[A lecture delivered before the Homoeopathic Medical College of Pennsylvania, Nov. 11, 1864]

By C. G. Raue, M. D., Philadelphia PA.

The face of a patient tells along story, and it will be well for the student to Observe closely its features, expressions, color, and temperature. The experienced physician reads on it, not only the degree of severity of an attack, but often also, its whole general nature. But this must be learned by practice. There are fine shades, which cannot well be described, but which, nevertheless, stamp upon the whole a peculiar character. I shall try to collect and delineate in rough outlines, what you will have to fill up at a later time, by your own observation and experience.

The Aspect of the Face. a. A delicate appearance, with long fringed eyelashes, often serves to point out the tubercular diathesis. b. The thickened alae nasi and upper lip of scrofula are most marked in childhood. c. The pallor of anaemia is very important; it is waxy in chlorosis, and pasty in diseases of the kidneys. d. A puffy appearance about the eyelids, along with anaemia, is very generally the indication of albuminuria. e. A bloated, blotchy, face, generally indicates irregular habits of living. f. The features undergo remarkable changes in erysipelas, parotitis, facial paralysis, etc. g. A sunken face, indicates exhaustion either from too great exertion, loss of sleep, want of nourishment, profuse diarrhea, or disturbed digestion. If it sets in suddenly during pregnancy, it is a premonitory sign of abortion. If you find it at the beginning of a disease, without previous weakening causes, it denotes a severe illness. If it sets in suddenly during a disease, without chill or spasm, by which it might be caused, it is a sign of extreme exhaustion or metastasis, mortification or apoplexia nervosa. h. The Hippocratic face is characterized in the following way: the skin upon the forehead is tense, dry or covered with cold perspiration; the temporal regions are sunken, the eyelids are pale and hang down, eyes are dull, without lustre, turned upwards and sunken; the alae nasi are pinched together, and the nose very pointed, the malar bones stick out and the cheeks are sunken and wrinkled; the ears appear to be drawn in and are cold, the lips are pale, livid; the lower jaw sinks down, and the mouth is open. It is always a sign of extreme prostration of vital powers, and is found in cholera, in mortification, during the death struggle. i. A wrinkled face is natural in old age but in children it is a sign of imperfect nutrition, and is found in consequence of exhausting diarrhea and atrophy. In boys and half grown lads, a wrinkled face is a sign of onanism.

The linea ophthalmozygomatica, is a line or fold, commencing at the inner canthus of the eye, running towards the zygoma, where it ends. It shows momentarily when children cry but becomes more permanent in children with affections of the brain. Its appearance in simple catarrh is said to indicate the setting in of whooping cough.

The linea nasalis, is a line or fold, which commences at the upper part of the alae nasi, and runs towards the orbicularis oris (the sphincter of the mouth), forming a more or less perfect half circle. This line, if found in children, denotes abdominal diseases, especially inflammation of the bowels, also rachitis, scrofula and atrophy. In grown persons it is said to have been observed as a concomitant symptom of albuminuria, ulcer and cancer of the stomach, and degenerations of the liver.

The linea labialis, is a line or fold, which commences at the corner of the mouth and runs down towards the side of the chin, where it ends, and whereby the chin appears to be elongated. This line is said to be a characteristic sign in children of inflammatory or chronic diseases of the larynx and lungs. It has been found very marked in grown persons, who suffered with ulceration of the larynx and bronchial affections, attended with difficulty in breathing, and much mucous discharge.

k. The risus sardonicus, a spasmodic distortion of the face, resembling a kind of laughing, is found in irritation and inflammation of the brain, in inflammation of the pericardium and diaphragm, in irritations of the intestinal canal, in abnormal condition of the menses; even after mental excitement, fright and depression of spirits.

The Expression of the Face is in health the reflex of the mind, and in disease it has a distinct reference to the nervous system. In general I may say: a. A rigid, staring, stupid, troubled, but sometimes also a smiling countenance is found in affections of the brain and typhoid conditions. b. An anxious, sad and restless expression is found in lung and heart diseases; and, c. A morose, long-faced and apathetic expression is found in abnormal disorders.

The Color of the Face. - a. Redness, if habitual, denotes a tendency to gout and hemorrhoids, and is a sign of indulgence in spirituous liquors. Flying, often changing redness is seen in children during dentition, in women before menstruation or after conception, and is also found in inflammation of the lungs. Bright vivid redness is found in nervous diseases, hysteria, and tendency to hemorrhoids. Dark purplish redness is found in congestion and apoplectic and suffocative conditions. Redness, coming and going in spots, I have often found in brain diseases of little children. One-sided redness with paleness and coldness of the other side is in inflammation of the brain, according to Schoenlein, a sign of formation of pus in that half of the brain which corresponds with the red side of the face. One-sided redness is found also in diseases of the lungs, of the heart and abdomen. The circumscribed hectic flush is characteristic of phthisis. Redness of the cheeks with a white ring around the alae nasi and the mouth. I have found in different exanthematic fevers.

Paleness. - Sudden paleness, especially around the mouth, is found in children with colic, spasms in the abdomen. Great paleness, alternating with flushes of redness, is found in inflammation of lungs and brain, also during dentition. A pale peculiar white and wrinkled face is found in children with chronic hydrocephalus. A sudden paleness after an inconsiderable limping in children, combined with great lassitude is a sign of a lingering hip disease. In women paleness is a sign of profuse menstruation, or suppression or chlorosis. Sudden paleness during pregnancy prognosticates that metrorrhagia, or death of the foetus, or coming on of abortus. Sudden paleness of the nose is in scarlet fever a bad sign; it denotes a metastasis to the brain; during the pealing off, it is a forerunner of dropsy. Sudden paleness after a fall indicates concussion of the brain. Pale lips are characteristic of chlorosis.

Blue Color of the Face. - It is found in organic diseases, of the heart, especially dilatation of the ventricles and disorganization of the valves, whereby the oxygenization of the blood is interfered with. In the highest degree it exists in cyanosis. Blue face of new born children is found after labor, with face-presentation, or if the navel-string was wound round the neck. If it lasts long after birth it denotes cyanosis. Livid greyish, lead color, denotes deep-seated organic diseases, scirrhus, gangrene.

Yellowish Color of the face is found mostly in diseases of the liver. A yellowish or brownish bridge over the nose, indicates Sepia. The yellowness of jaundice varies from a pale orange to a deep green yellow. There is a certain yellowness of the malignant aspect, which is distinguished from jaundice by the pearly lustre of the eyes.

Brown Spots in women are mostly signs of pregnancy or of irregularity in menstruation; they are also said to be found in liver complaints. Irregular brownish spots, a little raised above the skin and covered with small pustules, which sometimes discharge a bloody fluid, are in children a sign of congenital syphilis.

The Temperature of the Face. - a. Heat of the face is found in congestion of the head, in fevers, in inflammatory conditions, in coryza and other different complaints. b. Coldness of the face we find in chills, in spasms, exhaustion, in sickness of the stomach, in syncope. A deadly coldness in cholera also in violent hysterical paroxysms. In inflammation of the lungs coldness of the face is a bad sign of commencing suppuration. Sudden coldness of the face in scarlet fever indicates the near approach of death.