A treatise on the practice of medicine, for the use of students and practitioners of medicine

Front matter

UNITED STATES OF AMEKICA.

A TREATISE

ON THE

Preface To The Sixth Edition

exact, and to enJiance tlie practical character of the whole. I believe I may saj that little, properly pertaining to the domain of practice, has been overlooked, and that nothing superfluons has been admitted. That the work might have been written from a different standpoint is quite true, but then its character had been changed. As the purpose was to prepare a concise, practical treatise, to be independent in itself, and yet form a part of a larger whole, the subject must necessarily be discussed as has been done here. That some of my critics think differently, because they have conceived another ideal, is inevitable, but any regret I might have over this disapproval of my plans is quite tempered by the reflection that I am not striving to placate such critics so much as to please myself, and especially the large body of my sympathetic readers, whose approval is testified in the disappearance of successive large editions of the work. To them I repeat the assurance of my gratitude for the favor with which they have received my contributions to the Practice of Medicine.

E. B.

Philadelphia, 1527 Locust Street, July i, 1886.

PEEFAOE TO THE FIETH EDITIOK

Again there is imposed on me the grateful diitj of acknowledging my indebtedness to numerous readers for their imf ailing apjDreciation of my work.

The fifth edition has followed so soon on the fourth that but few changes are necessary; yet these happen to be important. The bacillus tuberculosis has been discovered, and minute organisms are increasing in pathogenetic importance. Any work presuming to represent the present state of medical knowledge can not be unmindful of such topics. Some other changes and additions have been made — ^in all, increasing the size of the work by about twenty pages.

In submitting this edition to the medical public, I can do no less than reiterate the expression of my hope that it may con tinue to enjoy the favor bestowed on the work from its first issue^

EOBEETS BaKTHOLOW.

1509 Walnut Strekt, Philadelphia, April 15, 1883.

PEEFAOE TO THE THIED EDITIOK

If tlie rapid sale of large editions of a work may indicate that it supplies the needs of many readers, I ought to be satisfied "with the measure of success to which this treatise has attained. That it is fulfilling its mission is demonstrated to me in the encouraging, even enthusiastic expressions of approval, coming from numerous correspondents, who have found in this work a safe guide and judicious counselor. It is especially gratifj^ng that those who have followed modes of treatment here inculcated have not been disappointed in the results. This fact seems to be a sufficient answer to those pessimistic critics who have found the author over-sanguine and dogmatic in his statements on therapeutical points.

That the confidence and esteem of my readers may continue to be justified, I have sought, in this edition, to make my work more thorough by adding some new articles, and by subjecting the whole to a careful revision. About fifty pages have been added, thus enlarging the scope, and, I hope, increasing the utility of the book. It does not yet approximate in its dimensions to the standard of those critics who estimate a work according to its weight, or to the number of its pages. As the author despairs of propitiating the favor or of conforming to the views of such critics, he must needs bear as best he can the weight of their displeasure. He is, however, supported in the midst of this trial by the circumstances that his work has been very fa-

X

PKEFACE TO THE THIRD EDITION.

vorablj judged by the most influential organs of professional opinion printed in the EngHsh language, and that it is now being translated into Chinese, for the use of the physicians of the Celestial Empire. Those characteristics of the work to which its popularity seems to be due are its directness, its brevity, and yet the sufficient detail in which the various topics have been treated. In the new articles the same method of exposition has been followed. I may, therefore, anticipate, I hope, that the third and improved edition will continue to enjoy the favor so generously bestowed on former issues.

The author has been furnished by various correspondents with the results of treatment, as obtained by them from the methods prescribed in the therapeutical sections. It is desirable to accumulate facts, and hence failures should be reported as well as successes. It is also desirable to ascertain if the results of drug administration correspond to the pretensions of therapeutists. Is the optimism of the positive school justified by the deductions of clinical experience? I hope that those of my readers who are making observations will publish them, in the interests of scientific truth, to silence the cavils of therapeutical nihilists on the one hand, or the claims of therapeutical optimists on the other.

KOBEETS BaETHOLOW.

1509 "WALimT Street, Philadelphia, January^ 1882.

In less than one month after the publication of the first edition of three thousand copies of this treatise, the publishers called on me to prepare a second edition. This result is the more surprising, as it was accomphshed before the numerous medical journals of the country had introduced the book to their readers, and pronounced a judgment on its merits or defects. I feel deeply grateful to my numerous readers for this substantial evidence of their appreciation of my labor. I have, also, a great many correspondents, in all parts of the country, to thank for kind expressions of approval, and for valuable suggestions.

In this edition I have corrected some typographical errors which escaped notice, and have amended some doubtful statements, and also have added articles on Alcoholism and on Sunstroke — topics overlooked in preparing the first edition. I have, further, enlarged the index, and have added an index of authors. In the first preface it was stated that I had avoided an attempt at bibliographical display, w^hich has perplexed some of my bibliolatrous critics. One of them, in a notice of the work, was pleased to observe that I had condensed my materials from the text-books and cyclopaedias. While expressly disclaiming an attempt to give a complete, even a full bibliography, I have indexed the authors referred to in the body of the work, which will show that I went to original sources for my information. Almost all of the works, monographs, and articles referred to, are contained in my own library of three thouxii

PKEFACE TO THE SECOND EDITION.

sand medical volumes ; and those not in my own were obtained from the library of the College of Physicians of this city. I wish my book, however, to be regarded, as it should justly be, the product of my own study, observation, and experience. An author with any training in the methods of authorship will agree with me, that to prepare a work, every detail of which the writer has made his own, is greatly more laborious than merely compiling a work from abundant bibliographical resources. I could more easily have prepared two volumes from the materials at hand, than write this book ; but it was not my purpose to merely compile a book on practice — rather to prepare one which contained my own conception of the subject. I venture to express the conviction that, the more carefully this work is examined, the more it will be found to contain the most recent and approved facts of special pathology and therapeutics, without verbose dilution, and literary and typographical padding. With the hope that the second edition will continue to enjoy the favor accorded to the first, I submit it to the discriminating judgment of the medical profession.

EOBERTS BaETHOLOW.

Philadelphia, 1509 Walnut Street, November 1, 1880.

P E E F A 0 E.

In undertaking the preparation of a treatise on the Practice of Medicine, I liad the intention to write a companion volume to mj work on Materia Medica and Therapeutics. When announced, the book was so far advanced that its completion was confidently anticipated within the year. Unfortunately, the condensation of material found necessary, when the work had reached that stage where its proportions could be judged with some accuracy, involved much additional labor. This was the more regrettable, as the incessant demands of a large private practice and the onerous duties of an exacting professorial position permitted little of that uninterrupted leisure which is essential for successful literary composition. Slow progress was inevitable under these circumstances, and hence it was not until my removal to Philadelphia last year that I could devote some hours each day to my arduous task. I trust that this explanation of the delay in the appearance of the treatise will be satisfactory to my readers, especially to the large number who have honored me by subscribing for the work long in advance of its publication.

As my treatise on Materia Medica and Therapeutics embraced those topics of importance to the physician, and omitted matters of rather extraneous interest, so in the preparation of this volume my purpose was to include the subjects embraced under the title of " Practice of Medicine," omitting those topics of general pathology, etiology, etc., with which the works on Practice usually open, and xiv

Preface

which, though sufficiently valuable in themselves, are too often passed over hastily, or not read at all, in the desire to reach the practical subjects. I have therefore omitted the topics in question from their position as an introduction to special pathology, and have, although at the disadvantage of some repetition, incorporated them in their proper relation with individual diseases.

That I should, under all the circumstances above stated, have undertaken such a task as the preparation of this treatise, for which, it may be suggested, there was no special need, and, if the need existed, there was no claim on me to supply it, may be accounted for by the fact that, when the work was begun, I was Professor of the Theory and Practice of Medicine and of Clinical Medicine in the Medical College of Ohio, and was urged, not only by the students and practitioners who attended my lectures, but also by many readers of my therapeutical treatise, to prepare a volume on Practice, which should have the practical characteristics, the definiteness of statement, the conciseness, and, at the same time, the fullness of the work on Materia Medica and Therapeutics. I was the more inclined to accede to these wishes because of a natural desire to appear as an author on subjects to which I had devoted all the years of my professional life, and under the most varied conditions. Serving as an officer of the medical staff of the United States Army in Kansas, Utah, Colorado, l^ew Mexico, Minnesota, and during the war of the rebellion at Washington, Nashville, Chattanooga, Baltimore, etc., followed by an extensive practice (private and hospital) of sixteen years at Cincinnati, I may justly claim to have enjoyed large opportunities for the clinical study of the diseases of the l^orth American Continent. With one or two unimportant exceptions, I have had personal charge of the maladies treated of in this work, and have made them the subject of clinical demonstration or jpost-mortem investigation, either privately or in public lectures.

In the treatment of the various topics, I have attempted to give to each just that amount of consideration to which its importance entitles it, within the limitations imposed by the size of the work. A just harmony and proportion can be secured only by condensing some subjects and displaying others. ISTo space has been given to merely historical disquisitions, or to the discussion of controverted

PREFACE.

XV points. Also, to utilize all available space, chapters liave been dispensed with, and the intervals between the sections have been abbreviated as much as possible. jSTotwithstanding mj utmost efforts at condensation, the work has grown beyond the contemplated size ; but I would fain hope that no part of it could be sacrificed without impairing the value of the whole.

Much of the matter embraced in a work of this kind is the common property of the medical profession, and hence I have not quoted many authorities. I have rather avoided references when their mention would have been mere pedantry, and would have occupied valuable space. Nevertheless, when I was distinctly indebted for some fact or opinion, I have given the reference to the authority. Sometimes, when the authority is well known, the name is merely inclosed in parentheses. It is a comparatively easy task, especially with the aids now at our disposal, to give an extended bibliography, but the space occupied would have swollen this work to encyclopedic proportions, without adding to its real utility. When an author only expresses the opinions of his authorities, he avoids the appearance of dogmatism, which must be the tone of a work giving utterance to indi\T.dual opinions ; but I could hardly do otherwise than draw my clinical material — the descriptions of diseases — from my own observations at the bedside. Also, a large experience in the treatment of disease could not fail to develop some positive convictions as to the real value of remedies. The reader will find that I have no sympathy with the therapeutical nihilism of the day, and that my convictions find expression in the recommendation of plans of treatment. In a work of this kind, intended for the guidance of young practitioners and students, some dogmatism, although offensive to the highest taste, may be pardoned, in view of the practical advantages of experienced leadership. Indeed, there is no department of the subject in which it seemed to me so necessary to express positive opinions. The influence of some of our most prominent medical thinkers has been opposed to the value of medicines in the treatment of disease. The modern school of pathologists, absorbed in the contemplation of the ravages of diseases, are either oblivious of the curative

powers of remedies, or openly ridicule the pretensions of thera- 2 xvi

PREFACE.

peutists. I have, therefore, in the therapeutical sections, especially endeavored to set forth true principles, and have taught the utility of drugs when rightly administered, but have none the less tried to indicate the limits of their utility, for he v^ho is unmindful of the injury done by ill-directed or reckless medication is as unsafe a guide as the most pronounced therapeutical nihilist.

The pathological doctrines inculcated in the work are derived from the highest sources. The few illustrations of morbid changes introduced were obtained from the admirable atlas of Thierfelder. As my information on this subject was derived from those best qualified to instruct, I have not hesitated to express with some decision the present state of knowledge in respect to the pathology of the various diseases, desiring in this, as in other departments of my subject, to give som.e positive views. I may be criticised with the observation that, in the progress of discovery, the doctrines at present received unreservedly may be entirely overthrown, and very different views be substituted. It will be time enough, however, when the change comes, to adapt our opinions to the new order of pathological doctrines.

Having thus explained my intentions in producing the work, I submit it to the judgment of the medical profession, with the assurance that, whether favorable or unfavorable, the decision will be just.

EOBEETS BaRTHOLOW,

1509 Walnut Street, Philadelphia, September, 1880.

TABLE OF COlSrTElsrTS.

SPECIAL PATHOLOGY AND THERAPEUTICS.

LOCAL DISEASES.

PAGE

Diseases of the Digestiye System ...... 1

Topography of the Abdomen : Physical Exploration .... 1

Superficial ......... 9

Gangrene of the Mouth ....... 17

Catarrh of Naso-pharyngeal Mucous Membrane . . . . 19

Catarrh of Lower Pharynx . . . . , . .21

Retro-pharyngeal Abscess 22

Diseases of the CEsophagus . . . . . . .23

Stenosis of the ffisophagus ....... 25

Dilatations of the (Esophagus . . . . . . .26

Diseases of the Stomach ....... 27

Acute Gastritis . . . . . . . . . 28

Toxic Gastritis . . . . . . . . 31

Phlegmonous Gastritis ........ 33

Atonic Dyspepsia ......... 39

Heematemesis ......... 60

Dilatation of the Stomach ....... 64

Diseases of the Intestine ........ 66

Catarrh of the Intestine ....... 66

Cholera Morbus 68 Infantum 71 Duodenitis ....»,.... 75 xviii