Complete Text (Part 2)

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Difficult breathing, both inspiratory and expiratory. 5. Brazen or croupous cough. 6. Examination shows inflamed mu- cous membrane. Acute Laryngitis. 1. Peculiar cough. 2. No difficulty in swallowing. CEdema Glottidis. History of general oedema — ulcers of larynx or acute disease, etc. Temperature often normal. Usually attacks adults. Inspiration alone affected. 5. Cough not croupous in character. 6. Examination at once discloses the oedematous condition of the larynx Retro-Pharyngeal Abscess. 1. Cough not peculiar. 2. Dysphagia. i6 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE, Acute Laryngitis. 3. No stiffness of the neck. 4. Brazen voice. 5. Dyspnoea relieved by throwing the head backward or by horizontal position. 6. Dyspnoea constant. 7. Examination shows presence of in- flamed mucous membrane. DISEASES TO BE DIFFERENTIATED. Retro-Pharyngeal Abscess. 3. Neck stiff and painful on motion or pressure along spine. 4. Voice guttural. 5. Dyspnoea greatly increased by throwing head backward or by the horizontal position. 6. Dyspnoea paroxysmal and brought on by swallowing or by pressure on larynx. 7. On examination a fluctuating pain- ful tumor is found at the back part of pharynx. Acute Laryngitis (Croupous). Diphtheria, See Diphtheria, page 20. Chronic Laryngitis. 1. Symptoms appear slowly. 2. Difficulty in breathing. 3. Cough and expectoration. 4. .Symptoms quite constant. 5. Pain in larynx. 6. Laryngeal examination positive. Chronic Laryngitis. Hysterical Change of Voice. 1. Advent sudden. 2. Absence of dyspnoea. 3. Cough slight and without expecto- ration. 4. Sudden relief of symptoms. 5. No pain in larynx. 6. Laryngoscopic examination nega- tive. Thoracic Aneurism. See Thoracic Aneurism, page 48. CEdema Glottidis. Acute Laryngitis. See Acute Laryngitis, page 15. CEdema Glottidis. Thoracic Aneurism. See Thoracic Ancurisvi, page 48. DISEASES OF THE MOUTH AND THROAT. 17 NAME OF DISEASE. CEdema Glottidis. See Asthma, CEdema Glottidis. 1. History of general oedema, ulcer of larynx, acute disease, etc. 2. Dyspnoea constant. 3. Dyspnoea inspiratory only. 4. Usually attacks adults. 5. Advent sudden. 6. No chills or sweating. 7. Dyspnoea increased by bending head forward. 8. Examination shows marked oedema of the glottis. DISEASES TO BE DIFFERENTIATED. Asthma. page 30. Retro-Pharyngeal Abscess. I. ;History of stiff neck, etc. 2. Dyspnoea paroxysmal. 3. Dyspnoea expiratory and inspira- tory. 4. Disease especially of children. 5. Advent gradual. 6. Fever, chills, and sweating. 7. Dyspnoea increased by throwing head backward. 8. Examination shov/s pr-^sence of a post-pharyngeal fluC "bating tu- mor. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE LUNGS AND PLEURA. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE LUNGS AND PLEURA. NAME OF DISEASE Pneumonia Broncho-pneumonia Acute phthisis Chronic phthisis Capillary bronchitis a « DISEASES TO BE DIFFERENTIATED, Acute pleurisy. Pleurisy with effusion. Broncho-pneumonia. Acute phthisis. Pneumonia. Capillary bronchitis, j Acute phthisis. (^ Atelactasis. Pneumonia. Broncho-pneumonia. Capillary bronchitis. Abscess of lung. Chronic bronchitis. Pulmonary infarction. I Cancer of lung. I Broncho-pneumonia. Acute catarrhal bronchitis. Broncho-pneumonia. Acute phthisis. (Edema of lungs. 21 22 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Chronic bronchitis Gangrene of lung Cancer of lunc Emphysema j Broncho-pneumonia. ( Chronic phthisis. ( Abscess of lung. ( Fetid bronchitis. j Phthisis. ( Pleurisy with effusion. ( Pneumothorax. \ Asthma. Asthma . Spasmodic affections of larynx. Emphysema. Angin?. pectoris. Hemoptysis ( Hematemesis. ( Epistaxis. Acute pleurisy Pleurisy with effusion Pneumothorax , Empyema . , Acute pericarditis Pneumonia, Intercostal neuralgia. Perihepatitis. ' Pneumonia. Cancer of lung. \ Hydatids of lung. Hydro thorax. [ Empyema. j Phthisical cavities. ' Emphysema. Pleurisy with effusion. Abscess of liver. Thoracic aneurism. DISEASES OF THE LUNGS AND PLEURA, 23 NAME OF DISEASE. Pneumonia. X. Begins with a well-marked chill. 2. Face flushed and congested. 3. Temperature from 104° to 106". 4. Expectoration rust-colored and viscid. 5. Marked dulness upon percussion. 6. Bronchial voice and breathing. 7. Crepitant rale at end of inspira- tion. Pneumonia. 1. Begins with a marked chill. 2. Face flushed and mahogany color. 3. Temperature from 104° to 106'. 4. Expectoration rust - colored and characteristic. 5. Breathing hurried and panting. 6. Dulness on percussion. 7. Bronchial voice and respiration. 8. Heart in normal position. 9. Crepitant rale at end of inspira- tion. 10. Aspiration negative. 11. Termination by crisis about sev- enth day. Pneumonia. 1. Begins suddenly with a chill. 2. Severe pains in side. 3. Affects one lung. 4. Attacks children or adults. 5. Bronchial voice and breathing. DISEASES TO BE DIFFERENTIATED. Acute Pleurisy. 1. Begins with pain in side. 2. Face pale and anxious. 3. Tem-perature from 100° to 103°. 4. Expectoration frothy and mucous. 5. But slight dulness on percussion. 6. Feeble voice and breathing. 7. Superficial friction-sound on both expiration and inspiration. Pleurisy with Effusion, 1. Begins with chilly sensations. 2. Face pale and anxious. 3. Temperature from 100° to 102°. 4. Expectoration scanty and mucous. 5. Breathing less hurried and catch- ing. 6. Flatness on percussion, but changes with position of patient. 7. Absence of voice and breathing. 8. Heart displaced. 9. Absence of rales. 10. Aspiration positive. 11. No critical days. Broncho-Pneumonia. 1. Begins as a severe bronchitis. 2. Stuffy feeling under sternum. 3. Affects both lungs. 4. Usually attacks children. 5 . Broncho-vesicular voice and breath- ing. 24 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Pneumonia. 6. Dulness unilateral and well marked. 7. Rales crepitant and subcrepitant. 8. Terminates by crisis. I. Pneumonia. with chill and pain in Begins side. 2. Affects one lung. 3. Characteristic pneumonic sputum Temperature high and somewhat remittent. Face flushed and mahogany color. No severe sweating until crisis. Physical signs unilateral. Breathing hurried and panting. Termination by crisis. DISEASES TO BE DIFFERENTIATED. Broncho-Pneumonia. 6. Dulness less marked and bilateral. 7. Rales subcrepitant and mucous. 8. Does not terminate by crisis. Acute Phthisis. 1. Begins as a bronchitis with chilly feeling. 2. Affects both lungs. 3. Sputum contains bacilli tubercu- losis. 4. Temperature irregular and inter- mittent. 5. Face has a hectic appearance. 6. Profuse night sweats. 7. Physical signs bilateral. 8. Respiration hurried but natural. 9. No critical days. Broncho-Pneumonia. Pneumonia. See Pneumonia, page 23. Broncho-Pneumonia. Often a secondary disease. Breathing panting. Temperature high. Dulness on percussion. Respiratory sounds broncho-vesicu- lar. Fine rales over dull areas. Broncho-Pneumonia. I. Usually a disease of children. Capillary Bronchitis. 1. Disease primary. 2. Breathing labored and hurried. 3. Temperature not so high. 4. Exaggerated pulmonarj' resonance. 5. Respiratory sounds vesicular and diminished. 6. Rales uniform all over chest. Acute Phthisis. I. Principally a disease of young adults. DISEA SE S OF THE L UNGS A ND PL E URA . 2 5 NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Broncho-Pneumonia. Phthisis. 2. Breathing panting and hurried. 2. Breathing quiet and hurried. 3. Bronchitis precedes signs of con- 3. Pyrexia precedes physical signs. soiidation. 4. Emaciation not very rapid. 4. Very rapid exhaustion and emacia- tion. 5. No hemoptysis. 5. Hemoptysis common. 6. No bacilli tuberculosis in sputum. 6. Sputum contains many bacilli. 7. Physical signs most marked in 7. Physical signs most marked at dependent portion of lungs, apices, usually. 8. Sweating not excessive. 8. Profuse sweating. Broncho-Pneumonia. Atelectasis. 1. Temperature high. i. Temperature about normal. 2. On inspection chest appears nor- 2. Chest-wall retracted. mal. 3. Diaphragm in normal position. 3. Diaphragm elevated. 4. Respiratory murmur broncho- vesic- 4. Respiratory murmur feeble. ular. 5. Vocal fremitus increased. 5. Vocal fremitus diminished. 6. Rales numerous and subcrepitant. 6. Rales rare in collapsed lung. Acute Phthisis. Pneumonia. See Pneumonia^ pa-ge 24. Acute Phthisis. Broncho-Pneumonia. See Broncho- Pneumonia, page 24. Acute Phthisis. Capillary Bronchitis. 1. Temperature very high and inter- i. Temperature less high and remit- mittent. tent. 2. Profuse sweats and chilly sensa- 2. No marked sweating or chilliness. tions. 26 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Acute Phthisis. 3. Emaciation very rapid. 4. Respiration hurried without dysp- noea. 5. Bacilli tuberculosis in sputum. 6. Dulness on percussion at apex. 7. Signs of lung consolidation. 8. Rales marked at apices. Acute Phthisis. 1. High temperature, followed usually at night with profuse sweats and chilly sensations. 2. Cough and expectoration profuse from the beginning. 3. Expectoration constant, 4. Expectoration contains tubercle bacilli. 5. Signs of cavity develop gradually. 6. No sudden improvement of patient. DISEASES TO BE DIFFERENTIATED. Capillary Bronchitis. 3. Emaciation less rapid. 4. Extreme dyspnoea. 5. No bacilli tuberculosis in sputum. 6. Exaggerated pulmonary resonance. 7. Lung not consolidated. 8. Rales heard all over chest. Abscess of Lung. 1 . Chills, followed by fever and sweat ing. 2. Cough and expectoration profuse after rupture of abscess into bron- chii. 3. Sudden expectoration of a large amount of pus. 4. Sputum contains many pus cells. 5. Signs of cavity develop suddenly. 6. Patient suddenly improves after discharge of the abscess into bron- chii. Chronic Phthisis. 1. Sputum contains bacilli tubercu- losis. 2. Profuse night sweats. 3. Rapid emaciation. 4. Hemoptysis common. 5. Physical signs most marked at apices. 6. Dulness on percussion. 7. Rales subcrepitant ai ' Chronic Bronchitis. 1. No tubercle bacilli in sputum. 2. No profuse sweats. 3. No rapid emaciation. 4. Hemoptysis uncommon. 5. Physical signs not limited to apices. 6. No dulness on percussion. 7. Rales mucous and submucous. DISEASES OF THE LUNGS AND PLEURA. 27 NAME OF DISEASE. Chronic Phthisis. 1. Temperature more or less elevated. 2. Hemoptysis a bright color. 3. Heart usually normal. 4. Sputum contains bacilli tubercu- losis. 5. Symptoms come on gradually. 6. Apices chiefly affected. Chronic Phthisis. 1. Chest retracted. 2. Pain intermittent. 3. Patient ansemic and hectic. 4. Disease primary. 5. Expectoration muco-purulent. 6. Temperature elevated. 7. Sputum contains tubercle bacilli. Chronic Phthisis. 1. Attacks any one, especially adults. 2. Temperature elevated, especially 3. Sputum contains tubercle bacilli. 4. Apices principally affected. 5. Hereditary. 6. Hemoptysis common. 7. Frequent signs of cavities follow- ing those of consolidation. 8. Profuse night sweats. Capillary Bronchitis. 1. Temperature very high. 2. Attacks children especially. 3. Extreme dyspnoea. DISEASES TO BE DIFFERENTIATED. Pulmonary Infarction. 1. Temperature nearly normal. 2. Expectorated blood dark and co- agulated. 3. Advanced valvular heart disease. 4. Sputum free from bacilli tubercu- losis. 5. Symptoms appear suddenly. 6. Lower lobes usually affected. Cancer of Lung. 1. Chest bulging. 2. Pain constant. 3. Patient cachectic. 4. Disease secondary. 5. " Currant-jelly " expectoration. 6. Temperature normal or subnor- mal. 7. Sputum contains cancer cells. Persistent Broncho-Pneumonia. 1. Attacks children especially. 2. Temperature nearly normal. 3. No tubercle bacilli in sputum. 4. Apices not often affected. 5. Not hereditary. 6. No hemoptysis. 7. No signs of cavities following those of consolidation. 8. No profuse sweating. Acute Catarrhal Bronchitis. 1. Temperature but moderately ele- vated. 2. Attacks any one. 3. No dyspnoea. 28 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE, Capillary Bronchitis. 4. Cyanosis common. 5. Restless and feverish. 6. Rales sibilant and sonorous. DISEASES TO BE DIFFERENTIATED. Acute Catarrhal Bronchitis. 4. No cyanosis. 5. Patient quiet and composed. 6. Rales mucous and submucous. Capillary Bronchitis. Broncho-Pneumonia. See Broncho- Pneumonia, page 24. Capillary Bronchitis. Acute Phthisis. See Acute Phthisis, pa-ge 26. Capillary Bronchitis. 1. Temperature elevated. 2. Expectoration tenacious. 3. Disease primary. 4. Exaggerated pulmonary resonance. Chronic Bronchitis. CEdema of the Lungs. 1. Temperature normal. 2. Expectoration frothy and watery. 3. Secondary disease. 4. Dulness on percussion. Chronic Phthisis. See Chronic Phthisis, page 26. I. Chronic Bronchitis. No dyspnoea if uncomplicated. 2. No lung consolidation. 3. Usually attacks adults. 4. Vocal fremitus normal. 5. Rales mucous and submucous. 6. Frequent formation of bronchiec- tatic cavities. Gangrene of Lung. 1. Sputum contains pulmonary tissue. 2. Unilateral disease. 3. Patient greatly prostrated. 4. Fever, septic or hectic in character. 5. Signs of pulmonary consolidation. Persistent Broncho-Pneumonia. 1. Dyspnoea, especially upon exej tion. 2. Lung consolidated. 3. Disease of children especially. 4. Vocal fremitus exaggerated. 5. Subcrepitant rales. 6. Lung remains consolidated. Fetid Bronchitis. 1. No pulmonary tissue in sputum. 2. Disease affects both lungs. 3. No marked prostration. 4. Temperature normal. 5. Bronchiectatic cavities quite com- moa- DISEASES OF THE LUNGS AND PLEURA. 29 NAME OF DISEASE. Gangrene of Lung. DISEASES TO BE DIFFERENTIATED. Fetid Abscess of Lung. I. Signs of cavity follow fetid expec- i. Signs of cavity precede the fetid toration. 2. Sputum a dirty black color. 3. Sputum contains lung tissue. 4. Fetor has a putrefactive smell. Cancer of Lung. expectoration. 2. Sputum purulent. 3. Sputum contains numerous pus- cells. 4. Fetor has a sv^^eetish odor. Chronic Phthisis. See Chronic Phthisis, page 27. Cancer of Lung. 1. Usually secondary. 2. Cancerous cachexia. 3. Dulness most marked above and in front. 4. Dulness stationary. 5. Areas of resonance throughout the dull portion of the lung. 6. Friction sound over area of duiness. Pleurisy with Effusion. 1. Usually primary. 2. Anaemia, but no cachexia. 3. Dulness most marked behind and belovv^. 4. Dulness changes with position of patient. 5. Uniform dulness or flatness belov/ level of fluid, 6. Absence of sound over flat area. Pneumothorax. I, Begins suddenly. Emphysema. 1. Symptoms come on gradually. 2. Dyspnoea paroxysmal and increased 2. Dyspnoea constant. upon exercise. 3. Disease bilateral. 4. Percussion sound vesiculo-tym panitic. 5. Breathing vesicular. 6. Expiration prolonged and low pitched. 3. Disease unilateral. 4. Percussion note tympanitic. 5. Breathing amphoric if audible. 6. Expiratory sounds usually absent. Emphysema, I. Vesiculo - tympanitic percussion note. Bronchial Asthma. I. Percussion note exaggerated. 30 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Emphysema. 2. Prolonged low-pitched expiration. 3. Always dyspnoea on exertion. 4- Chest barrel-shaped. 5. Heart displaced. 6. Disease constant. 7. Rales few in number, unless there is complicating bronchitis, and then mucous and submucous. Bronchial Asthma. 1. No change in voice. 2. Cough expulsive. 3. Dyspnoea expiratory. 4. Numerous sibilant and sonorous rales in chest. 5. Ausculatory signs negative over larynx. 5. Laryngoscopic examination nega- tive. Bronchial Asthma. No pain in region of heart. Pulse normal in regularity. Great difficulty in breathing. Many sibilant and sonorous rales in chest. DISEASES TO BE DIFFERENTIATED. Bronchial Asthma. 2. Expiration never low-pitched. 3. Dyspnoea only during the attack. 4. Shape of chest normal. 5. Heart not displaced. 6. Attacks purely paroxysmal. 7. Many sibilant and sonorous rales heard all over chest during attack. Spasmodic Affections of Larynx. 1. Voice much altered. 2. Cough and breathing stridulous. 3. Dyspnoea inspiratory. 4. Absence of chest rales. 5. Ausculatory signs positive over larynx. 6. Laryngoscopic examination often positive. Angina Pectoris. 1. Lancinating pain around heart. 2. Pulse intermittent and irregular. 3. Patient tries not to breathe deeply. 4. Absence of chest rales. Bronchial Asthma. Emphysema. See Emphysema, page 29. Hemoptysis. f. Blood liquid, bright, and frothy. 2. Blood free from foreign matter. 3. Sinks in water slowly. Hematemesis. 1. Blood dark and coagulated. 2. Mixed with food and bile. 3 Sinks in water rapidly. DISEASES OF THE LUNGS AxVD PLEURA. 31 NAME OF DISEASE. Hemoptysis. 4. Alkaline in reaction. 5. Preceded by cough and other chest symptoms. 6. History of lung trouble. 7. Hemorrhage followed by great prostration and irritable cough. 8. Moist rales in chest. Hemoptysis. 1. Blood bright, frothy, and fluid. 2. Attended and followed by cough, 3. History of lung disease. 4. Moist rales in chest. 5. Examination of nares and pharj'nx negative. 6. Great prostration. Acute Pleurisy. 1. Temperature elevated. 2. No tenderness over intercostal nerves. 3. Pain constant and localized. 4. No vomiting or herpetic eruption. 5 Friction sound heard on ausculta- tion. Acute Pleurisy. DISEASES TO BE DIFFERENTIATED. Hematemesis. . Acid in reaction. . Preceded by vomiting and pain in stomach. 6. History of gastric disturbance. 7. Not followed by cough or great prostration. 8. Absence of chest rales. Epistaxis. 1. Blood coagulated and dark. 2. No cough. 3. No history of lung trouble. 4. Absence of chest rales. 5. Examination of nares and pharynx positive. 6. No great prostration. Intercostal Neuralgia. 1. Temperature normal. 2 . Intercostal nerves tender upon pres- sure. 3. Pain shooting and intermittent. 4. Vomiting and herpes zoster com- mon. 5. No friction soimd heard on auscul- tation. Pneumonia. See Pneumonia, page 23. Acute Pleurisy. Acute Pericarditis. See Acute Pericarditis, page 39. Acute Pleurisy. Perihepatitis, See Perihepatitis, page 85. 32 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED Pleurisy with Effusion. Pneumonia. See Pneumonia, page 23. Pleurisy with Effusion. Cancer of Lung. See Cancer of Lung, page 29. Pleurisy v/ith Effusion. 1. Begins acutely with pain, fever, etc. 2. Quite rapid emaciation and loss of health. 3. Effusion produced rapidly. 4. Flatness on percussion changes with position of patient. 5. Fluid obtained by puncture con- tains no booklets. Hydatids of Lung. 1. Begins slowly and insidiously. 2. Health but slowly undermined. 3. Effusion forms slowly. 4. Flatness on percussion not much changed by position of patient. 5. Fluid contains characteristic hook- lets. Pleurisy with Effusion. Hydrothorax, I. Affects one side. I. Affects both sides. 2. Primary disease. 2. Secondary disease. 3- Temperature elevated. 3. Temperature normal. 4. Pain in side. 4. No pain in side. 5. No general dropsy. 5. General dropsy. Pleurisy with Effusion. Empyema. See Empyemc 1, page 33. Pneumothorax. Emphysema. See Emphysefua, page 29, Pneumothorax. 1. Developed suddenly. 2. Severe dyspnoea. 3. Bulging of intercostal spaces. 4. Heart displaced. 5. Vocal fremitus diminished or ab- sent. Phthisical Cavities. 1. Developed slowly. 2. Dyspnoea not severe. 3. Chest wall generally retracted. 4. Heart in normal position. 5. Vocal fremitus increased. DISEASES OF THE LUNGS AND PLEURA. 33 NAME OF DISEASE. Pueumothorax. 6. Physical signs heard all over af- fected side. 7. Succussion of fluid is present. S. Absence of rales. Empyema (pulsating). DISEASES TO BE DIFFERENTIATED. Phthisical Cavities. 6. Physical signs usually limited to apices. 7. No succussion, 8 Gurgling rales at apices. Thoracic Aneurism. See Thoracic Aneurism, page 48. Empyema. Abscess of Liver. See A bscess of Liver, page 80. Empyema. 1. Usually a history of previous dis- ease, as pleurisy, phthisis, general debility, etc. 2. Constitutional symptoms well marked. 3. Temperature often reaches 105°. 4. Chills and profuse sweats common, 5. Fluid remains unless it is with- drawn. 6. Exploring needle withdraws pus.

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