Diagnostic and therapeutic technic; a manual of practical procedures employed in diagnosis and treatment

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Preface To The Second Edition

In the short time that has elapsed since the publication of the first edition of this work many advances have been made in diagnosis and treatment necessitating in the preparation of the present edition a very careful revision of the old manuscript and the addition of much new material. Many new illustrations have been added and some of those appearing in the previous edition have been redrawn. These additions have resulted in a somewhat larger volume, though the plan of the original work has been followed without change. Every effort has been made to bring the present volume up to date and to maintain the thoroughly practical character of the original work, and it is earnestly hoped that the changes and additions that appear in this new edition will add materially to the usefulness of the book.

Finally, the writer wishes to express his appreciation of the very kind reception accorded this book by the Profession, without which this revision would have been impossible.

A.S.M.

New York City,

January, 191 5 vn

Preface

In this volume the writer has endeavored to bring together and arrange in a manner easily accessible for reference a large number of procedures employed in diagnosis and treatment. The book has been given the comprehensive title "Diagnostic and Therapeutic Technic." The scope of the work, however, can be best appreciated by consulting the table of contents on page xi.

While some of the methods herein detailed belong essentially to the domain of the specialist, the majority are the every-day practical procedures which the hospital interne or the general practitioner may at any time be called upon to perform. So far as the writer is aware there is no single book to which one may turn for information along these lines. Text-books of the present day, treating exhaustively as they do of the larger problems of medicine and surgery, must of necessity, if they are to be kept within reasonable limits, omit or else describe in a most condensed manner these so-called minor procedures. If the reader desires fuller and more detailed information it not infrequently happens that it is necessary for him to consult a number of works before he obtains all the desired information. To supply such a want is the object of this book.

The plan of the work comprises, first, a description of certain general diagnostic and therapeutic methods and, second, a description of those measures employed in the diagnosis and treatment of diseases affecting special regions and organs of the body. Operative methods have been omitted as far as possible, only those having been considered which are required in emergencies or which form a necessary part of some of the measures described. Each procedure has been given in detail, leaving nothing to the reader's imagination. For this reason, and that each section might be complete in itself without referring the reader to other portions of the text, some unavoidable repetition occurs.

All important steps have been illustrated so that the reader may grasp at a glance the technic of the various procedures, no expense having been spared in this direction. Nearly all the illustrations are line drawings made by Mr. John V. Alteneder, head of the W. B.

DC

X PREFACE.

Saunders' art department, from photographs under the author's supervision. The excellence and high character of his work has done much to elucidate the text. In instances where illustrations from other sources have been utilized due credit has been given.

I desire here to express my heartiest thanks to my father, Dr. Prince A. Morrow, and to Drs. T. J. Abbott, J. M. Lynch, J. H. Potter, and J. F. McCarthy for many valuable suggestions and criticisms, and to others who have assisted me in various ways in the preparation of the manuscript.

My thanks are also due the Kny-Scheerer Co., of New York, for having kindly furnished many of the instruments from which drawings have been made.

A. S. M.

New York City.

CHAPTER I Page

The Administration of General Anesthetics i

Preparations of the patient for general anesthesia 2

Stages of anesthesia 6

Nitrous oxid and oxygen anesthesia 27

Nitrous oxid and ether sequence » . . 28

Ethyl chlorid anesthesia 30

Anesthetic mixtures 33

Intubation anesthesia 34

Intratracheal insufflation anesthesia 36

Anesthesia through a tracheal opening 40

Intravenous general anesthesia 41

Rectal anesthesia 44

Oil-ether colonic anesthesia 47

Scopolamin-morphin anesthesia 48

Accidents during anesthesia and their treatment 48

After-effects of anesthetics 55

After-treatment of cases of general anesthesia 57

CHAPTER II Advantages and disadvantages of local anesthesia 60

Methods of producing local anesthesia 63

Drugs employed for local anesthesia 64

Preparation of patient for local anesthesia 67

Conduction of an operation under local anesthesia 68

Local anesthesia by cold 69

Surface application of anesthetic drugs 70

Practical application of infiltration, endo- and perineural methods of anesthesia to special localities 78

Operations on inflamed tissues under local anesthesia 92

Arterial anesthesia 97

Sacral anesthesia 105

CHAPTER III Sphygicoicanometry 109

Normal blood-pressure no

xi

XH CONTENTS

Page

Instruments for estimating blood-pressure in

Technic of estimating blood-pressure 114

Variations of blood-pressure in disease 116

CHAPTER IV Transfusion of Blood 119

Indications and contraindications 120

Hemolysis 121

Selection of the donor 121

Artery to vein transfusion 121

Technic by Crile's method 125

Brewer's method . . . . 127

HartwelTs method 128

Levin's method 128

Elsberg's method 129

Technic by Carrel's suture 129

Vein to vein transfusion 131

Injections of Human Blood Serum 132

CHAPTER IX Page

Effects of hyperemia 204

Indications 206

General principles underlying hyperemic treatment 207

Passive hyperemia by means of constricting bands 209

Passive hyperemia by means of suction cups 215

Active hyperemia 220

The Diagnosis and Treatment of Fistulous Tracts by Means of Bismuth

Paste 223

CHAPTER X Collection and Preservation of Pathological Material 227

Method of making smear preparations for microscopical examination . . 227

Method of inoculating culture tubes 235

Collection of discharges and secretions for bacteriological examination . 238

Collection of blood for microscopical examination 245

Collection of blood for bacteriological examination 250

Collection of sputum 252

Collection of urine 252

Collection of stomach contents 254

Collection of feces 254

Removal of a fragment of solid tissue for examination 254

CHAPTER XI Exploratory punctures in general 258

Exploratory puncture of the lung 264

Exploratory puncture of the pericardium 265

Exploratory puncture of the peritoneal cavity 268

Exploratory puncture of the liver 269

Exploratory puncture of the spleen 271

Exploratory puncture of the kidneys 273

Exploratory puncture of joints 274

Spinal puncture 277

Spinal puncture as a means of administering antitoxic sera 283

CHAPTER XII Aspiration of the pleural cavity 285

Aspiration of the pericardium 293

Aspiration of the abdomen for ascites 296

Aspiration of the tunica vaginalis 300

Aspiration of the bladder 303

Chapter XIII XIV Contents

Pagb

Inspection of the nasopharynx by means of Hays' pharyngoscope . . .317

Digital palpation of the nasopharynx 322

Transillumination of the accessory sinuses 323

Nasal douching 325

The nasal syringe 329

The nasal spray 330

Direct application of remedies 332

Passive hyperemia in diseases of the nose and accessory sinuses .... 343

Tamponing the nose for the control of hemorrhage 343

CHAPTER XIV Direct inspection 354

Otoscopy 355

Determination of the mobility of the dm n membrane 359

Hearing tests 360

Inflation of the middle ear for diagnosis 363

The ear syringe 370

Application of caustics 375

Inflation of the middle ear for therapeutic purposes 376

Inflation with medicated vapors 376

Injection of solutions into the Eustachian tubes 377

The Eustachian bougie 378

Massage of the drum membrane 380

Incision of the drum membrane 381

CHAPTER XV Direct laryngoscopy 39^

Autoscopy 399

The laryngeal spray 4°8

Direct application of remedies 409

Steam inhalations 412

CONTENTS XV

Page

Dry inhalations 4*5

Intubation 4*5

CHAPTER XVI Esophagoscopy 445

Lavage of the esophagus 449

Dilatation of esophageal strictures by the bougie 45 *

Intubation of the esophagus 45*>

CHAPTER XVII Inflation of the stomach 471

Extraction of stomach contents for examination 474

Test of motor function 482

Test of absorption power 483

Gastrodiaphany 483

Exploratory laparotomy 493

Lavage of the stomach 494

The stomach douche 499

Gavage 5°2

Duodenal feeding 5°5

Massage 5°7

Electrotherapy 509

Chapter XVIII

I. Abdominal Examination 5l8

XVI CONTENTS

Page

Inflation of the colon 521

II. Internal Examination 524

Palpation by the finger 527

Manual palpation 529

Examination by the bougie a boule 538

Examination by the probe 539

Lavage of the bowel 540

Examination of the feces 541

Enemata , 541

Enteroclysis 546

Saline rectal infusion 554

Nutrient enemata 560

Injection of fluids or air into the bowel in intussusception 563

Dilatation of rectal strictures by the bougie 565

Colonic massage 568

Auto-massage 570

Application of electricity to the rectum and colon 571

CHAPTER XIX Glass tests for locating urethral pus 579

Injection test for locating urethral pus 581

Examination by the bougie a boule 594

Urethrometry 596

Estimation of the urethral length 597

Urethroscopy in the male 598

Urethroscopy in the female 605

Urethral injections 607

Application of ointments 618

Urethroscopic treatment 620

Direct application of cold to the uretlm. 622

Prostatic massage 624

Meatotomy 626

Treatment of strictures by gradual dilatation 627

Treatment of strictures by continuous dilatation 640

CONTENTS XV11

CHAPTER XX Page

Urinalysis 646

Sounding for stone 653

Test of bladder capacity 657

Estimation of residual urine 658

Test for absorption from the bladder 659

Cystoscopy in the male 659

Auto-irrigations 675

Cystoscopic treatment 677

The destruction of vesical growths by the high frequency current . . . 678

Catheterization in the male 680

Catheterization in the female 687

Continuous catheterization 689

Aspiration of the bladder 692

CHAPTER XXI Palpation of the kidney 699

Palpation of the ureters 701

Urinalysis 704

Catheterization of the ureters in the male 705

Catheterization of the ureters in the female 714

Pyelometry . 720

Segregation of urine 721

Determination of the functional capacity of the kidneys 725

Pyelography 731

Medication of the renal pelvis and ureters 732

Dilatation of ureteral strictures 733

CHAPTER XXII . t

XVI 11 CONTENTS

Pact

I. Examination of the abdomen.

Mensuration 747

II. Examination of the pelvic organs.

Examination of discharges 749

Digital palpation 750

Examination by means of specula 759

Sounding the uterus 764

Digital palpation of the uterine cavity 766

Examination of sections and scrapings from the uterus 768

Exploratory vaginal incision 768

Vaginal irrigations 771

Local applications to the vagina and cervix 774

Application of powders to the vagina 775

Vaginal tampons 776

Intrauterine douche 779

Intrauterine applications 783

Tamponing the uterus 786

Bier's hyperemic treatment in gynecology 789

Pelvic massage 789

Scarification of the cervix 791

Dilatation of the cervix 803

Curettage 807

Index 813

■4IBRAB1

Diagnostic and Therapeutic

Technic