The principles and practice of medicine ...

Front matter

Class~ RC>4U

Book ' 8

GpiglitN?.

Preface To The Fourth Edition

Many and important changes have heen made in this edition. The article on Typhoid Fever has been in great part rewritten, and there is embodied in it the additional experience of my clinic. The subject of malaria has had to be recast, and the important new matter on etiology and prophylaxis has been added. Dysentery, Yellow Fever, and the Plague have attracted the attention of so many workers that it is difficult to keep pace with the rapid progress of our knowledge. I have tried to bring these articles up to date, and in rewriting them have kept in mind the needs of physicians practicing in the tropics. On the all-important disease, Pneumonia, the student will find many new paragraphs. I have incorporated in the article on Diphtheria the model work which has been done by McCollom and by Councilman and his colleagues at the Boston City Hospital. On Small-pox, Cerebro-spinal Fever, Rheumatic Fever, and many others of the acute infections, new points are added on diagnosis and treatment.

Dr. Futcher, my first assistant, has analyzed for this edition the experience of my clinic for the past twelve years on Diabetes and Gout, in which sections much new matter has been incorporated. The sections on Obesity and Arthritis Deformans have been changed.

Practically new articles, in whole or in part, are those on Acute Tuberculosis, Diseases of the Pancreas, Splenic Anaemia, Arsenical Poisoning, Herpes Zoster, Adiposis Dolorosa, Fibrinous Bronchitis, Albumosuria, Oxaluria, Meniere's Disease, Aphasia, Combined Sclerosis of the Cord, Myasthenia Gravis, Congenital Aneurism, Surgical Treatment of Aneurism and Scurvy.

Dr. McCrae has analyzed for this edition the material of the clinic on Pernicious Anaemia and Leukaemia.

Minor changes, too numerous to mention, have been incorporated, and my aim has been to deserve — and, if possible, to repay in some slight measviii PREFACE TO THE FOURTH EDITION.

lire — the confidence which the profession has shown in the previous editions of the work.

I have again to thank many friends for valuable help — my colleague, Dr. W. H. Welch, whom I have consulted on many questions; Dr. H. M. Thomas, for a revision of the article on Aphasia, and for many additions in the section on the Nervous System; my associates and assistants, Drs. Thayer, Futeher, McCrae, T. E. Brown, L. P. Hamburger, and Eufus Cole, for much important aid; Dr. Simon Flexner, now of the University of Pennsylvania, f or ftf ormation upon the forms of Dysentery; Drs. W. G-. MacCallum and E. L. Opie, for notes from the Pathological Department.

To friends too numerous to mention I am very grateful for memoranda, pointing out errors or making suggestions — two I must mention by name, H. D. Eolleston and George Blumer.

In passing through the press the work has again had the advantage of the supervision of Dr. F. E. Smith. To my secretary, Miss B. 0. Humpton, I am indebted for constant help in the preparation of the edition and for the revision of the index.

William Osleb.

Section I. Specific Infectious Diseases

PAGE

I. Typhoid Fever 1

II. Typhus Fever 49

III. Relapsing Fever 53

IV. Small-pox 56

Variola Vera 59

Hemorrhagic Sraall-pox 62

Varioloid 63

V. Vaccinia (Cow-pox) — Vaccination 68

VI. Varicella (Chicken-pox) 74

VII. Scarlet Fever 75

VIII. Measles 85

IX. Rubella (Rotheln) 89

X. Epidemic Parotitis (Mumps) 90

XI. Whooping-cough 92

XII. Influenza 95

XIII. Dengue 99

XIV. Cerebro-spinal Fever 100

XV. Pneumonia 108

XVI. Diphtheria 138

XVII. Erysipelas 157

XVIII. Septicaemia and Pyaemia / • . .160

Septicaemia 161

Septico-Pyaemia 163

Terminal Infections 165

XIX. Rheumatic Fever 166

XX. Cholera Asiatica 175

XXI. Yellow Fever 182

XXII. The Plague 189

XXIII. Dysentery 193

XXIV. Malarial Fever 203

Intermittent Fever 209

Continued and Remittent Malarial Fever 213

Pernicious Malarial Fever 215

Malarial Cachexia 216

XXV. Malta Fever 219

XXVI. Beri-beri 220

XXVII. Anthrax 224

XXVIII. Hydrophobia 227

XXIX. Tetanus 230

XXX. Glanders . .233

ix x CONTENTS.

PAGE

XXXI. Actinomycosis. 235

XXXII. Syphilis 238

Acquired 240

Congenital 242

Visceral 244

XXXIII. Gonorrheal Infection 255

XXXIV. Tuberculosis 258

1. General Etiology and Morbid Anatomy 258

2. Acute Tuberculosis 273

3. Tuberculosis of the Lymphatic System 280

4. " of the Lungs (Phthisis, Consumption) .... 289

5. " of the Alimentary Canal 317

6. " of the Liver 320

7. " of the Brain and Spinal Cord 321

8. " of the Genito-urinary System 322

9. " of the Mammary Gland 327

10. " of the Circulatory System 327

11. Diagnosis of Tuberculosis 328

12. Prognosis in Tuberculosis 328

13. Prophylaxis in Tuberculosis 330

14. Treatment of Tuberculosis 331

XXXV. Leprosy 338

XXXVI. Infectious Diseases of Doubtful Nature 342

1. Febricula (Ephemeral Fever) 342

2. Weil's Disease 344

3. Milk-sickness 344

4. Glandular Fever 345

5. Mountain Fever 346

6. Miliary Fever (Sweating Sickness) 346

7. Foot and Mouth Disease 347

Section II. Diseases Due To Animal Parasites

I. Psorospermiasis 349

1. Internal Psorospermiasis 349

2. Cutaneous Psorospermiasis 350

II. Parasitic Infusoria . 351

III. Distomiasis 351

IV. Diseases caused by Nematodes 352

1. Ascariasis 352

2. Trichiniasis 354

3. Anchylostomiasis 359

4. Filariasis 360

5. Dracontiasis 362

6. Other Nematodes 364

Acanthocephala . . . 365

V. Diseases caused by Cestodes 365

1. Intestinal Cestodes ; Tape-worms 365

2. Visceral Cestodes 368

Cysticercus Cellulosae 368

Echinococcus Disease . ......... 370

Multilocular Echinococcus 374

CONTENTS. xi

PAGK

VI. Parasitic Arachnids . - • . 375

VII. Parasitic Insects 376

VIII. Myiasis . 378

Section III. The Intoxications And Sun-stroke

I. Alcoholism • 380

1. Acute Alcoholism 380

2. Chronic Alcoholism 380

3. Delirium Tremens 382

II. Morphia Habit 384

III. Lead Poisoning 386

IV. Arsenical Poisoning 390

V. Food Poisoning 391

1. Meat Poisoning 391

2. Poisoning by Milk Products 393

3. Poisoning by Shell-fish and Fish 393

4. Grain Poisoning 394

VI. Sun-stroke 395

Section IV. Constitutional Diseases

I. Arthritis Deformans 399

II. Chronic Rheumatism 405

III. Muscular Rheumatism 406

IV. Gout 407

V. Diabetes Mellitus 418

VI. Diabetes Insipidus 432

VII. Rickets - 434

VIII. Obesity 439

Section V. Diseases Of The Digestive System

I. Diseases of the Mouth 441

Stomatitis 441

Aphthous Stomatitis 441

Ulcerative Stomatitis 442

Parasitic Stomatitis (Thrush) . 443

Gangrenous Stomatitis 444

Mercurial Stomatitis 444

Eczema of the Tongue 445

Leukoplakia buccalis 446

II. Diseases of the Salivary Glands . 446

Supersecretion . 446

Xerostomia 447

Inflammation of the Salivary Glands 447

III. Diseases of the Pharynx 448

Circulatory Disturbances 448

Acute Pharyngitis 448

Chronic Pharyngitis . 449 xii CONTENTS.

PAGE

Ulceration of the Pharynx 449

Acute Infectious Phlegmon of the Pharynx 450

Retro-pharyngeal Abscess 450

Angina Ludovici 450

IV. Diseases of the Tonsils 451

Acute Tonsillitis 451

Follicular or Lacunar Tonsillitis 451

Suppurative Tonsillitis 452

Chronic Tonsillitis 454

V. Diseases of the (Esophagus 458

Acute Oesophagitis 458

Spasm of the (Esophagus 459

Stricture of the (Esophagus 460

Cancer of the (Esophagus 461

Rupture of the (Esophagus ' . . 462

Dilatations and Diverticula 462

VI. Diseases of the Stomach 463

Acute Gastritis 463

Phlegmonous Gastritis 464

Toxic Gastritis 465

Diphtheritic Gastritis 465

Mycotic Gastritis 466

Chronic Gastritis (Chronic Dyspepsia) 466

Dilatation of Stomach 474

Peptic Ulcer (Gastric and Duodenal) 478

Cancer of Stomach 486

Hypertrophic Stenosis of the Pylorus 494

Hemorrhage from the Stomach 495

Neuroses of the Stomach 497

VII. Diseases of the Intestines 505

1. Diseases of the Intestines associated with Diarrhoea 505

Catarrhal Enteritis : Diarrhoea • • 505

Enteritis in Children . . 508

Diphtheritic or Croupous Enteritis 512

Phlegmonous Enteritis 512

Ulcerative Enteritis 512

2. Appendicitis (Typhlitis and Perityphlitis) 519

4. Constipation (Costiveness) . 538

5. Enteroptosis (Glenard's Disease) 541

6. Miscellaneous Affections 544

Mucous Colitis 544

Dilatation of the Colon 545

Intestinal Sand * 546

Affections of the Mesentery 546

VIII. Diseases of the Liver 548

1. Jaundice (Icterus) 548

2. Icterus Neonatorum 551

3. Acute Yellow Atrophy 551

4. Affections of the Blood-vessels of the Liver 553

5. Diseases of the Bile-passages and Gall-bladder 555

7. Cirrhoses of the Liver 569

8. Abscess of the Liver 577

CONTENTS. XJii

PAGE

9. New Growths in the Liver 582

10. Fatty Liver 585

11. Amyloid Liver 586

12. Anomalies in Form and Position of the Liver -. 587

IX. Diseases of the Pancreas 588

1. Haemorrhage 588

2. Acute Pancreatitis 589

3. Chronic Pancreatitis 592

4. Pancreatic Cysts 592

5. Tumors of the Pancreas 594

6. Pancreatic Calculi 595

X. Diseases of the Peritonaeum 596

1. Acute General Peritonitis 596

2. Peritonitis in Infants 600

3. Localized Peritonitis 600

4. Chronic Peritonitis 602

5. New Growths in the Peritonaeum ' . 604

6. Ascites (Hydro-peritonaeum) 605

Section VI. Diseases Of The Respiratory System

I. Diseases of the Nose 610

Acute Coryza 610

Chronic Nasal Catarrh 611

Autumnal Catarrh (Hay Fever) _ 612

Epistaxis 614

II. Diseases of the Larynx 615

1. Acute Catarrhal Laryngitis 615

2. Chronic Laryngitis 616

3. (Edematous Laryngitis 617

4. Spasmodic Laryngitis (Laryngismus stridulus) 617

5. Tuberculous Laryngitis 619

6. Syphilitic Laryngitis 620

III. Diseases of the Bronchi 621

1. Acute Bronchitis 621

2. Chronic Bronchitis 623

3. Bronchiectasis 626

4. Bronchial Asthma 628

5. Fibrinous Bronchitis 632

IV. Diseases of the Lungs 634

1. Circulatory Disturbances in the Lungs 634

2. Broncho-pneumonia (Capillary Bronchitis) 641

3. Chronic Interstitial Pneumonia (Cirrhosis of Lung) 649

4. Pneumonokoniosis t 652

5. Emphysema , 654

Compensatory Emphysema ......... 655

Hypertrophic Emphysema 655

Atrophic Emphysema 659

Acute Vesicular Emphysema . . 660

Interstitial Emphysema 660

6. Gangrene of the Lung 660

7. Abscess of the Lung 662

8. New Growths in the Lungs . 663 xiv CONTENTS.

PAGE

V. Diseases of the Pleura 665

Fibrinous or Plastic Pleurisy 665

Sero-fibrinous Pleurisy 666

Purulent Pleurisy (Empyema) 671

Tuberculous Pleurisy 673

Other Varieties of Pleurisy 673

2. Chronic Pleurisy 678

3. Hydrothorax 680

4. Pneumothorax (Hydro-pneumothorax and Pyo-pneumothorax) . . , 681

5. Affections of the Mediastinum 684

Section VII. Diseases Of The Circulatory System

I. Diseases of the Pericardium 688

2. Other Affections of the Pericardium 697

II. Diseases of the Heart 698

Acute Endocarditis 698

Chronic Endocarditis 705

Aortic Incompetency 709

Aortic Stenosis ... 715

Mitral Incompetency 717

Mitral Stenosis 721

Tricuspid Valve Disease 725

Pulmonary Valve Disease 727

Combined Valvular Lesions 728

Hypertrophy of the Heart 735

Dilatation of the Heart 741

Aneurism of the Heart 753

Rupture of the Heart . . . .753

New Growths and Parasites 754

Wounds and Foreign Bodies 754

Palpitation 755

Arrhythmia 756

Rapid Heart (Tachycardia) . . 758

Slow Heart (Bradycardia) 759

Angina Pectoris 761

6. Congenital Affections of the Heart 765

III. Diseases of the Arteries 770

1. Degenerations 770

2. Arterio-sclerosis (Arterio-capillary Fibrosis) 770

Aneurism of the Thoracic Aorta 777

Aneurism of the Abdominal Aorta . . 786

Aneurism of the Branches of the Abdominal Aorta 787

CONTENTS. xv

PAGE

Arteriovenous Aneurism . . 788

Congenital Aneurism 788

Section VIII. Diseases Of The Blood And Ductless Glands

I. Anaemia 789

Secondary Anaemia 789

Primary or Essential Anaemia 792

II. Leukaemia 802

III. Hodgkin's Disease 809

IV. Purpura . . 814

V. Haemophilia 819

VI. Scurvy 821

VII. Status Lymphaticus 826

VIII. Diseases of the Suprarenal Bodies 828

IX. Diseases of the Spleen 832

X. Diseases of the Thyroid Gland 835

Goitre 835

Tumors of the Thyroid 836

Exophthalmic Goitre 836

Myxcedema 840

XI. Diseases of the Thymus Gland 843

Section IX. Diseases Of The Kidneys

I. Malformations t g46

II. Movable Kidney 846

III. Circulatory Disturbances • # §49

IV. Anomalies of the Urinary Secretion 850

1. Anuria 850

2. Haematuria 851

3. Haemoglobinuria 852

4. Albuminuria 854

5. Pyuria (Pus in the Urine) 858

6. Chyluria (Non-parasitic) 859

7 Lithuria t 859

8. Oxaluria . 861

9. Cystinuria 861

10 Phosphaturia ... 862

11. Indicanuria 863

12. Melanuria 863

13. Pneumaturia ' 864

14. Other Substances 864

V. Uraemia 865

VI. Acute Bright's Disease .... 869

VII. Chronic Bright's Disease 874

Chronic Parenchymatous Nephritis 875

Chronic Interstitial Nephritis 877

VIII. Amyloid Disease 884

IX. Pyelitis -. . 886

X. Hydronephrosis •...., 889 xvi CONTENTS.

PAGE

XI. Nephrolithiasis (Renal Calculus) 891

XII. Tumors of the Kidney 896

XIII. Cystic Disease of the Kidney 898

XIV. Perinephric Abscess 900

Section X. Diseases Of The Nervous System

I. General Introduction 901

II. System Diseases 919

1. Introduction 919

2. Diseases of the Afferent or Sensory System 920

Locomotor Ataxia 920

Of the Whole Tract 928

Progressive (Central) Muscular Atrophy 928

Bulbar Paralysis 932

Progressive Neural Muscular Atrophy 933

The Muscular Dystrophies 933

System Diseases of the Upper Motor Segment 936

Spastic Paralysis of Adults 937

Spastic Paralysis of Infants 938

Hereditary Spastic Paraplegia 940

Erb's Syphilitic Spinal Paralysis 940

Secondary Spastic Paralysis 941

Hysterical Spastic Paraplegia 941

System Diseases of the Lower Motor Segment 941

Chronic Anterior Polio-myelitis 941

Ophthalmoplegia 942

Acute Anterior Polio-myelitis 942

Acute and Subacute Polio-myelitis in Adults 946

Acute Ascending (Landry's) Paralysis 946

Myasthenia Gravis 947

4. Combined System Diseases 947

Ataxic Paraplegia 948

Primary Combined Sclerosis (Putnam) ........ 949

Hereditary Ataxia (Friedreich's Ataxia) 949

Progressive Interstitial Hypertrophic Neuritis of Infants . . . 951

Toxic Combined Sclerosis 951

III. Diffuse Diseases of the Nervous System 951

1. Affections of the Meninges 951

Diseases of the Dura Mater (Pachymeningitis) 951

Hemorrhagic Pachymeningitis 952

Diseases of the Pia Mater 954

Simple Meningitis of Infants 957

2. Scleroses of the Brain 957

Insular Sclerosis 959

3. Chronic Diffuse Meningoencephalitis 960

IV. Diffuse and Focal Diseases of the Spinal Cord 964

Congestion 966

Anaemia 966

Embolism and Thrombosis 966

CONTENTS. X vii

PAGB

Endarteritis 967

Haemorrhage into the Spinal Membranes 967

Haemorrhage into the Spinal Cord 968

Caisson Disease f • ^9

3. Compression of the Spinal Cord 970

Lesions of the Cauda Equina and Conus Medullaris .... 972

4. Tumors of the Spinal Cord and its Membranes 973

5. Syringomyelia 975

6. Acute Myelitis 976

V. Diffuse and Focal Diseases of the Brain 979

2. Aphasia 988

Hyperaemia 994

Anaemia 995

(Edema of the Brain 997

Cerebral Haemorrhage 997

Embolism and Thrombosis 1008

Aneurism of the Cerebral Arteries 1013

Endarteritis 1014

Thrombosis of the Cerebral Sinuses and Veins 1015

Hemiplegia in Children 1017

4. Tumors, Infectious Granulomata, and Cysts of the Brain . . . 1020

5. Inflammation of the Brain 1024

Acute Encephalitis 1024

Abscess of the Brain . 1025

6. Hydrocephalus 1028

VI. Diseases of the Peripheral Nerves . 1031

1. Neuritis (Inflammation of the Bundles of Nerve Fibres) .... 1031

2. Neuromata 1037

Olfactory Nerves and Tracts 1038

Optic Nerve and Tract 1039

Lesions of the Retina 1039

Lesions of the Optic Nerve 1040

Affections of the Chiasma and Tract 1041

Affections of the Tract and Centres 1042

Motor Nerves of the Eyeball 1045

Fifth Nerve 1050

Facial Nerve 1051

Auditory Nerve 1056

The Cochlear Nerve 1056

The Vestibular Nerve * 1058

Glosso-pharyngeal Nerve 1059

Pneumogastric Nerve 1060

Spinal Accessory 1063

Hypoglossal Nerve . 1066

Cervical Plexus 1067

Brachial Plexus 1069

Lumbar and Sacral Plexuses . . . 1072

Sciatica 1073

VII. General and Functional Diseases . . . 1075

1. Acute Delirium (Bell's Mania) 1075

B xviii CONTENTS.

PAGB

2. Paralysis Agitans 1076

Other Forms of Tremor 1079

3. Acute Chorea (Sydenham's Chorea ; St. Vitus's Dance) .... 1079

4. Other Affections described as Chorea 1088

5. Infantile Convulsions (Eclampsia) 1091

7. Migraine 1102

8. Neuralgia 1104

9. Professional Spasms ; Occupation Neuroses 1107

13. The Traumatic Neuroses 1132

14. Other Forms of Functional Paralysis 1136

Periodical Paralysis 1136

Astasia; Abasia 1136

VIII. Vaso-motor and Trophic Disorders 1137

1. Raynaud's Disease 1137

2. Erythromelalgia 1139

3. Angio-neurotic (Edema 1140

4. Facial Hemiatrophy 1141

5. Acromegaly 1142

Osteitis Deformans 1144

Hypertrophic Pulmonary Arthropathy 1144

Leontiasis Ossea 1145

Micromegaly 1145

6. Scleroderma 1145

Ainhum 1147