The practice of medicine; a guide to the nature, discrimination and management of disease

Front matter

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Preface

The following pages represent an effort to prepare for the student and the junior practitioner of medicine a guide to the nature, discrimination, and management of disease that should contain the essentials unadorned with great detail. Since the determination of what is really essential must be a matter of individual judgment, the greatest problem encountered w T as what to exclude, so that the book, without exceeding a convenient limit, should be comprehensive, properly balanced, and in good perspective. An acquaintance with the present development and the trend of medical education, and a teacher's appreciation of the needs of students, make one realize the embarrassment of riches, the large number of facts, too often placed before minds not yet qualified to sort them in their order of importance and grasp their mutual bearings. This defect of medical pedagogy violates the physiology of the mind, which is so constituted that the natural stimulus to interest, and therefore to recollection, is the tracing of rational connection. The resulting mental indigestion and lethargy appear at examination time and when the student or junior practitioner is confronted with the necessity of applying at the bedside principles ill understood. A book, of course, cannot replace actual clinical experience, but it should in fairness offer its readers a well-ordered statement of existing knowledge as a basis for training their powers of observation and reasoning, especially in conformity with opportunities presented at the bedside.

These considerations determined me to devote most space and attention to the practical aspects of medicine; to the elucidation of those principles exemplified in disease at the bedside, in hospital wards and clinics, and in the consulting room; and to the clinically important and more common disorders rather than to the rarer diseases, however interesting. Such a plan seemed to offer more of value to students in recitations and in hospital-ward and dispensary work, and to practitioners desiring to recall elusive facts. A systematic arrangement of the subject matter has been adopted to facilitate comprehension of the mutual relations of different clinical and pathological entities. Emphasis has been laid upon the definition of processes of disease — to impress upon the student the necessity of accuracy in his use of terms and in his clinical descriptions. Inasmuch as the final object of medicine is practice, most space has been devoted to symptomatology, diagnosis, and treatment; and to ensure a rational grasp of these main objectives, they are presented in their natural relationship by means of brief vi PREFACE

connecting sections on etiological factors, essential anatomical lesions, and pathological physiology. The sections on pathological physiology might have been considerably expanded; but I venture to hope that, although limited to a statement of the main facts, they may prove serviceable to students in affording them a broad view of disease and of disturbed functions in general. Throughout the book an endeavor has been made to portray the nature and natural history of disease, to correlate disturbed or perverted function with altered structure, to explain the development of symptoms, and to elucidate the sequence of cause and effect. Such knowledge is essential to a correct and intelligent comprehension and interpretation of morbid phenomena (symptomatology and diagnosis), to the ability to forecast and provide against contingencies, to judgment of the course, duration, and termination of disease (prognosis), and to skill in rational treatment and prophylaxis. Under the individual diseases, I have, as a rule, emphasized at least one method of treatment that I know to be of value from my own experience; beyond this point, however, I have depended upon the recommendations of acknowledged competent authorities. A few formulae have been included as an aid to the junior practitioner; these with the other instructions mentioned should serve him in times of stress until his experience and judgment warrant his making his own modifications. Intentional limitation of space and the primarily clinical purpose of the book have made it seem desirable to omit discussions of the biological characteristics of the infectious microorganisms and of the technique of laboratory methods of diagnosis.

A book on such a boundless subject as Medicine must be evolved out of the collective experience of the masters of all times and all parts of the world, tinctured by the study, investigation, judgment, and experience of the author. Although this book, in large part, is based upon my own clinical and pathological experience, I must acknowledge my indebtedness to the many writers of many tongues whose contributions to medicine form the basis of my own knowledge. My experience with those disorders known as tropical has been almost limited to the rather few imported cases that an active hospital physician encounters in a large seaport. I have, nevertheless, included a brief account of these diseases, because of the widespread interest recently shown in their investigation, and on account of the increasing number of students who purpose practising in our tropical possessions; the clinical descriptions, however, are largely a reflection of those of such highly esteemed authorities as Manson, Cantlie, Jackson, and others. The descriptions of the metazoan parasites have been taken, in many instances verbatim, from Stiles — the recognized authority in this country. Elsewhere the attentive reader will note my indebtedness to other authors — to all of whom, I hope, I have given due credit.

A. O. J. K.

Philadelphia, 1910.

SECTION I General Observations and Pathological Physiology 17

Paratyphoid Fever 60

Erysipelas 67

Pneumococcic Infections 70

Meningococcic Infection ; Cerebrospinal Fever 86

Gonococcic Infection 90

Tuberculosis 92

Acute Miliary Tuberculosis 96

Tuberculosis of the Circulatory System 106

Tuberculosis of the Digestive System 117

Tuberculosis of the Genito-urinary System 120

Tuberculosis of the Nervous System 122

Tuberculosis of the Bones and Joints 124

Influenza ' 143

Bacillary Dysentery 145

Tetanus 149

Cholera 153

Plague 156

Glanders 159

Anthrax 161

Malta Fever 164

Leprosy 166

Actinomycosis 169

Mycetoma 170

Nocardiosis 171

Pulmonary Aspergillosis 171

Oidiomycosis 172

ZOOPARASITE INFECTIONS

Amcebiasis 175

Relapsing Fever 178 viii CONTENTS

Yaws 193

Trypanosomiasis ' 194

Kala-azar 195

Oriental Sore 196

Distomatosis 211

Pulmonary Distomatosis 211

Hepatic Distomatosis . 211

Intestinal Distomatosis 212

Venal Distomatosis 213

Intestinal Teniasis ; Tapeworm Infection 214

Somatic Teniasis 217

Uncinariasis -218

Strongyloidosis 219

Ascariasis 219

Oxyuriasis 220

Trichocephaliasis 221

Acanthocephaliasis 221

Trichinosis 221

Dracunculosis 223

Filariasis 223

Acariasis 224

Ixodiasis 224

Sarcoptic Acariasis 224

Parasitic Insects 225

Phthiriasis ; Pediculosis 225

Fleas 225

Bed-bugs 225

Myiasis 226

INFECTIONS OF UNKNOWN OR DOUBTFUL ETIOLOGY

Vaccinia 233

Varicella 235

Typhus Fever 237

Measles 247

Rotheln 250

Glandular Fever 252

Rheumatic Fever . . 253

Pertussis 257

Infectious Parotitis 260

Yellow Fever 261

Dengue 265

Hydrophobia 266

Rocky Mountain Spotted Fever 269

Epidemic Poliomyelitis 270

Acute Infectious Jaundice 272

Foot-and-Mouth Disease 273

Miliary Fever 274

Milk Sickness 274

Beriberi 275

Epidemic Dropsy 277

Nasha Fever 278

Japanese River Fever .... 278

Ponos 279

CONTENTS ix

Hill Diarrhoea 280

Sprue 281

Epidemic Gangrenous Proctitis 281

Tropical Phagedena 282

Tropical Bubo 283

Ulcerating Granuloma of the Genitals 283

Verruga 284

Kubisagari 285

Gangosa 286

Ainhum 287

Goundou 287

Psittacosis 287

SECTION II INTOXICATIONS Alcoholism 289

Opium Habit \ . . 292

Cocaine Habit 293

Lead Poisoning 294

Arsenical Poisoning 296

Mercurial Poisoning 297

Snake-venom Poisoning 298

Food Poisoning 299

SECTION III DISORDERS OF METABOLISM Auto-intoxications 303

Diabetes Insipidus 318

Obesity 327

Rickets 329

Scurvy 331

Amyloidosis 334

Infantilism . . , . . . . . 335

Section IV Diseases Of The Ductless Glands And Of Internal Secretion

CONTENTS

Acute Thyroiditis 340

Goitre 340

Hyperthyroidism and Exophthalmic Goitre 342

Hypothyroidism; Cretinism; Myxcedema . . 346

Tumors and Cysts of the Thyroid 349

DISEASES OF THE PARATHYROID GLANDS

Tetany 350

DISEASES OF THE ADRENALS AND THE CHROMAFFIN SYSTEM

Addison's Disease 353

DISEASES OF THE PITUITARY BODY

Akromegaly 356

SECTION V DISEASES OF THE BLOOD AND HEMOPOIETIC SYSTEM Acute Secondary Anemia 365

Chronic Secondary Anemia 367

Chlorosis 369

Leukemia 378

Erythremia . , 385

THE HEMORRHAGIC DISEASES

Hemorrhage in the Newborn 387

Purpura 387

Hemophilia 390

Lymphangitis and Lymphadenitis 393

Lymphangiectasis 395

Tumors and Tumor-like Formations 397

Hodgkin's Disease 398

Diseases of the Thoracic Duct 401

DISEASES OF THE THYMUS BODY

Enlargement of the Thymus 403

CONTENTS xi

Anomalies of Form and Position of the Spleen 406

Rupture of the Spleen . 406

Thrombosis, Embolism, and Abscess of the Spleen 406

Enlargement of the Spleen 407

Splenomegaly; Splenic Anemia • 407

Tumors and Cysts of the Spleen 410

SECTION VI Cardiac Pain 415

Palpitation of the Heart 416

Arrhythmia 416

Tachycardia 421

Bradycardia 422

The Weak or Insufficient Heart 424

The Overstrained or Irritable Heart 427

The Fatty Heart 430

The Infectious Febrile Heart . 431

The Fibroid Heart ... 434

Aneurysm of the Heart 443

Rupture of the Heart . . 444

Tumors and Parasites of the Heart 444

Disease of the Coronary Arteries 444

Chronic Endocarditis ... 450

Mitral Insufficiency 455

Mitral Stenosis 459

Aortic Insufficiency 462

Aortic Stenosis 466

Tricuspid Insufficiency 468

Tricuspid Stenosis 469

Pulmonary Insufficiency 470

Pulmonary Stenosis . 470

Combined Valvular Lesions 471

Pericarditis 478

Fibrinous Pericarditis 478 xii CONTENTS

Serofibrinous Pericarditis 480

Purulent Pericarditis 483

Chronic Pericarditis 484

Hydropericardium 487

Hemopericardium , 487

Pneumopericardium; Pyopneumopericardium 488

Chylopericardium 488

Acute Aortitis 489

Arteriosclerosis 489

Angina Pectoris 493

Section VII Diseases Of The Respiratory System

Epistaxis 511

Acute Rhinitis 512

Chronic Rhinitis 514

Hay Fever 515

Acute Catarrhal Laryngitis 517

(Edemat ous Laryngitis 519

Spasmodic L aryngitis 520

Chronic Laryngitis 521

Laryngeal Perichondritis 522

Tumors of the Larynx 523

DISEASES OF THE TRACHEA AND BRONCHI

Acute Bronchitis 524

Chronic Bronchitis 527

Fibrinous Bronchitis 530

Bronchiectasis 532

Bronchial Asthma . 534

Tracheal and Bronchial Obstruction 537

Hemoptysis 539

Congestion of the Lungs 541

(Edema of the Lungs 543

Pulmonary Embolism and Thrombosis 545

Atelectasis and Collapse of the Lung 547

Bronchopneumonia . . 549

Chronic Interstitial Pneumonitis 552

Pneumonokoniosis . 554

Emphysema 555

CONTENTS xiii

Abscess of the Lung 559

Gangrene of the Lung 561

Tumors of the Lung 562

Pleuritis 564

Fibrinous Pleuritis 564

Purulent Pleuritis 574

Hemorrhagic Pleuritis 576

Chronic Pleuritis '. 577

Hydrothorax 579

Pneumothorax 580

Chylothorax 583

Tumors of the Pleura 584

DISEASES OF THE MEDIASTINUM

Mediastinitis 584

Tumors of the Mediastinum 585

Section VIII Diseases Of The Digestive System

Stomatitis 587

Gangrene of the Cheek; Noma 593

DISEASES OF THE TONGUE

Glossitis 594

Eczema 595

Leukoplakia 595

Black Tongue 595

Macroglossia 596

Acute (Edema 596

Ranula 596

DISEASES OF THE SALIVARY GLANDS

Ptyalism .596

Xerostomia 596

Parotitis . 596

Gaseous Distention 597

Calculi 597

Ludwig's Angina 597

Acute Tonsillitis 598

Chronic Tonsillitis 601

Pharyngitis 603

Ulceration of the Pharynx 603

Acute Infectious Phlegmon of the Pharynx , 604 xiv CONTENTS

Retropharyngeal Abscess 604

Elongation of the Uvula 604

The Lingual Tonsils 604

DISEASES OF THE (ESOPHAGUS

Acute Oesophagitis 605

Chronic Oesophagitis 605

Ulceration 605

Varices 606

Dilatation 606

Diverticula 606

Spasm ' 606

Paralysis 607

Stenosis 607

Carcinoma 607

The Appetite 610

Thirst 611

Nausea and Vomiting 612

Hematemesis 613

Motor Disorders 614

Sensory Disorders 616

Secretory Disorders 618

Nervous Dyspepsia 621

Acute Catarrhal Gastritis 622

Phlegmonous Gastritis 624

Toxic Gastritis . v 624

Infectious Gastritis 625

Chronic Gastritis 626

Acute Dilatation of the Stomach 629

Chronic Dilatation of the Stomach 630

Carcinoma of Stomach 638

Non-carcinomatous Tumors _ 643

Hypertrophic Stenosis of the Pylorus 643

Symptomatic Disorders of the Intestine 646

Motor Disorders 647

Sensory Disorders . 649

Secretory Disorders 650

Intestinal Indigestion 650

Intestinal Hemorrhage 652

Mucous Colic 654

Constipation 655

Acute Enteritis 657

Chronic Enteritis 659

Diarrhceal Disorders of Children 661

Croupous or Diphtheritic Enteritis 667

Phlegmonous Enteritis 667

Appendicitis 668

Sigmoid Diverticulitis 672

Ulceration of the Intestine 673

CONTENTS xv

Dilatation of the Colon 682

Infarction of the Mesenteric Vessels 682

Intestinal Sand 683

Hemorrhoids 683

Visceroptosis 685

Anomalies of Form and Position of the Liver 695

Diseases of the Bloodvessels of the Liver 696

Fatty Liver 697

Acute Yellow Atrophy of the Liver 698

Active Congestion of the Liver 702

Passive Congestion of the Liver 703

Perihepatitis 704

Acute Perihepatitis 704

Local Chronic Perihepatitis 705

General Chronic Perihepatitis 705

Acute Hepatitis 705

Acute Non-suppurative Hepatitis 705

Suppurative Hepatitis 707

Chronic Interstitial Hepatitis : the Cirrhoses of the Liver . . . . . . 709

Biliary Cirrhosis 717

Tumors of the Liver 719

Congenital Obliteration of the Biliary Ducts .721

Acute Catarrhal Cholangitis 722

Suppurative Cholangitis « 724

Chronic Catarrhal Cholangitis 725

Acute Cholecystitis .... 726

Chronic Cholecystitis 728

Carcinoma of the Gall-bladder and Biliary Ducts 736

Hemorrhages into the Pancreas . 737

Acute Pancreatitis 738

Chronic Pancreatitis 741

Cysts of the Pancreas 743

Tumors of the Pancreas 744

Pancreatic Calculi 745

Ascites 746

Acute Peritonitis 748

Chronic Peritonitis 749

Multiple Serositis 750 xvi CONTENTS

SECTION IX DISEASES OF THE URINARY SYSTEM Anuria 763

Albuminuria 764

Albumosuria 767

Cylindruria 768

Hematuria 769

Pyuria . 769

Anomalies of Form and Position of the Kidneys 770

Circulatory Disturbances of the Kidneys 770

Nephritis 772

Active Diffuse Nephritis 773

Acute Suppurative Nephritis 779

Chronic Diffuse Non-indurative Nephritis 780

Cystitis; Ureteritis; Pyelitis; Pyelonephritis; Pyelonephrosis 788

Perinephritis and Paranephritis 792

Hydronephrosis 793

Nephrolithiasis 794

Cysts of the Kidney . 797

Tumors of the Kidney 798

Tumors of the Bladder 799

SECTION X DISEASES OF THE NERVOUS SYSTEM Neuralgia 808

Neuritis 811

Herpes Zoster 813

Neuromas 814

Olfactory Nerve 814

Optic Nerve 815

Oculomotor Nerve 816

Trochlear Nerve 816

Abducens Nerve 816

Trigeminal Nerve 817

Facial Nerve 817

Auditory Nerve 819

Glossopharyngeal Nerve 819

Pneumogastric or Vagus Nerve 819

Spinal Accessory Nerve 820

Hypoglossal Nerve 820

Diseases of the Spinal Nerves 821

Cervical Plexus 821

Brachial Plexus 821

Lumbar Plexus 824

Sacral Plexus . . 824

Diseases of the Cervical Sympathetic Nerves , , , , . 824

CONTENTS xvii

External Pachymeningitis 826

Internal Pachymeningitis 827

Leptomeningitis 828

Aphasia 840

Diseases of the Upper (Central) Motor Neuron

Lateral Sclerosis 845

Spastic Paralysis of Infants * 846

Hereditary Spastic Spinal Paralysis 847

Amaurotic Family Idiocy 847

Unilateral Ascending and Unilateral Descending Paralysis 848

Diseases of the Lower (Peripheral) Motor Neuron

Chronic Anterior Poliomyelitis . . 848

Progressive Neural Muscular Atrophy 849

Bulbar Paralysis 850

Ophthalmoplegia 851

Disease of the Upper (Central) and the Lower (Peripheral)

Motor Neurons

Amyotrophic Lateral Sclerosis 852

Diseases of the Sensory Neuron

Tabes Dorsalis 853

Interstitial Hypertrophic Progressive Neuritis of Childhood 856

Combined System Diseases

Hereditary or Family Ataxia 857

Hereditary or Family Cerebellar Ataxia 857

Ataxic Paraplegia 858

Toxic Combined Sclerosis 858

NON-SYSTEM DISEASE OF THE BRAIN AND SPINAL CORD

Multiple Sclerosis 859

Hyperemia of the Brain . 861

Anemia of the Brain 861

(Edema of the Brain 862 xviii CONTENTS

Cerebral Thrombosis * 868

Cerebral Embolism 869

Thrombosis of the Cerebral Sinuses 870

Acute Hemorrhagic Encephalitis 871

Abscess of the Brain 871

Tumors of the Brain 873

Hydrocephalus . 875

Vascular Disorders of the Spinal Cord 876

Hemorrhage into the Spinal Cord 876

Caisson Disease 878

Myelitis 879

Compression of the Spinal Cord 882

Tumors of the Spinal Cord 883

Syringomyelia • 884

NERVOUS DISEASES OF FUNCTIONAL OR UNKNOWN NATURE

Migraine 886

Epilepsy 888

Hysteria 892

Neurasthenia and Psychasthenia 895

Occupation Neuroses 897

Paralysis Agitans 898

Acute Chorea 900

Hereditary Chorea 902

Convulsive Tics 903

Choreiform Disorders 904

Family Periodical Paralysis 904

Heat Stroke 905

VASOMOTOR AND TROPHIC DISORDERS

Angioneurotic (Edema 907

Erythromelalgia 907

Acroparesthesia 908

Raynaud's Disease 908

SECTION XI DISEASES OF THE MUSCLES Muscular Rheumatism 911

Myositis 912

Progressive Muscular Dystrophy 912

Myoclonus 914

Congenital Myotonia 915

Congenital Amyotonia 916

CONTENTS xix

SECTION XII DISEASES OF THE BONES AND JOINTS Acute Arthritis 917

Chronic Atrophic Arthritis 918

Chronic Hypertrophic Osteo-arthritis 920

Osteomalacia 921

Osteitis Deformans 922

Hypertrophic Pulmonary Osteo-arthropathy 923

Osteogenesis Imperfecta 923

Achondroplasia 923

Facial Hemiatrophy 923

Leontiasis Ossea 924

THE PRACTICE OF MEDICINE.