Differential diagnosis and treatment of disease; a text-book for practitioners and advanced students

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Preface

To bring the broad domain of practical medicine fairly within the grasp of the family physician, and to assist the advanced student in acquiring a clinical foundation has been my aim.

The general practitioner, representing the unity and connection of the various branches of medical practice, must grasp the practical details of his art in order to be useful at the bedside; and a book to be of value to the family physician should convey clinical experience without the exhaustive and often purely theoretical details to be found and sought for in monographs. Such a work I have endeavored to write.

It has been my desire to reestablish the relations of internal medicine, surgery, and the several specialties; for this reason I have presented specialists methods from the view-point of the general clinician. Disease is neither medical nor surgical nor does it hover on the border lines, but the treatment of disease has become more surgical and the arbitary division into medical and surgical disease is no longer tenable. This unitarian principle should not be ignored in the presentation of disease, and many methods of diagnosis and treatment originally worked out by the specialist have become, or should become, common property.

Drugs no longer' dominate our therapeutics; therefore the prominence given to hygienic, prophylactic, dietetic, hydrotherapeutic, and physical methods of treatment. At the same time well-tried and valuable formula? are distributed throughout the book.

In prescription writing the apothecaries' weight and not the metric system has been used. However, simple rules for converting one into the other are given.

The special chapters on the Technique of Diagnosis and Laboratory Aids, on Paediatrics, and the various specialties, on diseases of the Osseous, Muscular, and Articular System, on Nutrition and Diet, on the Management of Dropsy and Effusion, on Massage, Vibration, Dry Hot Air Treatment, Poisons and Anaesthesia, it is to be hoped will not. be an unwelcome addition to a book on practice. Each chapter is prefaced by a synopsis of its contents and by brief introductory remarks on the clinical pathology of its subjects.

In writing this book a lucid brevity in general diction has been the aim of the author.

The bulk of this volume is from the author's pen.

The chapter on Orthopaedics was contributed by Dr. C. Jaeger, Chief of the Orthopaedic Department of Vanderbilt Clinic, New York.

vi

PREFACE

My brother, Wm. Caille, D.D.S., is the author of the Essay on the Care of the Teeth. Dr. R. L. Loughran has contributed Instructions for Keeping Case Records and Accounts.

Dr. R. H. Halsey and Dr. H. B. Sheffield, both instructors in Medicine in the New York Post-Graduate Medical School and Hospital, have given valuable aid in preparing the chapter on Infectious Fevers and Dermatological Memoranda.

In revising some of the special chapters, the author has received helpful suggestions from Dr. T. M. Brooks, Professor of Histology and Pathology ; Dr. G. M. Edebohls, Professor of Gynaecology; Dr. F. Torek, Professor of Surgery; Dr. G. M. Schlapp, Neurologist, Cornell University; and Dr. C. Mund, New York Ophthalmic and Aural Institute.

Dr. I. H. Berry has aided faithfully in arranging the manuscript, and my assistants in various institutions have helped to collect histories and original illustrations. The very excellent index is the work of Miss M. S. E. Cars well.

The author tenders appreciative thanks to all who have aided in this undertaking. To the publishers, thanks are due for their unvarying courtesy and hearty cooperation during the preparation of the work.

Augustus CailiA

753 Madison Avenue, New York.

Introduction: The Requisites of the General Practitioner, his Relation to the Community and to Specialism 1 •

Chapter I The Technique Of Diagnosis And Laboratory Aids To Clinical Diagnosis

The technique of diagnosis 9

The causes of disease . .• . . . 10

General examination 10

Regional examination 15

Special examinations 16

CHAPTER I — Concluded

Examination of the urine 17

Microscopical examination of urine 24

Examination of feces 27

Characteristics 27

Microscopical examination of feces 28

Worms 30

Clinical examination of the stomach contents ■ . . . .31

Microscopical examination 32

Chemical analysis 32

Examination of sputum 35

Transudates, puncture fluids, cyst contents 37

Exudates 38

Stains ' 40

Breast milk 40

Cultures 40

Blood • 42

Significance of hyperleucocytosis 44

Preparation of blood slides 44

Tissue specimens 50

Analysis of drinking water 51

Cytodiagnosis, cytolysis, etc. 52

Cryoscopy 54

Phloridzin test 55

Directions for preparing specimens 55 viii

Chapter II Page

Feeding in sickness 57

Rectal alimentation — Nutrient enemata 59

Gavage 60

Flushing the stomach and the bowels; lavage 60

Enteroclysis — Low and high enemata and colon inflation 63

Antipyretic measures 64

Drug antipyretics . . .65

Hydrotherapy; balneotherapeutics 65

Cold air 69

Stimulation 69

Drug stimulation 71

Dyspeptic symptoms and thirst 73

Laxatives in acute illness • ... 74

Diaphoretics and diuretics 74

Expectorants and cough mixtures 75

Inhalations 77

Dyspncea 77

Pain in acute and chronic illr.ess 78

Nervousness and insomnia in the absence of pain . 78

Venesection and depletion 79

The nasopharyngeal toilet 80

Tonics in the convalescent stage 82

Mental therapeutics and work for the sick 83

Invalid bed 85

CHAPTER III Care of the new-born . . . . . 87

Points to be observed by nurses 89

When children begin to walk 92

Deformities; malformations 102

Infant feeding 107

Breast feeding; maternal nursing 107

How to nurse .111

Facts about milk 113

Standard of cleanliness 113

Rationale of milk sterilization 114

Pancreatized milk (peptonized milk) 115

Diluents of cow's milk 116

Milk laboratories and prescription writing for milk food 118

Babcock milk tester 118

Diet for children after weaning or during the second year of bottle feeding and

after three years

Disorders of the digestive tract

CONTENTS ix

PAGE

Ailments of the mouth in children 126

Mumps; parotitis 128

Indigestion and diarrhoeal disorders 129

Habitual constipation and difficulties of defalcation in infants 129

Colic and vomiting 129

Acute indigestion 130

Acute catarrhal gastritis in infants 131

Difficult feeding cases in bottle fed infants (prolonged indigestion) . . . .132

Chronic indigestion in older children 133

Acute forms of diarrhoea 134

Dyspeptic diarrhoea; simple diarrhoea 134

Severe acute forms of diarrhoea 134

Enterocolitis, or follicular enteritis 139

Membranous enteritis, or dysentery 139

Chronic diarrhoea 140

Malnutrition and intestinal toxaemia (marasmus, rhachitis, scurvy) . . . 142

Rickets, rhachitis 143

Scurvy in children 145

Worms in children 148

Tuberculous peritonitis in children 149

Diseases of the respiratory tract in children .150

The clinical features of acute bronchitis in children 152

Bronchopneumonia in children (catarrhal pneumonia, capillary bronchitis) . . 153

Acute lobar pneumonia in children (fibrinous, or croupous, pneumonia) . . . 157

Circulatory failure and stimulation in pneumonia 160

Pleuropneumonia — Pleurisy with serous effusion and pyothorax in children . . 160

The significance of fever following operations for pyothorax 167

Whooping cough; pertussis 168

Thymus gland; enlargement and abscess 170

Enlarged bronchial lymph nodes 171

Paralysis and ataxia following diphtheria 179

Croup 179

Disinfection of the sick room 190

Tonsillitis, peritonsillitis; quinsy 191

Hypertrophic tonsils in children 193

Adenoid growths and their removal 195

Retropharyngeal lymphadenitis and abscess 197

Eruptive and other fevers 198

Measles; morbilli 198

Rubella; rotheln; German measles 200

Varicella (chickenpox) 201

Scarlet fever 201

Glandular fever 206

Malaria in children 207

Typhoid fever in children 207

^Vulvovaginitis 208

Masturbation in infants (thigh friction) 209

Familiar forms of nervous derangements peculiar to early life 209

Tics; habit spasms; paroxysmal running in children 209

X

PAGE

Head nodding and nystagmus in rhachitic children 210

Night and day terrors (pavor nocturnus et diurnus) . . . . . . .211

Tetany in infancy (pseudo tetanus) . . .211

Laryngismus stridulus (laryngospasm) 212

Enuresis; bed wetting; incontinence 213

Convulsions in children 214

Chorea (St. Vitus's dance) 215

The paralyses of infancy and childhood 215

Meningitis in children 220

Hydrocephalus 225

Disorders of speech: Stammering, stuttering, and lisping 226

Hysteria in children 226

Mental defects from arrested developments 228

Idiocy; imbecility; cretinism; mutism 228

CHAPTER IV Nutrition and diet

Remarks on digestibility of food 230

The absorption of food 230

The components of food ' 231

Practical dietetics: Liquid, soft, restricted, and special diet 235

Stimulants and beverages 236

Predigested food .238

Concentrated foods 238

Systems of diet 239

Vegetarianism ■ 240

Exercise and digestion 240

Tobacco, food, and digestion 241

CHAPTER V Diseases of the mouth 242

The care of the teeth 250

The care and treatment of the temporary set of teeth 251

Shedding of the temporary and eruption of the permanent set .... 252

Cleaning the teeth 254

Remarks on pulpitis-periostitis, alveolar abscess, and alveolar pyorrhoea . . 255

Remarks on the emergency treatment of toothache 255

Brief remarks on the regulation of the teeth 256

Family type of dental deformity 256

CHAPTER VI Diseases of the oesophagus 257

Anomalies of the oesophagus 257

Acute inflammations of the oesophagus 258

CONTENTS xi

PAGE

Chronic inflammations of the oesophagus — Ulcer and cancer 258

Stricture, paralysis, rupture, diverticulum, etc 259

Paralysis of the oesophagus 26 1

Rupture of the oesophagus 261

Foreign bodies in the oesophagus 261

Chapter VII

Clinical pathology of the stomach and intestine and diagnostic technique . . . 262

Remarks on the clinical pathology of the stomach 262

Motor phenomena and neurosis 262

Sensory phenomena of the stomach 263

Secretory phenomena of the stomach 263

Hydrochloric acid, HC1 264

Digestive ferments - . . . . . . . 265

Diagnostic technique 266

Remarks on the clinical pathology of the intestine 268

Motor phenomena 269

Sensory phenomena 270

Diagnostic technique 270

CHAPTER VIII Gastrointestinal ailments in adults . 273

Acute dyspepsia; acute indigestion; gastricismus 273

Acute gastritis, simple, phlegmonous, toxic, infectious, parasitic .... 273

Chronic dyspepsia 274

Clinical varieties of chronic dyspepsia 274

Dyspepsia with dilatation or atony of the stomach 276

Chronic nervous dyspepsia 277

Secretory neuroses of the stomach 278

Dyspepsia with hyperchlorhydria (hyperacidity) 278

Erosions and ulcer of the stomach 279

Cancer of the stomach 280

Syphilis of the stomach 281

Benign tumors of the stomach 281

Haemorrhage from the stomach 281

Gastrointestinal neuralgia (cardialgia, gastralgia, enteralgia, colic, "stomach

cramps") 282

Indications for operations on the stomach 283

Constipation; obstipation; faecal impaction 283

Tympanites and dilatation of the colon 287

Dilatation of the bowel, congenital and acquired 288

Acute catarrhal enteritis 288

Acute gastroenteritis in adults; cholera morbus 289

Chronic enteritis 290

Dysentery in adults ■ 290

Intestinal ulcer 291

Tuberculosis of the intestine r: ..... . 292 xii

PAGE

Appendicitis ... 292

Diagnostic palpation of the appendix vermiformis . ... 292

Benign and malignant neoplasms of the intestine 295

Intestinal obstruction, acute and chronic 296

Haemorrhage from the intestines 297

Remarks on strangulated hernia and taxis 297

Intestinal parasites 298

Enteroptosis; splanchnoptosis; Glenard's disease 300

Intestinal putrefaction and toxaemia; autoinfection from the intestines; intestinal

antisepsis 301

CHAPTER IX Proctological memoranda (rectal ailments) 304

Preliminary remarks 304

Catarrh of the rectum; proctitis 304

Impaction of faeces 305

Fistula in ano 306

Haemorrhoids (piles) 306

Rectal polypi 308

Pruritus ani 308

Prolapse of the rectum 309

Simple fissure and ulcer of the rectum 309

Ulceration and stricture of the rectum 310

Neuralgia of the rectum 311

Coccygodynia 311

The upper rectum and sigmoid flexure 312

CHAPTER X the digestive system — Concluded

Diseases of the liver 313

Jaundice as a symptom . 314

Catarrhal jaundice in older children and adults 315

Hyperemia or congestion of the liver 316

Acute yellow atrophy of the liver; malignant jaundice 316

Cirrhosis of the liver 317

Abscess of the liver and suppurative pylephlebitis 318

New growths of the liver 319

Hydatid cysts of the liver (echinococcus) 320

Chronic degenerative processes in the liver 321

Disease of the gall bladder and bile ducts 321

Acute catarrh of the bile ducts (not caused by gallstones) 321

Gallstones 321

Cancer of the biliary apparatus ............ 324

Diseases of the pancreas 324

Acute hemorrhagic pancreatitis . 325

Acute suppurative pancreatitis 325

Tumors of the pancreas 326

CONTENTS Xlii

PAGE

Cysts of the pancreas 326

Pancreatic calculus 328

Diseases of the peritonaeum, omentum, and mesenteric glands 329

Acute peritonitis 329

Subphrenic peritonitis (abscess) 331

Chronic peritonitis ■ 331

Cancer of the peritonaeum and omentum 332

The omentum and mesentery 332

Mesenteric and retroperitoneal glands 332

CHAPTER XI Remarks on the clinical pathology of the circulation 333

Congenital heart defects 335

Clinical aspect of hypertrophy and dilatation ......... 336

Acute circulatory failure (heart strain, shock, collapse, rupture) .... 338

Endocarditis, acute and chronic 339

Pericarditis; adherent pericardium; chronic adherent pericardium .... 341

CHAPTER XII THE circulatory system — Continued

Muscular and valvular insufficiency of the heart and heart neuroses . . . 344

Weak heart; congenitally small heart; flabby heart muscle 344

The fat-laden heart (cor adiposum) 345

Chronic degeneration of the heart muscle not due to valvular defects . . . 346

The senile heart and arteriosclerosis 346

Valvular heart disease 347

Signs and symptoms of valvular lesions 348

Diagnosis and prognosis of congenital heart disease 351

Principles of treatment '. ... 351

Visceral neuralgias in heart disease simulating other disease 355

Neuroses of the heart 356

Simple palpitation 356

Arrhythmia of the heart 357

Tachycardia (paroxysmal rapid heart) 358

Bradycardia 358

Spurious angina pectoris 358

Angina pectoris • 359

Diseases of the arteries and veins 359

Arteriosclerosis (atheroma) 360

Phlebitis (inflammation of veins) 361

Varicose veins . .361

Aneurysm . 362

Aneurysm of the aortic arch 362

Aneurysm of the abdominal aorta 363

Lymphatic system . . . . . . . 363

Lymphangeitis and lymphadenitis — Lymph stasis . . . . . . . 364 xiv

CHAPTER XIII the circulatory system — Continued

PAGE

Conditions of the blood ■ . 368

Terminology and definition 368

Leucocytosis 371

Anaemia 372

Simple anaemia from haemorrhage 372

Progressive pernicious anaemia . ... . . 374

Anaemia secondary to other diseases 375

Leucaemia (leucocythaemia) 377

Lymphatic leucaemia 378

Diagnosis of leucaemia, treatment, etc 379

Pseudoleucsemia 380

Splenic anaemia 381

Purpura and the hemorrhagic diathesis 382

Haemophilia; hemorrhagic diathesis; bleeders 384

Remarks on hemorrhage: external, internal, visible, invisible .... 385

Septicaemia and pyaemia (blood poisoning) 385

Chapter XIV

the circulatory system — Concluded

Clinical forms and therapeutic management of dropsy and effusion .... 387

Anasarca; general oedema 388

General management 388

(Edema of the lower extremities 389

Ascites 391

Management of ascites 391

Hydrothorax; pleuritic effusion 393

Aspiration from the patient's standpoint 397

Acute and chronic hydrocephalus; hydrencephaloid, or wet brain; cranial and spinal

puncture 397

Acute and subacute pulmonary oedema 399

Collateral, or inflammatory, oedema 402

Unilateral oedema from thrombosis and pressure 403

Encysted dropsy; retention cysts; serous cysts 404

Hydronephrosis . 404

Dropsy of the gall bladder 404

Hydrosalpinx 405

Hydrocele 405

Serous cysts 405

Hydatid cysts 406

Dropsy of the amnion (hydramnios) 4 06

(Edema bullosum of the urinary bladder 406

Dropsy of joints (hydrarthros); dropsy of bursae 4 °6

Dropsy of tendons, tendon cysts, simple ganglion 4 06

Resume' of diagnostic punctures ... 407

XV

Chapter XV Page

The upper respiratory tract 409

Remarks on clinical pathology of the respiratory tract 409

Rhinological and laryngological memoranda 411

Examination of the upper respiratory tract 411

Autoscopy and tracheoscopy 412

Nasal obstruction 415

Hypertrophic rhinitis 416

Chronic pharyngitis 416

Chronic laryngitis 417

Atrophic forms of rhinitis, pharyngitis, and laryngitis 418

Erosions and ulcers in the upper respiratory tract 418

New growths, benign and malignant, of the upper respiratory tract .... 420

Foreign bodies in the upper respiratory tract 422

Haemorrhage from the upper respiratory tract (epistaxis) 423

Nasal deformities 423

Disease of the accessory sinuses of the nose 424

The tonsil in adults 424

Phlegmonous amygdalitis with circumtonsillar abscess 424

Hypertrophy of the tonsils 425

The use of the tonsillar knife and tonsillar clipper ... ... 426

Mycosis of the pharynx and tonsils 426

Respiratory obstruction 426

(Edema of the larynx or glottis 426

Neuroses and paralyses of the upper respiratory tract 427

Vasomotor rhinitis; hay fever; pollen fever 427

Neuroses of the pharynx 428

Neuroses of the larynx 428

Formulae for nose and throat treatment 429

Chapter XVI

the respiratory system — Concluded

Deep respiratory tract 431

Clinical features of pulmonary congestion, oedema, etc 431

Pulmonary congestion (active, passive, hypostatic) 431

Pulmonary infarction or apoplexy 432

Abscess of the lung 432

Gangrene of the lung 433

Haemorrhage from the lung (haemoptysis) 433

Acute forms of bronchitis in adults 434

Acute bronchopneumonia (catarrhal pneumonia; capillary bronchitis) . . . 435

Acute tuberculous bronchopneumonia (hasty, or galloping, consumption) . . 437

Acute lobar pneumonia; fibrinous pneumonitis in adults 438

Chronic forms of bronchitis and bronchopneumonia 442

Simple chronic bronchitis 442

Chronic fibrinous bronchitis 442

Emphysema of the lung 444

Pneumoconiosis 445 xvi CONTENTS

PAGE

Bronchiectasis .... 446

Cirrhosis of the lung (chronic interstitial pneumonia) 446

Chronic pulmonary tuberculosis; tuberculous bronchopneumonia; consumption;

phthisis 446

Bronchial asthma 457

Acute and chronic pleurisy 460

Dry, fibrinous, or plastic pleurisy 461

Effusive pleurisy ; wet pleurisy 461

Chronic pleurisy . 464

Hydrothorax; hemothorax; pyothorax; pneumothorax 464

Intrathoracic tumors and cysts (benign tumors; dermoid and hydatid cysts; malignant tumors) 46^-

Affections of the mediastinum 468

CHAPTER XVII Diseases of the genitorurinary organs 460

Remarks on the clinical pathology of the genitourinary tract 469

Systemic poisoning from kidney insufficiency 471

Remarks on albuminuria 471

Hematuria 472

Hemoglobinuria 473

Pyuria; pus in the urine 474

Polyuria, oliguria, and anuria 474

Remarks on urination, catheterism, and vesical emergencies 475

Remarks on renal insufficiency and newer aids to diagnosis 476

Cystoscopy, ureteral catheterism, and cryoscopy 477

Diseases of the kidney 477

General remarks on diagnosis 477

Congestion of the kidneys; hyperemia of the kidneys; rupture of kidney . . 477

Remarks on acute and chronic nephritis CBright's disease) 478

Acute nephritis 479

Chronic nephritis (chronic Bright's disease) 479

Chronic parenchymatous nephritis 479

Chronic interstitial nephritis; cirrhosis of the kidney; contracted kidney . . 480

The surgical treatment of acute and chronic nephritis 481

Uremia in nephritis 481

Pyelitis and pyelonephritis; pyelonephrosis; surgical kidney 482

Perinephritic abscess 483

Movable kidney; floating kidney 484

Summary of diagnostic points in kidney lesions . . . ... . . 485

The ureters 485

Ailments of the urinary bladder 486

Acute chronic and ulcerative cystitis and pericystitis 487

Stone in the genitourinary tract 48£

Syphilis of the genitourinary tract 49(

. Tuberculosis of the genitourinary tract 491

Benign and malignant new growths .... 49 j

Parasites of the genitourinary tract 49'

Localized and minor ailments of the male genital organs . . . . . .49:

CONTENTS XVii

PAGE

Penis 492

Urethra 493

Prostate 494

Testicles and spermatic cord 495

Chapter XVIII

the genitourinary system — Continued

Venereal disease in the male and female, and derangements of the sexual function in

the male 497

Syphilis in adults and children 493

Hereditary syphilis; congenital syphilis; syphilis hereditaria tarda .... 500

Chancroid; soft chancre; ulcus molle 501

Gonorrhoea in the male and female, adult and child; remarks on its complications

and sequelae 502

Venereal disease in the female 505

Functional derangements in the male 505

Sexual erethism; masturbation; pollution 505