A handbook of medical diagnosis ... for the use of practitioners and students

Front matter

Class

Book JIA

Copyright IJ^"

Preface To The First Edition

This volume has been written partly in response to the wishes of some of my professional colleagues, partly to meet the urgent demands of many successive classes of pupils^ but chiefly in the hope that at this time a convenient and practical presentation of the subject of Medical Diagnosis will prove useful to the profession at large.

The treatment of the subject-matter under four main headings has been adopted with the view of simplifying the arrangement of the topics in a department of medicine which has attained large scope and insistent importance. It is the confident expectation of the author that this plan will fulfil the twofold requirement, that, within the compass of a single book, clinical phenomena, on the one hand, and, on the other, those complexes of cHnical phenomena which constitute diseases, are brought into correlation in such a manner that the practitioner who seeks information upon an obscure case may at once turn to the discussion of the methods available to clear it up, and the student may find the definite clinical applications of the same methods and their results in descriptive medicine.

Practical rather than theoretical considerations have been held constantly in view alike in the treatment of the clinical and the laboratory subjects. To attain this end a degree of positiveness of assertion not warranted under other circumstances and the avoidance of the discussion of moot and unsettled questions have seemed proper.

The Medical Diagnosis of J. M. Da Costa was published in 1864. That brilliant contribution to the literature marked an epoch in the progress of internal medicine. From the time of its appearance the traditional conception of diagnosis by intuition — a gift of the favored few — ceased to occupy the thoughts of medical men, and the subject ranged itself among the arts based upon scientific facts. It maintained in successive editions during the life of its distinguished author its position in the forefront of the progress of applied medicine during a period of extraordinary advancement in the collateral sciences upon which the practice of medicine rests. The continuing rapid development of knowledge relating to the facts of

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Preface

medicine in the last decade has rendered necessary fresh presentations of the subject, and from time to time excellent works have appeared. These differ greatly among themxselves, according to the views of their several authors, in method and detail. To add to this honorable list demands the justification of something different in method, new arrangement of detail, and the presentation of the whole subject in accordance with the requirements of contemporary medicine. It is hoped that in the present volume these demands are fulfilled. It is the outcome of many years devoted to work in the wards, with the controlling side-lights upon bedside diagnosis afforded by the clinical laboratory, revelations at the hands of surgical colleagues in the operating theatre and confreres in pathology in the post-mortem room, the frequent opportunity of seeing unusual and grave cases in consultation, and long experience as a teacher. Such a career arouses enthusiasm but begets caution. It does not encourage in any way the belief that diagnosis in medicine is an easy matter, but forces the conclusion that it is often difficult and in rare instances impossible. For this reason and because we are always eager to extend the boundaries of our knowledge, this art is as absorbing as it is useful.

In the making of a handbook of this kind it is necessary to draw at every step upon the great fund of acquired information which has become the common property of the profession. To those whose contributions have formed that fund and to those who are daily adding to it I tender grateful acknowledgment for its use. I have mentioned by name those to whose work I have especially referred, but, as a general rule, it has been impracticable for want of space to append systematic references to the literature.

The illustrations are in large part drawn from personal observations. They have been selected solely with the view to elucidate the subject in hand. Diagrams have been employed when this method of presentation has appeared desirable, and the free use of clinical charts constitutes an important feature of the work.

To the friends and fellow-workers who have rendered — some small, some larger, but all generous and willing — assistance, I desire to express my thanks. The list includes many colleagues in the hospitals with which I am connected, some who were and others who still are resident physicians. It includes also Mr. Wilbert and Drs. Bachmann, Manges, Rosen-

PREFACE.

berger, Rowntree, Royer, White, W. R. Wilson, and J. Leslie Davis. To Drs. de Schweinitz, Welch and Schamberg, T. M. Rotch, Packard, Piersol, Young, Emerson, Dudley Fulton, and many others, together with their publishers, I am indebted for permission to use illustrations. The pages on the diagnosis of diseases of the eye were w^ritten by Dr. Sweet; those on the stomach and intestines mainly by Dr. Gwyn; those on the nervous system by Drs. James Hendrie Lloyd and the late William Pickett; those on X-ray diagnosis by Dr. Moore, and those on the examination of the blood, urine, sputum, and other fluids by Dr. F. J. Kalteyer. The excellent drawings, plates, and other illustrations made by Messrs. Schmidt and Faber add much to the usefulness of the book.

I am under special and lasting obligation to Dr. Kalteyer for his most able and untiring aid while the work was in press, and to the publishers for their generous cooperation at every stage in its making.

J. C. Wilson.

Philadelphia, September, 1909.

Part I. Of Medical Diagnosis In General

L General Considerations 1

II. Medical Topography 8

III. The Examination of the Patient, and Case-taking 39

Part II. Of The Methods And Their Immediate Results

I. Medical Thermometry 53

II. Physical Diagnosis. General Considerations; Inspection; Palpation;

Mensuration; Percussion; Auscultation 61

III. The Examination of the Stomach and Intestines 194

IV. The Examination of the Upper Air-passages and the Ear. Rhinoscopy;

Laryngoscopy; Otoscopy 221

V. The Examination of the Blood 229

VI. The Examination of the Urine 264

VII. The Examination of the Sputum 296

VIII. The Examination of Transudates, Exudates, and the Contents of Cysts 300 IX. The Examination of the Nervous System. Preliminary Considerations; Motor Symptoms; Sensory Symptoms; Regional Diagnosis of Cerebral Disease; Aphasia and Other Defects of Speech; Spinal Localization; Combined Degenerations; the Reflexes; Electrodiagnosis; Trophic Disturbances; Pain and Temperature; the Muscular Sense;

the Stigmata of Degeneration 306

X. The Examination of the Eye 351

XL The Examination by X-rays 377

Part III. Of Symptoms And Signs

I. General Considerations 389

II. Appearance; Temperament and Diathesis; Facies; Weight, Form and

Nutrition 390

III. Bones; Joints; Musculature; Posture, Attitude and Gait; Posture

AND Movements of Infants 402

IV. Temperature; Heat Mechanism; Fever; Hypothermia; Significance

of Abnormal Temperatures 419

V. Respiration; Modified Respiratory Movements; Cough and Allied Phenomena; Significance of Cough in Diagnosis; Expectoration or

Sputum 436

VI. Circulation; Pulsation; Radial Pulse; Anomalies op the Pulse; Venous

Pulse; Pulsation of the Liver; Centripetal Venous Pulse 460

VIL The Digestive System. The Mouth; Lips; Teeth; Gums; Tongue 477

VIII. The Digestive System, continued. The Palate; Tonsils; Pharynx 490

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X

CONTENTS.

IX. The Digestive System, CONTINUED. The (Esophagus 495

X. The Digestive System, continued. General Symptoms. Appetite; Thirst; Eructations; Regurgitation; Nausea; Vomiting; The VomiTUs; Defecation; Constipation; Diarrhcea; Tenesmus; Painful Defecation; Fecal Incontinence; Character of the Discharges 500

XI. The Skin. Physiological and Pathological Changes and Their Significance; (Edema; Dropsy; Superficial Vascular Changes; Skin;

Nails; Hair 524

XII. Genito-urinary System. Micturition; Urinary Changes; the Reproductive Organs , 548

XIII. General Symptomatic Disorders of the Nervous System. Pain; Ten-

derness; Paresthesia 558

XIV. General Symptomatic Disorders of the Nervous System, contin-

ued. Vertigo; Convulsions; Tremor; Fibrillary Twitchings 586

XV. Psychical Conditions; Emotional States; Derangements of Consciousness; Insomnia and Other Disorders of Sleep 593

I. The Diagnosis Of The Specific Infections

II. Typhus Fever ; 641

III. Relapsing Fever 644

IV. The Variolous Diseases 647

A. Variola vera; Smallpox 651

(a) V. DISCRETA 651

(b) V. CONFLUENS 65-3

(c) V. HEMORRHAGICA 656

B. Variola modificata; Varioloid 657

C. Vaccinia — Vaccination 663

V. Varicella 668

VI. Scarlet Fever 670

VII. Measles 681

VIII. Rubella 687

The Fourth Disease 689

IX. Whooping-cough 689

X. Mumps 694

XI. Inlfuenza 697

XII. Dengue 702

XIII. Diphtheria 705

XIV. Vincent's Angina 713

XV. Croupous Pneumonia 714

XVI. Cerebrospinal Fever 730

XVII. Erysipelas 737

XVIII. Sepsis 742

Toxemia [ 744

Septicemia 744

Cryptogenetic Septicemia 744

Septicopyemia 744

Terminal Infections 744

XIX. Rheumatic Fever 745

CONTENTS. xi

XX. Yellow Fever 750

XXI. Cholera 752

XXII. Bacillary Dysentery 756

XXIII. The Plague 757

XXIV. Malta Fever 759

XXV. Beri-beri 761

XXVI. Tetanus 763

XXVII. Hydrophobia ; 767

XXVIII. Glanders 771

XXIX. Actinomycosis , 773

XXX. Anthrax 776

XXXI. Leprosy 780

XXXII. Tuberculosis 784

(A) Acute Miliary Tuberculosis 788

(B) Tuberculosis of the Lyiviph-nodes 792

(C) Tuberculosis of Serous Membranes 794

(D) Tuberculosis of the Alimentary Canal 797

(E) Tuberculosis of the Brain and Spinal Cord 800

(F) Tuberculosis of the Genito-urinary Organs 800

(G) Tuberculosis of the Lungs 802

(a) Acute Pneumonic Phthisis 803

(b) Chronic Ulcerative Phthisis 805

(c) Fibroid Phthisis 819

XXXIIL Syphilis 821

XXXIV. Gonorrhoea 831

XXXV. Ephemeral Fever 833

XXXVI. Rocky Mountain Spotted Fever; Tick Fever 834

XXXVII. Icterus Infectiosus; Weil's Disease 836

XXXVIII. Glandular Fever 837

XXXIX. MiLL\RY Fever 838

XL. FoOT-AND-MoUTH DiSEASE 839

XLI. Erysipeloid of Rosenbach 840

XLII. Erythema Infectiosum 841

II. The Diagnosis Of Diseases Caused By Animal Parasites

A. Diseases due to Protozoa 842

i. PSOROSPERMIASIS 842

ii. Amcebic Dysentery 842

iii. Trypanosomiasis 844

iv. DuM-DUM Fever 845

V. The Malarial Fevers 846

(a) Regularly Intermitting Fever of Tertian or Quar-

tan Type 850

(b) Irregular, Remittent, Continued, and Pernicious

Fevers 852

(c) Malarial Cachexia 854

B. Diseases due to Flukes: Distomiasis 855

C. Diseases due to Cestodes 858

i. Intestinal Cestodes: Tapeworms 858

(a) T^nia Solium 859

(b) T^nia Saginata 860

(c) T^nia Cucumerium 860 xii CONTENTS.

(d) T^NiA Nana 860

(e) TyENiA Flavopunctata 861

(f) T^NiA Lata: Bothriocephaltjs Latus 861

ii. Visceral Cestodes 862

(a) Cysticercus Cellulos^ei 862

(b) EcHiNOCoccus Disease 862

D. Diseases due to Nematodes 866

i. AscARiASis 866

ii. Trichiniasis 867

iii. Uncinariasis 870

iv. FiLARiAsis 872

V. Dracontiasis 875

III. The Diagnosis Of The Chronic Intoxications

I. Alcoholic Intoxication; Alcoholism 876

II. Opium Poisoning; Morphinism 879

III. Cocaine Poisoning; Cocainism 881

IV. Lead Poisoi^ing; Plumbism 881

V. Poisoning by Arsenic 884

VI. Poisoning by Mercury 887

VII. Poisoning by Phosphorus 889

VIII. Poisoning by Illuminating Gas , 890

IV. The Diagnosis Of Food Poisoning

I. Fish Poisoning; Ichthyismus 893

II. Meat Poisoning; Botulismus 894

III. Poisoning by Milk and Milk Products 894

IV. Grain and Vegetable Poisoning 895

V. The Diagnosis Of Autointoxications

I. The G astro-intestinal Autointoxications 896

II. The Retention Autointoxications 898

III. Autointoxication from Extensive Abolition of the Function of the

Skin 898

IV. Acidosis 898

V. Gout 898

VI. Glycosuria and Diabetes 898