Complete Text (Part 3)

General condition remains quite gOOvli. 3. Temperature seldom over 102°. 4. No chills or sv/eats. 5. Fluid disappears under appropriate medical treatment. 6. Exploring needle withdrav/s serum. 7. Absence of voice soup^ls below the level of the fluid. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE HEART AND BLOOD-VESSELS. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE HEART AND BLOOD-VESSELS. NAME OF DISEASE. Acute pericarditis Endocarditis Ulcerative endocarditis Cardiac hypertrophy Fatty heart Palpitation of heart (nervous) Angina pectoris Ejcophthalmic goitre . DISEASES TO BE DIFFERENTIATED. Acute endocarditis. Acute pleurisy. Cardiac enlargement. Acute pericarditis. Functional heart murumrs. j Typhoid fever. * ( Pyaemia. 'Cardiac dilatation. Displacement of heart. Acute pericarditis. Thoracic aneurism. Consolidation of lung tissue. Cardiac dilatation. Organic heart disease. . i Bronchial asthma. Hysteria. Intercostal neuralgia. Thoracic aneurism. Cystic goitre with heart disea§e. 37 38 DIFFERENTIAL DIAGNOSIS OF THE CARDIAC MURMURS. NAME OF DISEASE. DISEASES TO BE DIFFERfi>tXIATEI Mitral regurgitation. Tricuspid regurgitation. Anaemic bruit. Thoracic aneurism. Aortic regurgitation. Aortic obstructive Aortic regurgitation . i Aortic obstructive. Mitral obstructive. Pulmonary regurgitation Thoracic aneurism. Mitral obstructive Mitral regurgitation. Aortic regurgitation. Mitral regurgitation Aortic obstructive. Mitral obstructive. Tricuspid regurgitation' ANEURISMS. Abdominal aneurisms Pulsation of aorta. Abdominal tumors. Psoas abscess. Thoracic aneurism Aortic obstructive. Aortic regurgitation. Cancer of pleura. Chronic laryngitis. Pulsating empyema. Dilated heart. Angina pectoris. DISEASES OF THE HEART AND BLOOD-VESSELS. 39 NAME OF DISEASE. Acute Pericarditis. 1. Superficial friction sound. 2. Murmurs have limited areas of diffusion. 3. Murmurs intensified by inclination of body. 4. Murmurs intensified by taking a full inspiration. 5. Murmurs not necessarily synchro- nous with the heart-sounds. 6. Heart-impulse wavy and feeble. 7. In stage of effusion, extended peri- cordial dulness. 8. Murmurs disappear with the effu- sion, to return again with the absorption of the effusion. Acute Pericarditis. 1. Pain not severe. 2. Pain not affected by respiration. 3. Pulse feeble and irritable. 4. Friction sound constant until effu- sion takes place. Acute Pericarditis (with effusion). 1. Disease developed suddenly. 2. There is or has been a friction sound present. 3. Outline of dulness, triangular. 4. Cardiac dulness extends to the left of apex beat. 5. Heart-sounds indistinct and feeble. DISEASES TO BE DIFFERENTIATED. Acute Endocarditis. 1. Deep blowing sound. 2. Murmurs have wide areas of diffusioUc 3. Position of body does not influ- ence the intensity of the mur- murs. 4. Murmurs not increased in loud- ness by a full inspiration. 5. Murmurs synchronous with the heart-sounds. 6. Heart-impulse strong. 7. No extended pericordial dul- ness. 8. Murmurs constant. Acute Pleurisy. 1. Pain sharp and cutting. 2. Increased by inspiration. 3. Pulse regular and strong. 4. Friction sound ceases by holding the breath. Cardiac Enlargement (hypertrophy or dilatation). 1. Disease developed slowly. 2. No friction sound. 3. Outline of dulness, quadrilateral. 4. Dulness does not extend beyond apex beat. 5. Heart -sounds distinct, howevel feeble or strong. 40 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Endocarditis. Acute Pericarditis. See Acute Pericarditis, page 39. Endocarditis. 1. Signs of obstructed circulation. 2. Cardiac hypertrophy or dilatation. 3. Patient often robust. 4. Murmurs most frequent at apex. 5. Murmurs constant. 6. Murmurs do not disappear under treatment. Ulcerative Endocarditis. 1. Often rheumatic origin. 2. Temperature fluctuating. 3. Disease develops rapidly. 4. Cardiac murmurs present. 5. Frequent signs of embolus. 6. Petechial eruption on body. 7. No characteristic diarrhoea or nose- bleed. Ulcerative Endocarditis. i. Often of rheumatic origin. 2. Cardiac murmurs present. 3. Confusion of mind followed by de- lirium 4. Petechial eruption. 5. Sour breath Cardiac Hypertrophy. 1. Pulse full and bounding. 2. Face flushed. Functional Heart Murmurs. 1. No obstructed circulation. 2. No cardiac enlargement. 3. Patient anaemic and feeble. 4. Murmurs m.ost frequent at base. 5. Murmurs intermittent. 6. Murmurs disappear under appro- priate treatment. Typhoid Fever. 1. No history of rheumatism. 2. Weekly characteristic tempera- tures. 3. Disease develops slowly. 4. No cardiac murmurs. 5. Signs of emboli uncommon. 6. Rose-colored lenticular spots on abdomen. 7. Characteristic diarrhoea and nose- bleed. Pyemia. 1. History of surgical injury, or dis- ease. 2. No cardiac murmurs. 3. Mind at first clear, and then fol- lowed by stupor. 4. Skin deeply jaundiced. 5. Sweet breath. Cardiac Dilatation. 1. Pulse wea); and feeble. 2, Face pale and livid. DISEASES UP T-flE HEART AND BLOOD-VESSELS. 4 1 NAME OF DISEASE. Cardiac Hypertrophy. Beating carotids. Apex-beat distinct and forcible. Heart-sounds intensified. First sound prolonged and intensi- fied. Cardiac Hypertrophy. Subjective symptoms, as cerebral hypersemia. Heaving cardiac impulse. Increase of area of cardiac dul- ness. Change in character and intensity of heart-sounds. Cardiac Hypertrophy. DISEASES TO BE DIFFERENTIATED. Cardiac Dilatation. 3. Veins turgid. 4. Apex-beat indistinct and feeble. 5. Heart-sounds enfeebled. 6. First sound indistinct, short, and resembles the second sound. Displacement of Heart. 1. No subjective heart-symptoms. 2. Cardiac impulse normal. 3. No increase of heart-dulness. 4. Normal heart-sounds. Acute Pericarditis. See Actite Pericarditis, page 39. Cardiac Hypertrophy. No pain in the back. No dysphagia. Face flushed, cerebral hyperemia. Area of heart - dulness increased laterally and dov/nv/ard. Heaving cardiac impulse. No thrill or bruit. Cardiac Hypertrophy Pulse full and tense. Altered first sound. Outline of cardiac dulness, quadri- lateral. No bronchial voice or breathing. Absence of rales. Thoracic Aneurism. 1. Boring pain in dorsal spine. 2. Dysphagia common. 3. Face pale or livid — cerebral con- gestion. 4. Heart-dulness increased upward. 5. Impulse, dilating. 6. Aneurismal thrill and bruit. Consolidation of Lung Tissue. 1. Pulse weak. 2. Heart's sound normal. 3. Outline of dulness, irregular. 4. Bronchial voice and breathing. 5. Moist rales, 42 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Fatty Heart. 1. Pulse irregular. 2. Area of dulness not increased. 3. Absence of first sound. 4. No cardiac murmur. 5. Cheyne-Stokes respiration. 6. Marked cerebral symptoms. Organic Heart Disease (Cardiac palpitation.) I. Comes on gradually. DISEASES TO BE DIFFERENTIATID, Dilatation of Heart. 1. Pulse regular. 2. Area of dulness increased. 3. Enfeebled first sound, 4. Cardiac murmurs common. 5. Respiration normal, or humed. 6. No cerebral symptoms. Functional Heart Disease. (Cardiac palpitation.) I. Comes on suddenly. . Causes, rheumatism, syphilis, etc. 2. Causes, emotion, indigestion, to- bacco, etc. 3. Distinctly paroxysmal. 4. Increased by a sedentary life. 5. Patient very uneasy and worried. 6. No cyanosis. 7. No cardiac murmurs. 3. No distinct paroxysms. 4. Increased by exercise. 5. Patient not uneasy or worried. 6. Often accompanied by cyanosis 7. Cardiac murmurs present. Angina Pectoris. Bronchial Asthma. See Bronchial Asthma, page 30. Angina Pectoris. 1. Lancinating pain in side. 2. Pulse feeble and irregular. 3. Patient conscious and quiet. 4. History of cardiac disease. 5. Cardiac murmurs present. Angina Pectoris. 1. History of cardiac disease. 2. Attack quickly over. 3. No external tenderness. 4. Pain unilateral. Hysteria. 1. Globus hysteria. 2. Pulse strong and regular. 3. Patient has convulsions and semi- coma. 4. History of hysteria. 5. No cardiac murmurs. Intercostal Neuralgia. 1. History of neuralgic attacks. 2. Attack lasts for some time. 3. Marked external tenderness. 4. Pain often bilateral. DISEASES OF THE HEART AND BLOOD-VESSELS. 43 NAME OF DISEASE. Angina Pectoris. 5 Cardiac disturbance — feeble and irregular action of heart. 6 No herpetic eruption follows the attack. Angina Pectoris, 1. Pain referred to front of chest. 2. Pain paroxysmal and lancinating. 3. Pulse irregular and intermittent. 4. Heart diseased. 5. No thoracic pulsating tumor. 6. Respiration shallow and catching. Exophthalmic Goitre. 1. Paroxysmal enlargement of dis- eased thyroid gland. 2. Thyroid very elastic. 3. Eyes have lustrous appearance and marked by exophthalmus. 4. No cardiac murmur. 5. Cardiac palpitation paroxysmal. Aortic Obstruction. 1. Pulse hard and wiry but regular. 2. Subjective symptoms are cerebral in character. 3. Murmur hai^sh. 4. Loudest at base. 5. Conveyed into vessels of neck. 6. Pulmonic second sound feeble. DISEASES TO BE DIFFERENTIATED. Intercostal Neuralgia. 5. Heart normal. 6. Attack often followed by herpes zoster. Thoracic Aneurism. 1. Pain referred to back. 2. Pain quite constant and boring. 3. Pulse regular, but often unlike at the wrists. 4. Heart normal. 5. Pulsating thoracic tumor. 6. Respiration hurried and difficult. Cystic Goitre with Cardiac Dis- ease. 1. Thyroid remains enlarged without fluctuating in size. 2. Thyroid less elastic. 3. Eyes have a dull appearance with- out great exophthalmus. 4. Cardiac murmurs present. 6. Palpitation of the heart not strict- ly paroxysmal. Mitral Regurgitation. 1. Pulse compressible and irregular. 2. Subjective symptoms are pulmon- ary, renal, interstitial, etc. 3. Murmur soft. 4. Loudest at apex. 5. Conveyed to the left and behind. 6. Pulmonic second sound intensi- fied. 44 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISKASE. Aortic Obstruction. 1. No venous pulsation. 2. Hypertrophy of left heart. 3. Murmur heard loudest at second costo-sternal articulation. 4. Conveyed upward into carotids. Aortic Obstruction. 1. Pulse hard and wiry. 2. Patient often robust. 3. Cardiac hypertrophy. 4. Murmurs loudest over base. 5. Murmur harsh in character. 6. No venous hum. Aortic Obstruction, 1. No pain. 2. Having apical impulse. 3. No dilating impulse on palpitation. 4. Bruit single. 5. Pulse the same at both wrists. 6. Sphygmographic tracings diag- nostic. 7. No laryngeal or, oesophageal sub- jective symptoms. Aortic Obstruction. 1. Hard, small wiry pulse. 2. Systolic murmur. 3. Conveyed upward into carotids. 4. No capillary pulsation. Aortic Regurgitation. I No well marked pulmonary symp- -ons. DISEASES TO BE DIFFERENTIATFD. Tricuspid Regurgitation. 1. Pulsation of jugular. 2. Hypertrophy of right heart. 3. Murmur heard loudest over lowei part of sternum. 4. Murmur seldom heard above the third rib. Anaemic Bruit. 1. Pulse soft and compressible. 2. Patient always anaemic. 3. Small heart. 4. Murmur loudest in carotids. 5. Munnur soft and blowing. 6. Loud venous hum. Thoracic Aneurism. 1. Boring pa,in in back and chest, 2. Normal apical impulse. 3. Dilating impulse over aneurism. 4. Bruit double. 5. Pulse often different at the tv/o wrists. 6. Sphygmographic tracings often differ at the wrists. 7. Subjective laryngeal and oesoph^ geal symptoms common. Aortic Regurgitation. 1. " Shot" pulse. 2. Murmur diastolic. 3. Conveyed downward to xiphoid. 4. Capillary pulsation. Mitral Obstruction. I. Pulmonary symptoms well marked upon exercise. DISEASES OF THE HEART AND BLOOD-VESSELS. 45 NAME OF DISEASE. Aortic Regurgitation. 2. " Shot " pulse. 3. Capillary pulsation seen at fundus, of eye and under nails. 4. Murmur diastolic. 5. Murmur soft and musical. 6. Murmur very diffuse. 7. No purring tlariil. 8. Left ventricle hypertrophied. Aortic Regurgitation. 1. "Shot" pulse. 2. Capillary pulsation. 3. Left ventricle hypertrophied. 4. Murmur heard v/ith maximum in- tensity, at right second intercostal space, or at xiphoid cartilage. Aortic Regurgitation. 1. " Shot" pulse. 2. Capillary pulsation. 3. Cardiac hypertrophy. 4. Diastolic murmur. 5. Murmur transmitted downward. DISEASES TO BE DIFFERENTIATED. Mitral Obstruction. 2. Pulse soft and full. 3. No capillary pulsation. 4. Murmur presystolic. 5. Murmur grating and blubbering. 0. Murmur limited. 7. Purring thrill. 8. No ventricular hypertrophy. Pulmonary Regurgitation. 1. Pulse soft. 2. No capillary pulsation. 3. Right ventricle hypertrophied. 4. Murmur heaid with greatest inten- sity at the left second intercostal space. Thoracic Aneurism. (Sinus of valsalva.) Pulse feeble and compressible. No capillar}' pulsation. Cardiac degeneration. Systolic aneurismal murmur. Murmur never transmitted toward apex. Aortic Obstruction. Aortic Regurgitation. See Aortic Obstruction, page 44. Mitral Obstruction. Aortic Regurgitation. See Aortic Regurgitatio?i, page 44. Mitral Obstruction, Mitral Regurgitation. Murmur diastolic. ' i. Murmur presystolic. 2. Murmur of limited area. 2, Conveved around to the back 46 DIFFERENTIAL DIAGNOSIS OF THE 5. NAME OF DISEASE. Mitral Obstruction. Murmur blubbering in character. Heard loudest above apex. Purring thrill. Mitral Regurgitation. DISEASES TO BE DIFFERENTIATED. Mitral Regurgitation. 3. Murmur soft and blowing. 4. Heard loudest at apex. 5. No thrill. Aortic Obstruction. See Aortic Obstruction, page 43. Mitral Regurgitation. Mitral Obstruction. See Mitral Obstruction, page 45. Mitral Regurgitation. Pulmonary symptoms prominent. Murmur loudest at apex. Murmur conveyed to the left. Pulmonary second sound intensi- fied. No venous pulsation. Abdominal Aneurism. Deep boring pain in back and shooting down the thighs. Throbbing localized in a pulsating tumor. Expansive pulsation of tumor. Double murmur. 5. Marked thrill. Abdominal Aneurism. 1. Health good. 2. Tumor has an expansive pulsation. 3. Impulse not lessened by knee- chest position. 4. Tumor not movable. Tricuspid Regurgitation. 1. No pulmonary symptoms. 2. Murmur loudest near xiphoid. 3. Transmitted upward and to the right. 4. Pulmonary second sound infeebled. 5. Jugular pulsation. Pulsating Aorta. 1. Absence of pain. 2. Throbbing felt along whole course of the aorta. 3. Pidsation sudden and jerky. 4. No murmur. 5. No thrill. Pulsating Abdominal Tumors. 1. General health poor. 2. Tumor has a forward pulsation. 3. Impulse lessened by the knee- chest position. 4. Tumor usually movable. DISEASES OF THE HEART AND BLOOD-VESSELS. 47 NAME OF DISEASE. Abdominal Aneurism. % Boring pain, and darting down the thighs. 6. Marked thrill. 7. Double murmur. Abdominal Aneurism. 1. Disease of spine secondary. 2. Expansive pulsating tumor. 3. Well marked thrill. 4. Double murmur. 5. No fluctuation. 6. No difficulty in walking. 7. Temperature normal. Thoracic Aneurism. DISEASES TO BE DIFFERENTIATED. Pulsating Abdominal Tumors. 5. Pain usually dull and not neuralgic in character. 6. No thrill. 7. No murmur — if any, single. Psoas Abscess. 1. Disease of spine primary. 2. No expansive pulsating tumor. 3. No thrill. 4. No murmur. 5. Deep fluctuation. 6. Often great difficulty in walking due to pain and flexion of thigh. 7. Temperature often elevated. Aortic Obstruction. See Aortic Obstruction, page 44. Thoracic Aneurism. Aortic Regurgitation. See Aortic Regurgitation, page 44. Thoracic Aneurism. Cardiac Hypertrophy, See Cardiac Hypertrophy, page 41. Thoracic Aneurism. Angina Pectoris. See Angina Pectoris, page 43. Thoracic Aneurism. Not hereditar}'', or secondary. Pain v/andering and not constant. Pain increased by excited heart's action. Pulse at two wrists often unlike. No enlarged glands in neck or ax- illa. Cancer of Pleura. 1. Hereditary or secondarj'. 2. Pain constant. 3. Pain not increased by over-action of the heart. 4. Pulse at the wrists alike. 5. Enlarged cervical and axillary veins and glands. 48 DISEASES OF THE HEART AND BLOOD-VESSELS. NAME OF DISEASE. Thoracic Aneurism. 6. Expansive pulsation. 7. Double murmur. 8. Well-marked thrill. 9. Subjective sense of throbbing. Thoracic Aneurism. 1. Pain wandering. 2. No chills, fever, or sweating. 3. Heart in normal position. 4. Double murmur. 5. Well-marked thrill. 6. Exploring needle withdraws blood. Thoracic Aneurism. 1. Pain in chest. 2. Pulsating tumor in chest. 3. Double murmur and thrill. 4. Cough, paroxysmal and ringing. 5. Voice not unifoimly changed in character. 6. Stridulous voice and breathing come on suddenly and are parox- ysmal, 7. Laryngoscopic examination shows spasm of vocal cords. DISEASES TO BE DIFFERENTIATED. Cancer of Pleura. 6. No expansive pulsation. 7. No double murmur. 8. No thrill. 9. No throbbing sensations. Pulsating Empyema. 1. Pain stationary. 2. Chills, fever, and sweating. 3. Heart pushed to one side. 4. No murmur. 5. No thrill. 6. Exploring needle withdraws pus. Chronic Laryngitis. 1. Pain referred to larynx. 2. No tumor in chest. 3. No murmur or thrill. 4. Cough more constant and stridu- lous. 5. Voice always changed. 6. Change in voice and breathing less paroxysmal in character. 7. Laryngeal examination shows dis- ease of larynx. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE DIGESTIVES TRACT AND PERITONEUM, DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE DIGESTIVE TRACT AND PERITONEUM. NAME OF DISEASE. Cancer of the oesophagus . Acute gastritis . Toxic gastritis . Chronic gastritis Gastric dyspepsia Cancer of stomach Ulcer of stomach DISEASES TO BE DIFFERENTIATED, j Organic stricture. ( Hysterical stricture. c Toxic gastritis, ( Acute peritonitis-- ' Acute gastritis. Acute peritonitii. Acute enteritis. Cholera morbus. Cholera. I Dyspepsia. ^ Ulcer of stomach. Cancer of stomach I Chronic gastritis. -I Acid fermentation. Cerebral vertigo. Chronic gastritis. Ulcer of stomach. xVodominal aneurism. Cancer of liver. Chronic gastritis. Cancer of stomach. Cardialgia. 51 52 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE, Hematemesis . Acute enteritis . . . Cholera morbus Cholera infantum Dysentery. . , , Perityphlitis Intestinal obstruction Tubercular enteritis . Cancer of intestine . Proctitis DISEASES TO BE DIFFERENTIATED. Hemoptysis. Acute poisoning. Acute peritonitis. Cholera morbus. Typhoid fever. Acute enteritis. Asiatic cholera. Acute poisoning. Enteritis of children. Hydrocephalus. Diarrhoea with hemorrhoidSc Proctitis. Cancer of rectum. Typhlitis. Cancer of caecum. Distension of caecum. Psoas abscess. Intussusception. Intestinal colic. Peritonitis. Hepatic colic. Renal colic. Chronic constipation Tubercular meningitis.' Tubercular peritonitis. Floating kidney. Proctitis. Perityphlitis. Hemorrhoids, Periproctitis. Cancer of intestine. Dysentery. Hemorrhoids, DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 53 NAME OF DISEASE. Hemorrhoids Intestinal colic . A-cute peritonitis Chronic peritonitis Tuberculous peritonitis Ascites • • Cancer of CEsophagus. I. History of hereditary cancer. z. Pain constant. DISEASES TO BE DIFFERENTIATED. Proctitis. Dysentery. Cancer of rectum. Intestinal hemorrhage. Acute peritonitis. Intestinal obstruction. Hepatic colic. Renal colic. Intestinal perforation. Muscular rheumatism. Uterine colic. Acute enteritis. Intestinal colic. Hysteria. Renal or hepatic colic. Acute gastritis. Intestinal obstruction. Acute poisoning. Tuberculous peritonitis. Cancerous peritonitis. Ascites. Cancer of peritoneum. Chronic peritonitis. Tubercular enteritis. Ovarian dropsy. Distended bladder. Hydatids of liver. Pregnancy. « Chronic peritonitis. Cirrhosis of the liver. Simple Organic Stricture. 1. History of injury or inflammation of oesophagus, 2. Pain inconstant. 54 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cancer of (Esophagus. 3. Pain increased by taking food. 4. Cervical glands enlarged. 5. Hemorrhage common. 6. Lungs affected. 7. Bougie brings up cancerous shreds. Cancer of CEsophagus. 1. History of hereditary cancer. 2. Comes on gradually. 3. Greatest difficulty in swallowing, solids. 4. Cancerous cachexia. 5. Lungs affected. 6. Bougie meets with stricture. Acute Gastritis. 1. Temperature elevated. 2. Bowels usually constipated. 3. Mouth and pharynx normal. 4. Symptoms not very