moved, and a character grave and meditative.

    3.  The Bilious or Choleric Temperament, intermediate between the two preceding, marked by black curling hair, dark eyes, a swarthy, and at the same time, a ruddy complexion, a thick, rough, hairy skin, and a strong full pulse.

    4.  The Phlegmataic, or Pituitous Temperament.  This differs from all the rest in the laxity of the skin, the lighter color of the hair, and the greater sluggishness of the faculties.  Without keeping to the old theory, modern physiologists to a certain extent adopt these terms, to which they have added.

    5.  The Nervous Temperament, marked by some of the above-named characteristics, with a quick and brilliant intellect, and great susceptibility.  Not often do these temperaments occur in a pure form.  We meet with the indications of two, or even three, of them mingled in one person, -- whom, therefore, we must call nervous-sanguine, or nervous-bilious-sanguine, as the case may be.

    Viewing temperament as a predisposing cause of disease, we may say that sanguine persons are more liable to acute inflammation than others, nervous, to mental disorders and affections of the nerves, phlegmatic, to scrofula, phlegmatico-sanguine, to gout, and bilious, to hypochondria, and disorders of the digestive organs.

    Idiosyncrasy -- In most persons there are certain mental bodily peculiarities which we term IDIOSYNCRASIES; and these, to a certain extent, shape and fashion the life and mode of thought, and greatly influence the state of health.  In reference to the latter subject, when we say that a man has a predisposition to gout or gravel, we allude to one of his idiosyncrasies, and we speak of that gouty or other state of that man as his Diathesis.  What we call antipathies are the peculiar result of states or conditions of the system, to which the above terms may be properly applied.  It is impossible to affix any assignable cause for these, nor can the operator be aware of them until he has noticed them in their effects, or been informed of them by the patient or his friends.

    To some persons a peculiar odor is perfectly unbearable; others cannot abide a certain sound; the sight of an insect, or other animal not obnoxious to other people, will make this or that person ready to faint away, and fill the mind with a nameless dread.

    The operator will find in studying the temperaments, a great advantage in gaining knowledge of your patient’s condition, and he will better know how to handle the case in order to produce the best results.  It will be observed that the mind is looming up all through the temperaments in a more or less degree, and demonstrates that it dominates the body in its entirety.