A text-book of medicine : for students and practitioners

Front matter

I

A

TEXT-BOOK OF MEDICINE

Author's Preface To The Thirteenth Edition

The extent to which my text-book has been used, both in Germany and in other countries,* justifies me in the assumption that it has exercised some little influence upon the professional thought and practice of numerous medical readers, and imposes upon me the obligation of employing every opportunity for the improvement and perfection of my work. Yet I must confess that this task seems more difficult to me with every new edition of the book, for scientific workers are making deep and extensive investigations into the many subdivisions of internal medicine, with such zeal and skill that it becomes difficult for any one man to keep step with the unceasing progress of investigation in this wide domain, and to maintain that complete and universal command of facts and theories which is essential for a presentation of the subject, which shall be at once brief and true to the present standpoint of science. The author has often been painfully sensible of these limitations of his personal knowledge and ability, but he hopes that this will be regarded not merely as subject for criticism, but also as an excuse and an incentive to clemency, in case a reader who is expert in any specialty finds here and there an omission or an error. Above all, I beg the reader to consider that no text -book such as the present one ought to replace, or could replace, the vast material of the larger reference books. My purpose was not to collect all the facts of pathology which have been discovered up to date, nor all the methods of treatment which may have been recommended, wisely or unwisely, nor ail the theories or views which have been propounded. My wish was to give a complete presentation of the essentials of our present knowledge and views with regard to the various diseases, from a scientific and individual standpoint ; and I desired particularly to impart to the reader an insight into the origin and relation of the various morbid phenomena. To this end I have brought the facts of clinical experience into the closest possible relation with the data of pathological anatomy and of general pathology, and have endeavored, also, in discussing therapeutics, to deduce from the nature of the symptoms a basis for rational medical opinion and treatment, although I have not undervalued the importance

* So far as I have been informed, translations of my text- book have appeared in the following languages : French, English, Italian, Spanish, Russian, modern Greek, Turkish, and Japanese : and some of these translations have had several editions.

iii iv

AUTHOK'S PKEFACE of simple experience. A text-book intended for students and a larger circle of graduate readers ought not to incline too decidedly toward any one of the prevailing currents of scientific opinion. It should, however, acquaint the reader to such an extent with the questions at present under discussion relating to internal medicine, as to give him at least a fair start in his further studies.

The author has made an honest effort to bring the present thirteenth edition of this book up to the level of contemporary medical thought and knowledge. Large portions of the book have been almost completely rewritten — in particular, the whole doctrine of gastric diseases and several chapters in other sections, including gall-stones, intestinal parasites, etc. Almost all portions of the book have received numerous additions and improvements, so that this edition may be said with justice to be completely revised. That even now my work is imperfect I am well aware. I shall, therefore, be thankful to any one who will inform me of the mistakes or omissions he discovers.

A. Strumpell.

TRANSLATORS' PREFACE

The work of Professor Striimpell has been so long familiar that it is hardly necessary for the translators to introduce it again to the English-speaking portion of the medical profession or to express again their admiration of the work. Since the second edition of this translation was published in 1893 seven new editions have appeared in Germany, so that the book has been almost wholly rewritten, although it still retains all the merits of the earlier production, with the advantage of being fully in line with the most recent medical investigations. The translators have kept as close to the original as seemed consistent with clearness. The doses in the metric system have been changed to the approximate equivalents in apothecaries' weight, the original doses being retained in parentheses. As in the former editions, the translators have substituted specimens of handwriting in English in the chapter on general paralysis for the original in German script. These specimens were kindly furnished them by the late Dr. E. P. Elliot, of the Danvers Insane Hospital. The translators have also added a chapter upon the plague and various notes which they hope may prove of assistance to the American practitioner. These additions are inclosed in brackets and signed by the initials of the translators, to distinguish them from the (unsigned) additions, also in brackets, of Dr. Shattuck.

Boston, June, 1901.

c oj^teistt s

I. Typhoid Fever .1

Phenomena and Complications relating to the Separate Organs . . 9 Peculiarities in the Course of the Disease ....... 20

Relapses of Typhoid Fever ......... 21

IT. Typhus Fever . . 30

III. Relapsing Fever .33

IV. Scarlet Fever 38

VH. Small-pox 54

Course of the Fever, Symptoms presented by Separate Organs, and

Complications ........... 57

VIII. Varicella .... . .62

IX. Erysipelas . 63

X. Diphtheria . / ■ . . . 67

XI. Influenza (Grippe) . . . . . . . ... .77

XH. Dysentery - . . . . . . .81

XIV. Malarial Diseases 93

Intermittent Fever ........... 96

Pernicious Intermittent Fever . . . . . . . .98

Remittent and Continuous Forms of Malarial Fever . . . .99

Chronic Malarial Cachexia . . . . . . . .99

Masked Intermittent Fever .99

Typho-malarial Fever . . . . . . . . . .100

XV. Dengue . . . 102

XVI. Yellow Fever . . . 104

XVTI. Plague 107

XVIII. Epidemic Cerebro-spinal Meningitis . Ill

XIX. Septic and Pysemic Diseases . . . . . . . . .116

XX. Hydrophobia (Rabies canina) 122

XXI. Glanders (Farcy) 125

XXII. Malignant Pustule (Anthrax. Mycosis intestinalis) 127

XXIII. Trichinosis 131

DISEASES OF THE NOSE

I. Coryza . . . 135

II. Chronic Rhinitis * 137

III. Nose-bleed . . .139

yii viii

DISEASES OF THE LARYNX CHAPTER PAGE

I. Acute Laryngeal Catarrh (Acute Laryngitis) ...... 140

II. Chronic Laryngitis (Chronic Laryngeal Catarrh) ..... 143

III. Laryngeal Perichondritis ......... 145

IV. (Edema of the Glottis . . 146

V. Tuberculosis of the Larynx (Consumption of the Larynx) .... 147

VI. Paralyses of the Laryngeal Muscles ........ 150

Paralyses in the Distribution of the Superior Laryngeal Nerve . . . 150 Paralyses in the Distribution of the Inferior Laryngeal or Recurrent Nerve . 150

VII. Spasm of the Glottis 153

VIII. New Growths in the Larynx ......... 155

Benignant Growths in the Larynx ........ 155

Malignant Growths. Carcinoma of the Larynx ..... 155

Section III Diseases Of The Trachea And The Bronchi

I. Acute Catarrh of the Trachea and the Bronchi ...... 156

The Milder Forms of Acute Bronchitis ....... 159

The Severer Febrile Forms of Acute Bronchitis 159

Catarrh of the Finer Bronchi. Capillary Bronchitis ..... 160

II. Chronic Bronchitis . . . . . . . . . . . 162

III. Foetid Bronchitis (Putrid Bronchitis) 167

IV. Croupous Bronchitis (Fibrinous Bronchitis) ...... 170

V. Whooping Cough (Pertussis) ......... 172

VI. Bronchiectasis ............ 176

VII. Stenosis of the Trachea and Bronchi ....... 180

Tracheal Stenosis 180

Bronchial Stenosis ........... 181

VIII. Bronchial Asthma 181

Section IV Diseases Of The Lungs

I. Pulmonary Emphysema . . . . . . . . . .187

Symptoms and Course of the Disease . . . . . . . 190

Other Symptoms in the Lungs and in Other Organs ..... 193

II. Pulmonary Atelectasis (Compression of the Lungs. Aplasia of the Lungs) . 195

III. Pulmonary CEdema . . .197

IV. Catarrhal Pneumonia (Broncho-pneumonia. Lobular Pneumonia) . . 199 V. Croupous Pneumonia . . . . . . . . . 204

Description of Single Symptoms and Complications ..... 209

Special Peculiarities and Anomalies in the Course of Pneumonia . . 218

VI. Tuberculosis of the Lungs (Pulmonary Phthisis. Pulmonary Consumption) 226

General Pathology and iEtiology of Tuberculosis . i . . . 226

^Etiology of Tuerbculosis in Man ........ 228

Pathological Anatomy of Tuberculosis, especially of Pulmonary Tuberculosis 231 Clinical History of Tuberculosis in General and of Pulmonary Tuberculosis

in Particular 234

Special Symptoms and Complications ....... 237

Symptoms on the Part of the Lungs ........ 237

Symptoms on Physical Examination ....... 241

General Symptoms in Pulmonary Tuberculosis . . . . . 246

Symptoms and Complications on the Part of other Organs . . . 248

VII. Acute General Miliary Tuberculosis ........ 261 ix

VIII. Gangrene of the Lungs 266

IX. Diseases from the Inhalation of Dust (Pneunionoconiosis) . . . 270 X. Embolic Processes in the Lungs (Hsemorrhagic Infarction of the Lungs) . 273 XL Brown Induration of the Lungs (Lungs of Heart Disease) . . . . 275 XII. Tumors of the Lungs. Cancer of the Lungs. Echinococcus of the Lungs.

Pulmonary Syphilis .......... 276

Section V Diseases Of The Pleura

I. Pleurisy . . .279

Physical Signs 285

Various Forms of Pleurisy ......... 288

II. Peripleuritis . . .295

III. Pneumothorax . . . . . . . . . . . 295

TV. Hydrothorax. Hsematothorax ........ 299

V. New Growths of the Pleura 300

VI. Mediastinal Tumors 301

VII. Actinomycosis of the Thoracic Cavity ....... 302

DISEASES OF THE HEART

I. Acute Endocarditis (Endocarditis verrucosa, Endocarditis ulcerosa) . . 304

EL Valvular Disease of the Heart 308

General Pathology of Valvular Disease of the Heart ..... 310 Insufficiency of the Mitral Valve . . . . . . . .311

Stenosis of the Mitral Orifice (Mitral Stenosis) 314

Insufficiency of the Semilunar Valves of the Aorta . . . . .316

Stenosis of the Aortic Orifice ......... 320

Insufficiency of the Tricuspid Valve ........ 321

Stenosis of the Tricuspid Orifice ........ 322

Insufficiency of the Pulmonary Valve ....... 323

Stenosis of the Pulmonary Orifice (Pulmonary Stenosis) and the other Congenital Lesions of the Heart . . . . . . . 323

Combined Valvular Diseases of the Heart ....... 325

General Sequelae and Complications of Valvular Disease of the Heart . 326 General Course and Prognosis of Valvular Disease of the Heart . . 333 Treatment of Valvular Heart Disease . . . . . . . 334

III. Diseases of the Myocardium ......... 340

Interstitial Myocarditis (Fibrinous Degeneration of the Myocardium. Sclerosis of the Coronary Arteries) . . . . " . . . . 340

So-called Idiopathic Hypertrophy of the Heart (Mechanical Strain of the

Heart) .345

Hypertrophy of the Heart, Associated with Congenital Smallness of the

Systemic Arteries . . . ... . . . . . 350

Primary Weakness of the Myocardium ( Congenital Weakness of the Heart ; Weakened Heart; Acute Muscular Strain of the Heart; Toxic Weakness of the Heart) . . . . . . . . . 351

The So-called Fatty Heart 353

IV. Cardiac Neuroses ........... 355

Angina Pectoris (Stenocardia) ......... 355

Nervous Palpitation .......... 356

X

DISEASES OF THE PERICARDIUM CHAPTER PAGE

Special Forms of Pericarditis 363

II. Hydro-pericardium, Haemo-pericardium, and Pneumopericardium . . 369

SECTION III

DISEASES OF THE VESSELS

I. Arterio-sclerosis (Endarteritis chronica deformans. Atheroma of the Vessels) 370

II. Aneurism of the Thoracic Aorta . . . . . . . 374

III. Aneurisms of the Other Vessels , 379

IV. Rupture of the Aorta .......... 380

V. Narrowing of the Aorta .......... 380

DISEASES OF THE MOUTH, TONGUE, AND SALIVARY GLANDS

I. Catarrhal Stomatitis .......... 382

II. Ulcerative Stomatitis . . . . . . . . . . 383

III. Aphthous Stomatitis .......... 385

TV. Thrush .386

V. Glossitis ' 388

Acute Parenchymatous Glossitis . . . . . . . 388

Glossitis Dissecans . . . . . . . . . . 388

Lingual Psoriasis. Leucoplacia ........ 388

VI. Noma .389

VII. Parotitis (Mumps) 390

Idiopathic, Primary Parotitis ......... 390

Secondary Suppurative Parotitis . . . . . . . .391

VIII. Angina Ludovici 392

IX. Anomalies of Dentition .......... 392

DISEASES OF THE SOFT PALATE, TONSILS, PHARYNX, AND NASO -PHARYNX

I. Sore Throat (Inflammation of the Soft Palate and of the Tonsils) . . 394

Catarrhal Sore Throat . . . . . . ... . 395

Follicular Tonsillitis . . .396

Tonsillar and Peritonsillar Abscess (Parenchymatous Sore Throat) . . 396

Necrotic Tonsillitis (Necrotic Sore Throat) ...... 397

II. Chronic Hypertrophy of the Tonsils . . ... . . . . 399

III. Chronic Pharyngitis . . . . . . . . . . 400

Chronic Catarrh of the Naso-pharynx, Chronic Posterior Nasal Catarrh . 400

Pharyngitis Sicca . . . . . . . . . . . 401

Hypertrophic Catarrh in the Pharynx and Naso-pharynx .... 401

IV. Retropharyngeal Abscess .......... 403

SECTION III

DISEASES OF THE OESOPHAGUS

I. Inflammation and Ulcer of the (Esophagus ....... 404

II. Dilatation of the (Esophagus ......... 406

CONTEXTS xi

Diffuse Dilatation ........... 406 m. Stenosis of the (Esophagus ...... . 409

TV. Cancer of the CEsophagus ......... 412

V. Rupture of the CEsophagus . 414

VI. Neuroses of the CEsophagus . . . . . ... . . 414

Sp*asni of the CEsophagus .......... 414

Paralysis of the CEsophagus ...... . 415

SECTION IV

DISEASES OF THE STOMACH

I. Brief Preliminary Eemarks on the Examination of the Gastric Contents . 415 Constituents of the Gastric Juice, particularly Free Hydrochloric Acid.

Pep sine, and Lactic Acid . . . . . . . . .417

Determination of the Motor Activity of the Stomach . . . 419

Estimation of the Size and Position of the Stomach ..... 420

Testing the Absorptive Powers of the Stomach . . . . . .421

Demonstration of Blood in the Gastric Contents ..... 422

II. Acute Gastric Catarrh (Acute Gastritis) 422

III. Chronic Gastritis. Chronic Catarrh of the Stomach ..... 425

IV. Phlegmonous Gastritis .......... 432

V. Gastric Ulcer 432

VI. Cancer of the Stomach . . . . . . . .' 444

VII. Anomalies of the Secretion of Gastric Juice ...... 452

Anacidity of the Stomach (Achlorhydria) . Achylia Gastrica . . . 452

Hypersecretion and Hyperacidity of the Gastric Juice (Acid Dyspepsia) . 455

Dyspepsia with Hypersecretion of the Gastric Juice ..... 457

Periodical (Intermittent) Hypersecretion (Gastroxynsis) .... 459

VIII. Abnormalities in the Size and Position of the Stomach. Motor Disturbances of the Stomach ....... . - . 460

Abnormalities in the Size of the Stomach. Atony of the Stomach . . 460

Abnormal Position of the Stomach. Gastroptosis ..... 462

IX. Nervous Dyspepsia ........... 463

SECTION V

DISEASES OF THE IXTESTIXES

I. Intestinal Catarrh - 468

Appendix. Membranous Enteritis and Mucous Colic .... 474

EE. Cholera Morbus (Cholera Infantum) . . . . . . . 475

in. Intestinal Catarrh of Children .477

TV. Typhlitis and Perityphlitis (Appendicitis) ... . . 482

V. Perforating Ulcer of the Duodenum ........ 488

VI. Tuberculosis of the Intestines . . . . . . . . . 488

VII. Syphilis of the Eectum . 490

VIII. Cancer of the Intestines .......... 491

IK. Haemorrhoids 493

X. Habitual Constipation .......... 495

XI. Stricture and Obstructions of the Intestines ...... 499

Intestinal Constriction . . . . . . . . . . 502

Intestinal Obstruction .......... 503

XII. Intestinal Parasites .......... 508

Oxyuris vermicularis ... . . . . . . . . 516

Anchylostoma duodenale .......... 518

Trichocephalus dispar . . . . . . . . .519 xii

Section VI Diseases Of The Peritoneum Chapter Page

I. Acute Peritonitis . . .• • . . . . . . 520

II. Chronic and Tubercular Peritonitis ........ 529

III. Ascites . .533

IV. Cancer of the Peritoneum .......... 535

Section VII Diseases Of The Liver, Bile-ducts, And Portal Veln

I. Catarrhal Jaundice ........... 536

II. Acute Febrile Jaundice (Infectious Jaundice. Weil's Disease) . . . 542

in. Biliary Calculi 54a

IV. Suppurative Hepatitis . . . . . . . . . . 553

V. Cirrhosis of the Liver .......... 555

VI. Biliary Cirrhosis and Hypertrophic Cirrhosis of the Liver .... 562 VII. Acute Yellow Atrophy of the Liver ........ 565

Appendix. Pernicious Jaundice. Cholsemia and Acholia . . . 569

VIII. Icterus Neonatorum . . . . . . . . . . 570

LX. Syphilis of the Liver . . . . . . . . . . 571

X. Cancer of the Liver and Bile-ducts ........ 572

XL Echinococcus of the Liver ......... 575

XII. Circulatory Disturbances in the Liver . . . . . . . 578

XIII. Atrophy, Hypertrophy, and Degenerations of the Liver .... 579

XIV. Anomalies in the Shape and Position of the Liver ..... 581 XV. Suppurative Pylephlebitis . ........ 582

XVI. Thrombosis of the Portal Vein ' . .583

Appendix. Diseases of the Pancreas ....... 585

Hsemorrhages into the Pancreas ........ 585

Atrophy of the Pancreas .......... 585

Cysts of the Pancreas .......... 586

Cancer of the Pancreas . . . . . . . . . .586

Pancreatic Calculi . . . . ... . . . . 587

Diseases of the Kidneys, the Pelvis of the Kidney, and the Bladder diseases of the kidneys

I. General Preliminary Remarks upon the Pathology of Renal Disease . . 588

Casts and other Abnormal Morphological Constituents of the Urine in Renal

Disease * • 592

The Dropsy of Renal Disease . . . . . . . • 594

The Changes in the Circulatory Apparatus in Renal Disease . . . 601

II. Acute Nephritis 603

III. The Subchronic and Chronic Forms of Nephritis, with the Exception of the

Genuine Contracted Kidney ........ 618

IV. Contracted Kidney . . . . . ... . ... 625

VI. Purulent Nephritis and Perinephritis ....... 640

Purulent Nephritis • -640

Perinephritic (Paranephritic) Abscess ....... 641

VII. Disturbances of Circulation in the Kidneys ...... 643

CONTEXTS xiii

The Congested Kidney .......... 643

Embolic Infarction in the Kidneys ........ 643

VIII. New Growths in the Kidneys . . . . . . . . 644

IX. Parasites of the Kidneys and of the Urinary Passages. Chyluria . . 646

Echinococcus of the Kidney ......... 646

Distoraa Haematobium (Bilharzia Hsematobia) ...... 646

Strongylus or Eustrongylus Gigas ........ 647

Filaria Sanguinis. Chyluria ......... 647

X. Movable Kidney (Floating Kidney. Pen Mobilis) ..... 648

Appendix. The Diseases of the Suprarenal Capsules and Addison's

Disease (Bronzed Skin) ......... 650

SECTIOX II

DISEASES OF THE PELVIS OF THE KIDNEY AND OF THE BLADDER

I. Inflammation of the Pelvis of the Kidney. Pyelitis ..... 654

IT. Nephrolithiasis ........... 657

TIL Tuberculosis of the Genito -urinary Apparatus ...... 662

TV. Hydronephrosis ........... 665

V. Cystitis 667

VI. New Growths in the Bladder . . . . . . . . .672

VTI. Enuresis Nocturna . . . . . . . . . . 673

I. Acute Articular Rheumatism . . . . * . . . . . 675

II. Chronic Articular Rheumatism (Chronic Polyarthritis) and Arthritis

Til. Acute and Chronic Muscular Rheumatism ....... 694

IV. Acute Polymyositis 698

Diseases affecting1 the Blood and Tissue-metamorphosis

I. Anaemia and Chlorosis . . . . . . . . ( . . 708

General Preliminary Remarks as to the Classification and JEtiology of the

Various Forms of Anaemia ........ 708

Symptomatology of Anaemia . . . . . . . . .711

II. Progressive Pernicious Anaemia . . . . . . . .719

IV. Pseudo-leukaemia . . . . . . . ' . . 733

V. HsemoglobinEemia and Hemoglobinuria . . . . . . .736

VI. Scurvy 738

Appendix. Barlow's Disease ........ 743

VII. Purpura. Morbus Maculosus VCerlhoni. Peliosis ..... 744 VTLT. Haemophilia 746

EK. Diabetes Mellitus 748

X. Diabetes Insipidus ........... 767

XL Gout 770

XII. Obesity .779

m Scrofula . . 787 xiv