Mental diseases: a public health problem. James Vance May
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for actual sound, over the head).
4. Taste:
Test separately the anterior two-thirds of tongue and the posterior third with weak solution of sugar, quinine, acid, salt.
5. Smell:
Test each nostril with oil of cloves, bergamot, peppermint, wintergreen and lemon. Note the actual answers.
Parosmia. Put down the actual extent of discrimination and recognition, with explanation of defect (mental, local, or nervous).
6. Cutaneous Sensibility:
1. Tactile sensibility (use the finger-tip, feather, or pin). Compare both sides of face, arms, hands, fingers, breasts, inner and outer aspects of thighs and legs. (Never omit the ulnar side and the area outside and above the knee). Sole and dorsum of feet.
2. Localization of touch (time and space) and tickle.
3. Sensibility to pain (cautious pricks with a pin, localization in time and space), with or without the attention of the patient.
4. Sensations of heat and cold (cold water and warm water in a glass tube).
(a) Sense of position: See below.
(b) Stereognostic sense.
5. Subjective sensations (formication, feeling of needles and pins, numbness).
6. Tenderness of nerve trunks and muscles on pressure and percussion. The distribution to be noted on the drawings of the body surface.
7. Biernacki's sign (analgesia of the ulnar nerve); anesthesia of eyeball; of testicles.
7. Vasomotor and Trophic Conditions:
Salivation, seborrhea.
Cyanosis or pallor; scaliness or loss of hair; change of nails.
Blushing, dermatographia. General or localized perspiration. Temperature of paralyzed or anesthetic parts.
8. Motor Functions:
Mobility of facial muscles (laugh) (wrinkle the forehead and the nose; move the ears; show the teeth and shut the eyes); tongue; palate.
Muscles of the neck, trunk and extremities; gait.
Functions of the successive segments: In case of paresis or paralysis define the limits of the condition and indicate the results of the following tests: For loss of power: for the coordination of movement (writing, buttoning coat); for muscular sense (discriminating difference in weight; with eyes shut tell the position of the limbs and show with one side the position of the other). Balancing power: (walking along a straight line, stand upright with heels and toes together and eyes closed).
Never forget the test of equality of grip, flexor and extensor strength of elbow, knees and toes. For test of weakness of one lower extremity have both lower extremities raised and hold to fatigue limit. The weaker limb will sink a certain number of seconds before the other.
9. Reflexes:
1. Deep reflexes.
Masseteric: elbow, wrist, knee-jerk with or without Jendrassic, with clonus, or contralateral adductor reflex, knee-cap reflex; ankle clonus and Achilles tendon reflex.
2. Superficial reflexes:
Plantar (with full description as to the Babinski reflex), gluteal, cremasteric, abdominal, epigastric, scapular, corneal, palmar, sneezing.
10. Condition of the Paralyzed Muscles:
Firm and of good tone, or flaccid or deficient in tone. Rigid and contracted. Note attitude of limb and the limitation of the motion, active and passive. Atrophy, hypertrophy, electric reaction of nerve and muscle (galvanic and faradic irritability when required).
11. Fibrillary Twitching:
Its distribution.
12. Tremor:
Of what parts; rhythm, intensity, rapidity. Condition at rest during sleep; when first observed. Condition during motion, how influenced by will.
13. Organic Reflexes and Their Control:
Bladder; delay of micturition. Dribbling from empty bladder, from distended bladder. Peculiar sensations on micturition.
Sexual reflexes: Frequent involuntary contraction and evacuation.
Defecation: Is the patient conscious of evacuation?
14. Convulsions:
Distribution: Extending over head, trunk, extremities, one side, one member.
Character: Which parts first and most attacked, and how do the waves of the tonic and clonic spasm spread; what movements predominate?
Average duration, frequency, occurring night or day, or early in the morning.
Breathing; pupils; vasomotor condition; froth and bites.
Sphincters: Consciousness totally or partially lost.
Aura.
Equivalents: with or without what automatic movements.
Physical and nervous symptoms before and after attack.
Hysterical attacks.
III. THORACIC ORGANS:
Respiratory organs: Is there any difficulty of breathing, permanent or in attacks? Sleep with mouth open? Any pain on deep inspiration? Any cough or expectoration (where from). Nose and larynx. Shape of chest. Frequency of respiration. Respiratory movements. (Compare both sides in deep inspiration and expiration).
Lungs: Percussion. Auscultation. Expansion.
In case of dullness or other abnormalities: Fremitus.
Contents of pleura.
Circulatory organs: Is there any palpitation? In attacks? Due to what? Subjective sensation of arhythmia? Heart: The impulse seen and felt in what area? Relative dullness (right, upper and lateral borders). Sounds and bruits (localized). Pay special attention to muffling of the first sound, to duplication; to change of murmurs in inspiration and by position. Rhythm and accentuation.
Radial pulse: Rate, quality, on lying and sitting and standing. Special attention to variability through position or motion or exertion. If desirable, sphygmogram.
Condition of radial, brachial and temporal arteries.
Arcus senilis.
Sclerosis of veins. Varicosities.
Blood pressure.
IV. DIGESTIVE AND ABDOMINAL ORGANS:
Appetite, thirst, anorexia, nausea: Relative to quantity and quality of food. Vomiting (time and form), eructations and brashes; pain (locality, irradiation and time).
Mouth and teeth. Fetor. Fauces and pharynx. Stomach (position, etc.). Digestion. Movement of bowels. Any subjective feeling of obstacle? Form of stools. Flatulence and distensions. Hemorrhoids and fistulas.
Liver and spleen.
If indicated, examination of stomach contents.
V. URINARY APPARATUS:
Micturition: Urine, amount in 24 hours, specific gravity, color, reaction, odor, albumen, sugar and indican, etc.
Macroscopic and microscopic examinations of sediment, clouds and threads; casts, epithelia, erythrocytes, leukocytes, bacteria, threads, crystals, amorphous substances.
VI. GENITAL ORGANS:
Scars of genital organs. Menstruation: regular; profuse; scanty; accompanying symptoms.
Discharges at intervals; constant; profuse; color.
Internal examination.
In men: Frequency and character of the sexual functions. Frequency of emissions, their occasional exciting causes and correlated