Some generalizations are in order to help you evaluate the most common symptoms of disease. These questions may be asked: When did it begin? What were you doing when the problem started? Have you ever had such a problem before? What measures seem to give relief? Has the disease progressed; or, is it getting better?

Are there measures that promote comfort? Where does the primary problem seem to be located? Are there other symptoms that appeared to begin at the same time? This approach to history taking, whether applied to pain, headache, stomachache, and many other common symptoms, will help you elicit the true story of illness in a direct and constructive manner.

• Loss of Appetite - The medical term for this is anorexia. This symptom may be associated with a disease of the digestive system, such as an ulcer, or some problem located elsewhere in the body, such as an infection or emotional reaction.

• Nausea and Vomiting - Nausea is a feeling of discomfort in the region of the stomach, often associated with loss of appetite. When vomiting occurs, the patient throws up the contents from the stomach through his mouth. This action results from a sudden strong contraction of the diaphragm and stomach muscles.

Strong emotional reactions, effects of drugs or their withdrawal, excessive fatigue, and many diseases such as ulcer, appendicitis, gallstones, even brain tumor, are examples of diseases that produce nausea and vomiting.

• Diarrhea - An increased number of loose or watery stools is known as diarrhea. The frequency may vary from one or two, to thirty or forty per day. Usually diarrhea is a symptom of irritation in the bowel and not an actual disease. The body tries to rid itself of this irritation by increasing the movements of the intestines.

Because of the rapid passage of the intestinal contents, there is more fluid in the stool, and sometimes its passage is associated with abdominal pain or cramping. In severe cases, dehydration may occur, resulting in thirst and dryness of the mouth and skin.

A sudden and excessive loss of fluid is especially dangerous in infants and small children. There are many causes of diarrhea. Nervousness may produce this condition. Many types of laxatives produce an increased number of loose stools. Spoiled food, over-ripe fruit, contaminated canned foods, all irritate the intestines.

Diarrhea may also be a symptom of intestinal obstruction, infection of the intestine, or inflammation of the colon, called colitis. Microorganisms, such as the amoeba, typhoid bacillus, and other bacteria may cause diarrhea.

• Constipation - The individual who produces fewer stools than usual has constipation. The fecal material may be hard and dry. This condition may be a symptom of organic disease, such as an obstruction in the bowel or just increased muscle tone. Nervous conditions can also cause constipation.

In such a situation, the colon becomes spastic, preventing normal elimination. Lack of exercise may result in constipation, as does a diet low in roughage, fruits, and vegetables. Drinking an insufficient amount of fluid or taking narcotic drugs for pain may inhibit intestinal contractions (peristalsis) and trigger this symptom.

• Dehydration - This results from the loss of water within the body’s tissues. Normally water makes up over 75% of your body’s weight. Replacement of water is the body’s most urgent dietary requirement. A patient who is dehydrated has extreme thirst, dry tongue, parched lips, dry skin, and reduced amount of urine.

If this disturbed water balance is not corrected, particularly in the infant, the patient may lose consciousness or die. Loss of fluid may result from excessive perspiration, from diarrhea or excessive urination, from hemorrhage, or persistent vomiting.

Inability to drink fluids occurs in unconscious patients and in those with nausea and vomiting, and severe loss of appetite. Complications in the aftermath of surgery may result in slight dehydration due to fever or vomiting.

• Edema - Fluid retention in the cellular tissues results in swelling. Edema is the medical term for dropsy. It may be a symptom of heart disease, kidney disease, or a local obstruction of lymphatic or venous circulation. Edema usually occurs in the part of the body that is closest to the ground and tends to settle by the action of gravity.

• Chills - When a patient has a chill, he feels cold, and shivers and shakes. This increased muscular activity raises the body temperature. It can be compared with the shivering that occurs when a person is cold and trying to get warm. When the chill is the result of nervousness, the patient generally does not have a fever. However when chills are symptoms of infection, fever commonly results.

• Fever - A patient with a fever has a body temperature above normal. The average normal temperature varies in different parts of the body, but in the mouth it is 37° Centigrade or 98.6° Fahrenheit. The rectal temperature is slightly higher at 38° C. or 100.4° F. Fever is usually a symptom of infectious disease.

However, strenuous exercise, heat stroke, and dehydration can also cause a fever. This is one of the most important defenses of the body against infection. Measures to reduce fever should not be used too frequently, except in cases of extreme temperature elevation.

• Cough - Coughing is a violent expulsion of air following a deep respiration, as a rule occurring involuntarily. Usually it is a symptom of irritation in the respiratory tract, but it may be a nervous habit or a means of attracting attention. A cough usually, however, is a symptom of a disease.

Sore throats, tuberculosis, whooping cough, bronchitis, pneumonia, or lung tumors can all cause coughing spells. Inhalation of food particles, or irritating substances, such as tobacco smoke, dust, or other toxic gases, can trigger a coughing episode.

At times blood will be present in the sputum. This alarming event, called hemoptysis, may occur in patients with heart failure or diseases of the lung, such as pneumonia, cancer or lung abscesses. When a chronic cough causes persistent respiratory distress, the cause should promptly be identified.

• Shortness of Breath - A patient who has difficulty breathing may be showing signs of obstruction in the respiratory tract or of lung disease, heart disease, or some blood disease, such as anemia. Medically, this condition is called dyspnea, and basically refers to shortness of breath.

• Cyanosis - When the skin around the mucous membranes, the lips, or the nail beds turn bluish in color, the patient has cyanosis. This is a sign of inadequate oxygen transport in the red blood cells. Sometimes in lung disease an insufficient supply of oxygen is obtained from the air. In other conditions the circulation becomes stagnated and cyanosis is seen.

• Nose Bleeds - Bleeding from the nose usually occurs from injury. A delicate blood vessel within the nostril gets ruptured. Seen particularly in children, this may be secondary to picking the nose. Medically this condition is called epistaxis.

Nosebleed may also be a symptom of certain disease conditions, such as high blood pressure, rheumatic fever, measles, influenza, or a disorder of blood clotting mechanism. Injuries, trauma to the face, and the excessive use of certain drugs, such as aspirin, may cause nosebleeds.

• Variation in Heart Rate - Sometimes the heart can beat exceptionally slowly. This may be a symptom of disease and is medically termed bradycardia. Kidney failure, underactive thyroid gland, heart disease, or overdose of certain cardiac drugs, such as digitalis may produce slowness of the heartbeat.

At times the heart beats too rapidly. This is called tachycardia. This may be associated with fever, an overactive thyroid gland, emotional excitement, hemorrhage, heart failure, or just a normal effect of exercise.

When the heartbeat is irregular, the diagnosis is more difficult. This may be the result of aberrant contraction in the heart or a complete instability of heart rhythm. An electrocardiogram is usually needed to establish the precise diagnosis.

• Pain - Pain is one of the most common symptoms that prompt an individual to receive therapy. It results from irritation and stimulation of nerves that carry the feeling of pain to the brain. Actually, pain is a protective mechanism of the body.

It is usually a warning that certain parts of the body are either diseased or injured. Sometimes, however, pain may be felt in an area of the body that is not diseased. This is called referred pain. Study the next chapter for a more comprehensive outline to various causes of pain and their rational treatment.

• Convulsions - Convulsions are sometimes called spasms or fits. This usually is a sign of serious disease in the body. Such problems as epilepsy, a brain tumor, brain injury, stroke, or high blood pressure can cause convulsions. Some poisons, and drug overdoses (such as Insulin), may also produce seizures.

First aid requires the patient’s protection from injury. A rapid and careful diagnosis, then, is important to understand the mystery of these seizures. These symptoms and many others comprise the signs of diverse disease states.

It is easy to see how complicated actually determining the cause may become. Nevertheless, an important review of these signals, and their interrelationships, may provide the missing link to understanding the real causes of illness.