A practical treatise on surgical diagnosis : designed as a manual for practitioners and students

Front matter

TOM x aS WN

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SON

Preface To First Edition

AT the request of my private classes I publish this volume.

As a text book for students it will, I trust, aid memory by presenting the symptoms of diseases in marked contrast ; while to the practising physician it may prove a book of easy reference, when questions of diagnosis arise leading towards doubt or error.

Iam aware that many points of distinction given will admit of question, as authorities do not always agree. I have, however, selected from such authors as, in my opinion, best merit attention, and have avoided as far as possible all points on which argument is demanded, or from which serious error is liable to follow.

I have endeavored to make, in most instances, selections for contrast of such diseases as are most liable to be confounded, and, for perspicuity, have been forced to frequently duplicate the symptoms of many of them.

in this volume all questions of etiology, pathology and treatment have been purposely omitted, as they have no direct bearing upon diagnosis, and therefore do not properly appertain to it.

Each differentiation is, in most instances, so arranged as to allow the symptoms of each to be reviewed separately by reading from above, downwards ; while by reading across the page the points of contrast become prominent.

The “Common Symptoms” written below each differentiation explain, in general, the possible causes of error in diagnosis.

At the close of this volume will be found enumerated under the head of bibliography those authors to whom I am indebted for many statements advanced and from whom occasional extracts have been given. I have adopted this method of acknowledgment since the arrangement of disease in a tabulated form precludes the frequent interpolation of authorities. Confusion would thus often result unless explanatory paragraphs were also inserted and the object of marked contrast in symptoms would be thus thwarted.

Tf I succeed in placing before students and the medical profession at large a work whose system and arrangement will probably be its chief recommendation, the object of this volume will have been accomplished.

156 Maprson AVENUE,

January, 1879. aD lll

Preface To The Second Edition

ScaRcELy more than a year has yet elapsed since the first edition of this work was given to the public. At that time, the question whether the plan of the book would meet professional favor was certainly an open one, and it affords some personal gratification that the increasing demand for the work, both as a text-book and as an aid to the general practitioner, justifies a revision of its matter and an addition to its former pages.

I have changed my opinion somewhat since this work was first issued, as to the advisability of employing the plan of contrast of symptoms, in the form of differential tables, to the exclusion of descriptive text; as I have found that, however valuable they might be as a summary to the student, or as an aid to the practitioner at the bedside, such tables alone will not fill the requirements of a text-book, or be as generally useful as if accompanied by a concise and general enumeration of the etiology and symptomatology of each of the more important diseases to which the attention of the surgeon is most often directed, and which must, therefore, form the basis of most lectures given to the student.

In preparing this revised edition, I have followed, as far as my judgment approved, all those suggestions which have from time to time been made to me by different instructors throughout the country, and have endeavored to make this volume especially valuable and attractive to the studént in medicine, as well as to those more advanced in their knowledge of disease.

The work, in its present form, cannot be called elementary in any sense, nor is that, in my opinion, a desirable quality in a text-book ; but it will, I trust, be found improved by the additions made, and better fitted for the purpose for which it was at first intended.

In this edition, all errors of statement have been carefully expunged where detected by the author, and the first three sections of the present volume’ have been rendered much more complete than in the first edition of the work.

Vv vi PREFACE TO THE SECOND EDITION.

In the section upon “Diseases of the Male Genitals,” many additions and improvements have been made; and in the section upon “Diseases of the Abdomen,” the subject of hernia has been enlarged and many smaller alterations incorporated.

I have introduced, as a preparation for the study of “ Diseases of Tissues,” a hasty summary of inflammation, arranged in a tabular form, which is rather an outline sketch than a full résumé, but which may possibly prove of some little value to those who need some guide to follow in studying more extensive treatises, or who wish to understand the first elements of pathological changes.

A new index of this work has been made, which will be found quite complete, as the amount of new matter which has been added demanded it, and as the one of the previous edition did not seem to fill all the requirements of a book of reference. In the pages of bibliography, appended at the close of the volume, the full titles of the volumes from which extracts have been made have been supplied, where previously omitted, with the date and place of publication, as a guide to those who wish to consult authorities upon any special subjects.

It is not probable that everything has been added that would give additional value to the book, but time and the continued use of the work as a text-book will enable the author to be further enlightened as to its requirements.

The author begs, in closing, to acknowledge the valuable hints afforded him in some of the able reviews of the first edition, and many other personal friends, who have also made suggestions of value ; also to his friend and student Henry C. Moir, for the valuable assistance which he has rendered me in preparing an index, which, from its completeness, will greatly facilitate reference, and thus add to the value of the work.

156 Mapison AVENUE, April, 1880.

Part I. Diseases Of The Blood-vessels

GENERAL table of diseases of the blood-vessels. Atheroma, its causes and diagnostic symptoms. Fatty degeneration of vessels, its causes and symptoms. Aneurism, its varieties, its causes, its most frequent situations ; the conditions affecting its growth ; the general symptoms of aneurism and their diagnostic value ; the symptoms of special forms of aneurismal tumors ; the differential diagnosis of aneurism in general. Occlusion of Arteries, itsetiology and symptoms. Diseases of the veins : Hypertrophy of the venous coats, its causes and symptoms. Atrophy of veins, its causes and surgical importance. Degeneration of the venous coats, its varieties, causes, and diagnostic importance. Adhesive inflammation of veins (thromballosis). Suppurative inflammation of veins (diffuse phlebitis), its causes and symptoms. Varicose veins. Parasites of veins. Phlebolithes (calculi of veins). Tables of contrast of symptoms headed as follows : Aneurism and tumor onan artery. Aneurism and erectile tumors, Aneurism and aortic pulsations, Aneurism and abscess over a vessel. Diagnoses of special types of Aneurism : Abdominal aneurism and abdominal tumors, Abdominal aneurism and painful diseases of abdomen, Abdominal aneurism and psoas abscess, Thoracic aneurism and intra-thoracic tumors. Thoracic aneurism and pulmonary consolidation with a murmur in some large vessel, Aneurism of bone and cancer of bone, Cirsoid aneurism and pulsatile tumors of bone, Aneurism and encephaloid cancer, Aneurismal varix and aneurism, Cirsoid aneurism and erectile tumors, Cirsoid aneurism and nevi, Aneurism of arch of aorta and aneurism of the innominate artery, Varicose aneurism and aneurismal varix, Varicose aneurism and varicose veins. Diseases of the arterial coats: Atheromatous degeneration, Fatty degeneration of vessels. Diseases of the veins : Adhesive phlebitis, Suppurative phlebitis. Abnormal conditions of vessels : Embolism, 1S Te en aA Te Eeee, A ee ROEDER eee eg Pages 1-47

Part II. Diseases Of The Joints

General classification of joint diseases. Synovitis, its causes, varieties, and general symptoms. Acute synovitis, its causes and pointsof diagnosis. Suppurative synovitis (acute articular abscess), its causes, symptoms, and points of differential diagnosis. Chronic synovitis, its causes, symptoms, and differential diagnosis. Scrofulous synovitis, its causes, symptoms, and differential diagnosis. Rheumatic synovitis, its causes, symptoms, and differential diagnosis. Gouty synovitis, its causes and symptoms. Gonorrhceal synovitis (gonorrhcal rheumatism), its causes and symp- : vil

Vili CONTENTS.

toms. Syphilitic synovitis, its diagnostic symptoms. Arthritis, its causes, symptoms, and varieties. Chronic rheumatic arthritis (rheumatic gout, morbus coxe senilis), its causes, most frequent situation, and symptoms. Anchylosis of Joints, its varieties, causes, and symptoms. Dropsy of joints (hydrarthrosis), its causes and symptoms. Articular neuralgia, its causes and symptoms. Loose cartilages in joints, varieties, situation, and symptoms. Tables of contrast of symptoms of joint diseases, headed respectively: I. Duseases of the joints in general: Synovitis and rheumatic inflammation of joints, Scrofulous synovitis and hydrarthrosis, Acute arthritis and chronic rheumatic arthritis, Acute arthritis and syphilitic periostitis near a joint, Acute arthritis and suppuration external to a joint, Bony anchylosis and fibrous anchylosis. II. Diseases of special joints: Morbus coxarius, its varieties, its common symptoms, its diagnosis. Congenital dislocation of the hip-joint, its symptoms and differential diagnosis. Sacro-iliac disease, its causes, symptoms, and differential diagnosis. Tables of contrast of symptoms of the more important diseases of special joints. Differential diagnosis of morbus coxarius and congenital dislocation of the hip, Morbus coxarius and psoas abscess, Morbus coxarius and sacro-iliac disease, Morbus coxarius and trochanteric disease of the femur, Morbus coxarius and lateral curvature of the spine, Morbus coxarius and rheumatic deformity of the hip, Morbus coxarius and disease of the crest of the ilium, Morbus coxarius and inflammation of the psoas bursa, Morbus coxarius and infantile paralysis. Diagnostic points of tenderness in inflammation of the larger joints. Ill. Deformities of joints: General classification. Talipes, its varieties, Symptoms of talipes varus, Talipes valgus, Talipes equinus, Talipes equinus with paralysis of the extensors of the toes and flexors of the tarsus, Talipes valgus (spurious), Calcaneo-valgus of moderate severity (Chinese foot), Flat foot, Diagnosis between spurious valgus and sprain of ankle-joint........... sceeeeee- Pages 48-96

Part III. Diseases Of Bone

Classification of bone diseases. Osteitis, its causes, symptoms, and differential diagnosis. Osteo-myelitis, its causes. symptoms, and differential diagnosis. Abscess of bone, its causes, most frequent seat, symptoms, and differential diagnosis. Periostitis, its varieties, causes, and symptoms. Hypertrophy of bone, its causes and symptoms. Atrophy of bone, its causes and symptoms. Rachitic condition of bone, theories as to its cause, its symptoms, and differential diagnosis. Mbollities ossium (malacosteon, fragilitas ossium, etc.), its causes and symptoms. Caries, its causes, pathology, symptoms, and differential diagnosis. Necrosis, its stages, causes, symptoms, and differential diagnosis. Cancer of bone, its most frequent situation, and its symptoms. Osteo-aneurism (pulsatile tumors of bone). Enchondrvoma, its causes, situation, symptoms, and differential diagnosis. Exostosis, its varieties, causes, and symptoms. Cystic tumors of bone (osteo-cystoma), varieties, eauses, situation, and symptoms. Fibro-cystic tumors of bone (osteo-sarcoma). Fibrous tumors of bone. Entozoa of bone. Tables of contrast of symptoms of the principal diseases of bone: Osteitis and osteo-myelitis, Caries and necrosis, Osteitis and periostitis, Periostitis near a joint and acute arthritis, Abscess of bone and arthritis, Rickets and malacosteon, Exostoses and cysts of bone, Cancer of bone and pulsatile tumors of bone, Pulsatile tumors of bone and aneurismal tumors. Local] types of bone diseases. Abscess of the antrum, Solid tumors of the antrum, Cystic tumors of the antrum, Malignant tumors of the antrum, Extra-cranial tumors, Intra-cranial tumors, Exostoses of the cranium................ -+++-Pages 97-132

CONTENTS. iz

Part IV. Dislocations

Definition, varieties, causes, and general symptoms of dislocation. Dislocations of special joints: I. Dislocations of the jaw: Differential diagnosis between the unilateral dislocation and bilateral dislocation, Unilateral dislocation and congenital dislocation, Dislocation of jaw and chronic rheumatic arthritis of the tempero-maxillary articulation. II. Dislocations of the shoulder: Classification of the varieties. Differential diagnoses between ‘‘Sub-glenoid ” dislocation and fracture of neck of humerus, ‘‘Sub-clavicular” dislocation and ‘‘sub-spinous” dislocation, ‘‘Sub-spinous” dislocation and separation of the great tubercle of the humerus, ‘‘Sub-coracoid” dislocation and ‘‘supra-coracoid”’ dislocation. Comparative table of the three more important dislocations of the humerus at the shoulder joint. Dislocations of the clavicle. Varieties and etiology. Subluxation of outer end of clavicle (dislocation of scapula). III. Dislocations at the elbow joint: Classification of. Differential diagnoses between both bones of forearm backwards and fracture of humerus above the condyles, Both bones of forearm backwards and radius forwards, and ulna backwards, Both bones of forearm backwards and both bones of forearm forwards, Both bones of forearm backwards and ulna alone backwards, Radius forwards and radius backwards, Ulna forwards and ulna backwards. Comparative table of the dislocations of both bones of the forearm at the elbow joint. IV. Dislocations at the wrist: Dislocations of the carpus, of the separate carpal bones, of the lower end of the ulna. Differential diagnoses between dislocation of the carpus and Colles’ fracture, Dislocation of the carpus and sprain of the wrist joint, Dislocation of the carpus and transverse fracture of both bones close to the

. wrist joint, Dislocation of the carpus and separation of the epiphyses of radius and ulna. Symptoms of dislocation of the lower end of the ulna forwards and backwards, and of dislocation of the os magnum. V. Dislocations at the hip joint : Varieties of dislocation: of the upper end of the femur. Differential diagnoses between ‘dorsum ilii” dislocation and ‘‘sciatic notch” dislocation, ‘‘Sciatic notch ” dislocation and fracture of the femur with inversion of the foot, ‘‘ Pubic ” dislocation and ‘‘ thyroid” dislocation, ‘‘ Pubic” dislocation and fracture of the neck of the femur, Dislocation of the hip aud contusion over the trochanter. Table of contrast of the symptoms of each dislocation of the hip. VI. Dislocations at the knee joint : Varieties of dislocation of the tibia and of the patella. Symptoms of dislocation of the tibia forwards, backwards, in rotary displacement, in lateral displacement. Symptoms of dislocation of the patella inwards, outwards, upwards, and in rotary displacement. VII. Dislocations at the ankle joint: Varieties of dislocation of the astragalus. Symptoms of dislocation of the astragalus forwards, backwards, externally, internally, and upwards, Differential diagnosis between dislocation of the astragalus upwards and fracture of both bones of the leg, Dislocation at ankle and a severe sprain, Dislocation at ankle and a previous deformity associated With iInjUury.......esseceerercceccnceresccccsece Weare se Pages 133-186

Part V. Fractures

Definition, Varieties of fractures of long bones. Fractures of flat bones. General symptoms of fracture. Classification of special fractures. I. Fractures of the skull. Classification of varieties. . Differential diagnoses of complete fracture of the skull and tract of outer table only, Fracture of outer and inner tables only, Fracture of inner table only, and apoplexy with complicating injury, Fracture of the base of x CONTENTS.

the skull and cerebral concussion, Cerebral compression and cerebral concussion Il. Fractures of the upper jaw. Ill. Fractures of the lower jaw. Differential diagnosis from dislocation of lower jaw. IV. Fractures at the shoulder joint. Classification. Fractures of the scapula. Differential diagnoses between fracture of body and the spine of the scapula, Fracture of the neck of the scapula and fracture of the neck of the humerus, Fracture of the neck of the scapula and dislocation of the humerus. Fractures of the clavicle. Varieties of, and their location. Differential diagnosis between fracture of clavicle inside of coracoid process and fracture outside of the coracoid process. Fractures of the humerus near the shoulder joint. Varieties of, and their location. Differential diagnoses between simple intra-capsular fracture and simple extra-capsular fracture, Impacted intra-capsular and impacted extra-capsular fractures, Fracture of the neck of the humerus and ‘‘sub-glenoid ”’ dislocation, Fracture of the neck of the humerus and fracture of the neck of the scapula, Separation of the great tubercle of the humerus and *‘sub-spinous”’ dislocation. V. Fractures at the elbow joint. Varieties of, and their location, Differential diagnoses between fracture of the condylesof humerus, fracture of coronoid and olecranon process, Fracture of the olecranon process and rupture of the triceps tendon, Fracture of the upper ends of radius and ulna, Transverse fracture of humerus and dislocation at elbow joint.

VI. Fractures near the wrist joint. Varieties of, and their location. Differential diagnoses between Colles’ fracture and dislocation of the wrist, Fracture of both bones near wrist and dislocation of carpus, Separation of the epiphyses and dislocation of the carpus, Colles’ fracture and transverse fracture of both bones near the wrist joint. VII. Hractures near the hip joint. Varieties of, and their location. Differential diagnoses between simple intra-capsular fracture and simple extra-capsular fracture, Impacted intra-capsular and impacted extra-capsular fracture, Intra-capsular fracture of the femur and chronic rheumatic arthritis with contusion, Fracture of femur with inversion of the foot and ‘sciatic notch” dislocation of the femur, Fracture of the neck of the femur, and the “pubic” dislocation of the femur. VIII. Fractures at the knee. Varieties of, and their location. Fractures of the patella. IX. Mractures at the ankle. Transverse fracture of both bones of the leg. Pott’s fracture. Fractures of the malleoli. Compound fractures of ankle joint. X. Hractures of the trunk. Fractures of the sternum. Fractures of the vertebre. Fractures of the ribs, Differential diagnoses between fracture of the ribs and the dry stage of pleurisy associated with contusion, Fracture of the ribs and pneumothorax of a traumatic origin, Fracture of the ribs and emphysema of tissues, Fractures in general in the vicinity of joints and dislocation of bone.............. SSeS ats Se awe Ge sete SESD Pages 187-254

Part VI. Diseases Of The Male Genitals

I. Diseases of the testicle. Inflammatory orchitis. Syphilitic orchitis. Tubercular orchitis. Malignant orchitis. Cysts of testis. Sarcoma of testis. Hzmatocele of testis. Lipoma of testis. Fibrous tumors of testis. Enchondroma of testis, Benign fungus of testis (hernia testis). Chronic induration of testis. Arrested devel. opment of testis. Congenital malformations of testis. Neuralgia of testis. Atrophy of testis. Incomplete descent of testis. Calcareous deposit of testis. Differential diagnoses between acute orchitis and neuralgia of the testis, Syphilitic orchitis and tubercular orchitis, Malignant orchitis and syphilitic orchitis, Cysts of testicle and hydrocele, Benign fungus of testis and cancer of testicle with fungous growth, Orchitis and epididymitis. Diagnostic table of the four principal enlargements of the testicle. I. Diseases of the tunica vaginalis and the spermatic cord. Simple hydro-

CONTENTS. = cele, Hydro-sarcocele. Congenital hydrocele. Encysted hydrocele of the testis. Diffuse hydrocele of the spermatic cord. Encysted hydrocele of the spermatic cord. Varicocele. Cirsocele. Table of causes of varicocele. Lipoma of the spermatic cord. Spasm of the cremaster muscle. Differential diagnoses between hydrocele and scrotal hernia, Varicocele and scrotal hernia, Encysted hydrocele and cysts of the testicle, Hydrocele and congenital hernia, Hydrocele of the cord and inguinal hernia, Hydrocele and hematocele. III. Diseases of the bladder. Malformation of, and its varieties : Deficiency of, Multiplicity of, Extroversion of. Inflammatory conditions : Acute cystitis, Chronic cystitis, Ulceration of the bladder, Suppuration of the vesical walls, Gangrene of the bladder. Hypertrophy. Tumors of the bladder. Bar at the neck of bladder. Hernia of the bladder. Inversion of the bladder. Rupture of the bladder, its causes, symptoms, and means of positive diagnosis. Calculi of bladder, etiology, number, and volume, consistency and appearance, shapes, rational symptoms, physical signs, rules for sounding, causes of error in sounding. Foreign bodies in bladder. Tubercle of bladder, Paralysis. Atony. Spasm. Neuralgia. Retention of urine. Incontinence of urine. Overflow of urine.

Differential diagnoses between cancer of the bladder and vesical calculus, Rupture of the bladder and retention of urine, Retention of urine and suppression of urine, Retention and incontinence due to overflow, Acute cystitis and stone in bladder, Paralysis of bladder and atony of bladder, Chronic cystitis and chronic prostatitis. IV. Diseases of the prostate gland. Inflammatory conditions: Acute prostatitis, chronic prostatitis, Prostatic abscess. Hypertrophy of the prostate. Atrophy. Cancer. Tubercle. Cystic disease. Prostatic calculi. Prostatic hemorrhage. Prostatic phlebolites. Wounds of the prostate. Differential diagnoses between acute prostatitis and chronic prostatitis, Hypertrophy of the prostate and organic urethral stricture. V. Diseases of the urethra. Inflammatory conditions : Gonorrhcea, Urethritis, Chancre and chancroid of the urethra, Urethral stricture, its varieties, causes, symptoms, and means of positive diagnosis. Urethral dilatation. Urethral rupture. Urethral deformities. Urethral tumors. Urethral abscess. Urethral fistule. Urethral spasm. Congestive stricture. Urethral calculi. Foreign bodies in the urethra. Symptoms of urethral rupture within the triangular ligament, perineal abscess, rupture of the urethra in front of its membranous portion, rupture in front of the peno-scrotal junction, Fracture of the penis, Organic stricture, and Urethral tumors. VI. Diseases of the penis. Diseases of the glans penis: Balanitis, Posthitis, Herpes progenitalis, Vegetations, Venereal sores, Epithelioma. Diseases of the prepuce: Phimosis, Paraphimosis; Diseases of the corpora cavernosa: Inflammation, Calcification, Gummy tumors, Chronic circumscribed inflammation, Fracture of the penis, Anomalies of the penis.

Part VII. Diseases Of The Abdominal Cavity

Injuries to the abdomen : Contusions, Wounds, Foreign bodies in the intestinal canal. Diseases of the intestine: Fecal abscess, Intestinal obstruction, Hemorrhoids, Prolapse of the rectum, Fistule of the rectum, Fissure of the anus, Stricture of the rectum, Cancer of the rectum, Polypi of the rectum, Pruritus ani, Neuralgia of the rectum. Hernia. Classification of hernia. Nomenclature of hernia. Predisposing causes. Exciting causes. Symptoms of hernia in general. Congenital hernia. Ventral hernia. Diaphragmatic hernia, its causes, symptoms, and means of posixii CONTENTS.

tive diagnosis. Table of diagnoses of inguinal hernia. Diagnoses of femoral hernia.

Differential diagnoses between typhilitis and perityphilitis, External hemorrhoids and internal hemorrhoids, External hemorrhoids and condylomata of anus, Internal hemorrhoids and rectal polypus, Rectal prolapse and rectal polypus, Cancer of rectum and stricture of rectum, Fissure of anus and fistula of rectum, Direct and indirect inguinal hernia, Scrotal hernia and sarcocele, Scrotal hernia and hydrocele, Scrotal hernia and varicocele, Scrotal hernia and hematocele, Incomplete inguinal hernia and bubo, Bubonocele and undescended testicle, Inguinal herria and impaction of feces, Inguinal hernia and.hydrocele of the cord, Femoral hernia and enlarged glands, Femoral hernia and psoas abscess, Femoral hernia and varix of the saphenous vein, Femoral hernia and inguinal hernia, Femoral hernia and lipoma of the femoral canal, Ventral hernia and umbilical hernia, Thyroid hernia and perineal hernia, Diaphragmatic hernia and mediastinal tumors, Congenita] hernia and hydrocele, Congenital hernia and infantile hernia.............. Pages 333-377