Medical diagnosis : with special reference to practical medicine: a guide to the knowledge and discrimination of disease

Front matter

HX641 22301 RC71 .D11 1880 Medical diagnosis :

RECAP w

JUL mo

Preface To The Fifth Edition

This edition has been thoroughly revised ; condensed in some parts, extended in others. I have especially aimed at taking cognizance of all such new facts of importance as have been added to Medical Diagnosis in the last few years; and this has necessitated almost rewriting some chapters, in particular those on the Nervous System and on the Blood. In the laborious undertaking I have been stimulated by the continued favor the volume has received. I may add that a German translation is now in process of publication by Hirschwald, in Berlin. A number of new wood-cuts have been introduced into the present edition.

1700 "Walnut Street, Philadelphia, Dec. 1, 1880.

Open Knowledge Commons

EXTRACT FROM PREFACE TO THE FIRST EDITION.

My chief aim in writing this work has been to furnish advanced students and young graduates of medicine with a guide that might be of service to them in their endeavors to discriminate disease. I have sought to offer to those members of the profession who are about to enter on its practical duties a book on Diagnosis of an essentially practical character, — one neither so meagre in detail as to be next to useless when they encounter the manifold and varying features of disease, nor so overladen with unnecessary detail as to be unwieldy and lacking in precise and readily-applicable knowledge.

In executing my undertaking, two plans offered themselves : either to describe morbid states in compliance with the usual pathological classification followed in treatises on the Practice of Medicine, or to group them according to their marked symptoms. The former plan would have been far the easier, but the latter seemed to me the more suitable for a volume of this kind; and although it has involved much labor, and has rendered the task much more difficult of accomplishment, its advantages appeared to me so great that I have adopted it throughout. That this attempt at a purely clinical classification is not perfect, I am fully aware. But, with all its shortcomings, I venture to hope that it will not be devoid of value as an aid in their studies to those for whom it is intended.

Some of the statements made may appear too absolute, and as not taking sufficient notice of the many exceptions which may arise; but it was impossible to avoid this without very lengthy discussion : and even in the lengthiest discussion all exceptions and all possible points of fallacy would not have been mentioned; for Nature does not limit herself in her irregularities any more than in her rules. The text must, therefore, be looked upon as

6 EXTRACT FROM PREFACE TO THE FIRST EDITION.

treating only of general laws and of their most notable infractions ; in fact, but as a series of etchings, with here and there a prominent figure shaded, but not as an attempt to reproduce the colors of an original whose varied hues could not be closely copied, even by the hand of a master.

The main object of this work is, what its title implies, the consideration of Medical Diagnosis. In connection with this, however, I have endeavored to take cognizance of the prognosis of individual affections, and occasionally the record of cases has been introduced by way of elucidation. To have done this to a much greater extent, though in some respects desirable, would have swelled the work to an inordinate size.

The wood-cuts employed as illustrations are all original. Many are from sketches, or at least are based on sketches, taken directly from cases of interest.

Philadelphia, April, 1864.

EXAMINATION OF PATIENTS, AND SOME SYMPTOMS OP GENERAL IMPORT.

Position of the Body 30

General Aspect — Expression of Countenance 31

Skin 33

Pulse. 34

Tongue 40

Sensations of Patients 43

Temperature of the Body 44

Chapter II. ' Diseases Of The Brain, Spinal Cord, And Their Nerves

Deranged Intellection 52

Delirium '. 53

Stupor 55

Coma 56

Insomnia 57

Deranged Sensation 57

Hyperesthesia 57

Anaesthesia 59

Headache : 64

Vertigo 66

Derangement of Special Senses , 69

Deranged Motion 76

Paralysis 76

Hemiplegia 85

Monoplegia 92

Paraplegia 94

Palsies usually limited 104

Local Palsies 108

Locomotor Ataxia 117

Tremor 121

Spasms— Convulsions 123

PAGE

Deranged Nutrition and Secretion 125

Acute Affections of which Delirium is a Prominent Symptom 129

Acute Meningitis 129

Tubercular Meningitis 134

Cerehro-spinal Meningitis 139

Delirium Tremens 139

Acute Mania 142

Diseases marked by Sudden Loss of Consciousness and of Voluntary

Motion..' 143

Sun-stroke 156

Catalepsy 158

Diseases marked by Convulsions or Spasms 159

Epilepsy 159

Chorea 164

Diseases characterized by Gradual Impairment of the Mental Faculties

with Paralysis 175

Chronic Softening 175

Tumor 179

General Paralysis 182

Diseases characterized by Enlargement of the Head 184

Chronic Hydrocephalus 184

Hypertrophy of the Brain 185

Diseases characterized by Paroxysmal Pain 186

Neuralgia in General 186

Facial Neuralgia 188

Hemicrania 189

Sciatica 191

Chapter III. Diseases Of The Upper Air-passages

Acute Laryngeal Affections 202

Acute Laryngitis 202

(Edema of the Glottis 204

Croup 205

Chronic Laryngeal Affections 212

Chronic Laryngitis 212

Diseases of the Trachea 218

Chapter IV. Diseases Of The Chest

General Considerations 218

Section I. Diseases Of The Lungs

PAGE

Different Methods of Physical Diagnosis, and the Physical Signs of Pulmonary Diseases 221

Mensuration 222

Sounds of Eespiration in Health and in Disease 236

Changes in the Vesicular Murmur 237

Bronchial Respiration 241

New or Adventitious Sounds 243

Auscultation of the Voice 248

Combination of the Physical Signs and the Examination of Patients

affected with Disease of the Lungs 250

Principal Symptoms of Diseases of the Lungs 253

Dyspnoea 254

Cough 258

The Sputa 261

Haemoptysis 262

Diseases in which Clearness on Percussion is met with 265

Acute Bronchitis 266

Chronic Bronchitis 270

Emphysema 272

Diseases in which Dulness on Percussion occurs 277

Acute Affections of the Lungs ; 301

Acute Phthisis 301

Acute Pneumonia 305

Acute Pleurisy ". 316

Diseases presenting Dilatation of the Chest, Displacement of the Liver

and Heart, and Dyspnoea 322

Pneumothorax 323

Diseases in which Extraction of the Chest occurs 335

Section II. Diseases Of The Heart

Examination of the Heart by the different Methods of Physical Diagnosis 342

PAGE

ral and Local Symptoms oi D of the Heart 356

Cardiac Dropsy 356

Derangement of the circulation 357

Cardiac Pain 358

Palpitation 362

Functional Disorders of the Eearl 363

Disorders characterized by Palpitation, associated or not with

Change of Rhythm 364

Organic Disease- of the Eearl 369

Acute Diseases presenting Pain in the Cardiac Region; Symptoms of a Disturbed Circulation ; and a Change in the Sounds of

the Heart, or their Replacement by .Murmurs 369

Acute Endocarditis 370

Acute Pericarditis 376

Myocarditis 385

Cbronic Diseases attended with Increased Extent of Percussion

Dulness, l>ut with Normal or almost Normal Heart-Sounds. 386

Hypertrophy 386

Dilatation 390

Diseases of the Heart exhibiting more or less of the Signs and Symptoms of Enlargement of the Organ, and accompanied

by Endocardial Murmurs 396

Valvular A Meet ions 396

Displacements of the Heart 410

DISEASES OP THE ABDOMEN.

General Considerations 440

PAGE

Methods and General Eesults of Physical Examination of the Ahdomen 441

Section I. Diseases Of The Stomach

Loss of Appetite 449

Excessive Acidity of the Stomach 451

Platulency 452

Nausea and Vomiting 452

Pain 460

Diseases of the Stomach with Pain and Soreness at the Epigastrium, and

Vomiting 466

Acute Gastritis 466

Chronic Diseases of the Stomach 471

Chronic Gastritis 471

Gastric Ulcer 472

Gastric Cancer 476

Section II. Diseases Op The Intestines And Peritoneum

Alvine Discharges 484

Diseases attended with Paroxysms of Pain referred chiefly to the Middle or Lower Part of the Abdomen, without marked Tenderness,

etc 486

Diseases attended with Pain and marked Tenderness in the Umbilical

Eegion or diffused over the Abdomen 497

Acute Enteritis 497

Acute Peritonitis 500

Chronic Peritonitis 511

Diseases attended with Pain and Tenderness in tbe Eight Iliac Eossa 513

Affections of the Caecum and its Appendix 513

Diseases attended with Constipation, and of which it is a Prominent

Symptom 518

Intestinal Obstruction 519

Habitual Constipation 529

Disorders in which Morbid Discharges from the Bowels occur 531

Diarrhoea 532

Dysentery 536

Intestinal Hemorrhage, or Melsena 539

Patty Diarrhoea 540

PAGE

Diseases attended with Vomiting and Purging 541

Cholera Infantum 541

Cholera Morbus 543

Cholera 544

Section III. Diseases Of The Liver

Jaundice 548

Acute Diseases of the Liver, attended generally with Slight Enlargement

of the Organ, and with more or less Jaundice 553

Acute Congestion 553

Acute Hepatitis 554

Inflammation of the Gall-Bladder and Gall-Ducts 559

Acute Diseases characterized by Decrease in the Size of the Liver, and

by Deep Jaundice 561

Acute Yellow Atrophy 561

Chronic Diseases attended with Enlargement of the Liver, and with

slight or no Jaundice 563

Chronic Congestion 563

Chronic Hepatitis 566

Abscess of the Liver 567

Fatty Liver 572

Waxy Liver 573

Cancer of the Liver 574

Hydatids of the Liver 582

Chronic Diseases attended with Decreased Size of the Liver and with

Abdominal Dropsy 586

Cirrhosis 586

Chronic Atrophy of the Liver 592

Section IV. Abdominal Enlargement

General Abdominal Enlargement 593

Ascites 593

Chronic Tympanites 600

Partial Abdominal Enlargement 601

Abdominal Tumors 601

Section V. Abdominal Pulsation

Aortic Pulsation 614

Abdominal Aneurism 614

Chapter VII. On The Urine, And On Diseases Op The Urinary Organs

PAGE

Urine 619

Color 623

Specific Gravity 627

Eeaction 628

Changes in the Quantity of the more Important Constituents 630

Presence of Abnormal Substances in the Urine 645

Sediments 668

Urinary Organs 670

Diseases of the Kidney of which Pain is a Prominent Symptom... 670

Nephritis 671

Nephralgia 672

Diseases marked by an Albuminous Condition of the Urine, with

more or less Dropsy 676

Acute Bright's Disease 677

Chronic Bright's Disease 684

Diseases associated with Purulent Urine 699

Acute Cystitis 699

Chronic Cystitis.-. 700

Abscess of the Kidney 701

Pyelitis 704

Disorders in which a very large Amount of Urine is discharged... 707

Diabetes 707

Chronic Diuresis 710

Diseases in which little or no Urine is discharged 712

Suppression of Urine 712

Pretention of Urine 713

RHEUMATISM AND GOUT.

Acute Kheumatism 752

Chronic Kheumatism 757

Gout 760

Rheumatic Arthritis 762

Rickets 764

Chapter XI. Fevers

Continued Fevers 770

Simple Continued Fever 770

Catarrhal Fever 771

Typhoid Fever 773

Typhus Fever 785

Cerebro-spinal Fever 794

Relapsing Fever 801

Periodical Fevers 805

Intermittent Fever 807

Remittent Fever 810

Congestive Fever 818

Yellow Fever 826

Eruptive Fevers 832

Scarlet Fever 832

Measles 837

Rubeola 840

Smallpox 841

Dengue 846

Erysipelas 847

Chapter XII. Diseases Op The Skin

Erythematous Diseases 853

Papular Diseases 855

Vesicular Diseases 856

Bullous Diseases 858

LIST OF ILLUSTKATIONS. 15

PAGE

Pustular Diseases 859

Squamous Diseases 860

New Growths 863

Hypertrophies 864

Parasitic Diseases 865

Altered Gland Secretions 868

Nervous Diseases 869