Complete Text (Part 4)

Toxic Gastritis. 1. Temperature often subnormal. 2. Diarrhoea. 3. Mouth and pharynx congested. 4. Symptoms severe from the begin- ning. 5. Symptoms make their appearance within an hour after eating. 6. Bloody mucus mixed with the vomited matter. 7. Great prostration and collapse. 8. Vomited matter contains poison. Acute Peritonitis. See Acute Peritonitis ^ page 69. Toxic Gastritis. Acute Gastritis. (Acute poisoning.) See Acute Gastritis, above. DISEASES OF DIGESTIVE TRACT A. YD PERITONEUM. 55 NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Toxic Gastritis. Acute Peritonitis. See Acute Peritonitis, page 6g. Toxic Gastritis. Acute Enteritis. See Acute Enteritis, page 58. Toxic Gastritis. Cholera Morbus. See Cholera Morbus, page 59. Toxic Gastritis. Cholera. See Cholera, page 120. Chronic Gastritis. Disease secondary. Associated with chronic alcohohsm, renal, hepatic, or thoracic disease. Pain and tenderness in epigastric region. Tongue alway.s coated. Constant thirst. Frequent vomiting. Stimulating ingesta aggravate the symptoms. Many deposits in urine. Chronic Gastritis. Secondary disease of the heart, liver, or kidneys. Pain slightly increased by taking food. Constant thirst. Tongue greatly coated. Vomiting most frequent in early morning. Hematemesis rare. Common disease of adults and elderly people. No rapid emaciation. Deep pressure causes dull pain. Dyspepsia. 1. Disease primary. 2. Dependent upon the habits of life. 3. Little or no epigastric pain and tenderness. 4. Tongue pale and flabby. 5. Moderate thirst. 6. Vomiting infrequent. 7. Spices, etc., often relieve the symptoms. 8. Urine natural in appearance. Ulcer of Stomach. 1. Disease primary, 2. Pain greatly increased by taking food. 3. No thirst. 4. Tongue red and glazed. 5. Vomiting occurs after eating. 6. Hematemesis common. 7. Common in young adults, especial' ly females. 8. Emaciation rapid. V9. Deep pressure causes sharp pain. 56 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Chronic Gastritis. 1. Usually a secondary disease. 2. Pain constant and moderate. 3. Pain increased by taking food. 4. Some tenderness on pressure. 5. Vomiting occasional. 6. Hematemesis rare. 7. No tumor in epigastric region. 8. No enlarged cervical glands. 9. No cachexia. 10. Temperature normal. Gastric Dyspepsia. 1. Pain follows taking food imme- diately ; or, 2. Pain occurs when the stomach is empty, and relieved by taking food. 3. Vomiting common. 4. Mental and constitutional symp- toms not marked. 5. Flatulence uncommon. 6. No sarcince in vomited matter. Gastric Dyspepsia. (Vertigo.) 1. History of dyspepsia. 2. Consciousness never lost. 3. Special senses (except eyes) not affected. 4. Patient knows that the motion of surrounding objects is unreal. DISEASES TO BE DIFFERENTIATED. Cancer of Stomach. 1. Disease hereditary. 2. Pain constant and severe, at times. 3. Pain not increased by taking food. 4. No tenderness on pressure. 5. Vomiting frequent. 6. Hematemesis common. 7. Turnor felt in epigastric region. 8. Cervical glands enlarged. 9. Marked cachexia. 10. Attacks of moderate fever. Acid Fermentation. 1. Pain comes on sometimes after eating. 2. Pain never occurs with an empty stomach. 3. Vomiting uncommon. 4. Mental and constitutional symp- toms well marked. 5. Flatulence common. 6. Sarcinae present in vomited matter. Cerebral Vertigo. 1. History of mental disorder. 2. Consciousness lost at times. 3. Special senses affected. 4. Movement of surrounding objects seems real. Gastric Dyspepsia. Chronic Gastritis. See Chronic Gastritis, page 55. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 5/ NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Cancer of Stomach. Chronic Gastritis. See Chronic Gastritis^ page 56. Cancer of Stomach. Ulcer of Stomach. 1. History of hereditary cancer. i. History of anaemia or chlorosis. 2. Occurs in people over forty years 2. Occurs usually in young adults. of age. 3. Pain constant and lancinating. 3. Pain intermittent — worse after eating. 4. Deep pressure not painful. 4. Deep pressure very painful. 5. Hematemesis small in amount and 5. Hematemesis bright red and large "coffee grounds" in appear- in amount, ance. 6. Vomiting appears late in the dis- 6. Vomiting is one of the first symp- ease. toms. 7. Vomiting does not relieve the 7. Vomiting relieves the pain. pain. 8. Cancerous cachexia. 8. Anaemia. 9. Presence of tumor in epigastric 9. No tumor in region of stomach. region. Cancer of Stomach. Abdominal Aneurism. See Abdominal Aneurism, page 46. Cancer of Stomach. Cancer of Liver. See Cattcer of Liver, page 83. Ulcer of Stomach. Chronic Gastritis. See Chronic Gastfitis, page 55. Ulcer of Stomach. Cancer of Stomach. See Cancer of Stomach, above. Ulcer of Stomach. Cardialgia. T. History of anaemia. i. Histor}' of neuralgia. 2. Pain increased by taking food. 2. Pain not increased by eating. 3. Pain increased by deep pressure. 3= Pain diminished by deep pressure. 58 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE Ulcer of Stomach. Electricity increases the pain. Hematemesis common. Gastric disturbance constantly present. Hematemesis. DISEASES TO BE DIFFERENTIATED. Cardialgia. 4. Pain relieved by electricity. 5. No hematemesis. 6. Gastric symptoms during the attack. only present Hemoptysis. See Hemoptysis, page 30. Acute Enteritis. 1. Onset comparatively slow. 2. Gastric symptoms not severe. 3. Intestinal symptoms first to make their appearance. 4. Temperature elevated. 5. No vomiting of blood. 6. Prostration not severe. 7. Vomited matter free from poison. 8. Mouth and pharynx normal. Acute Enteritis. 1. Onset comparatively slow. 2. Temperature high. 3. Diarrhoea. 4. Abdomen but slightly tympanitic. 5. Pulse feeble and rapid, 5. Vomited matter not characteristic. 7. Abdomno-thoracic breathing. 8. No severe prostration or collapse. Acute Enteritis. 1. Onset comparatively slow. 2. Temperature high. 3. Occasional attacks of diarrhoea aiul vomiting. Acute Poisoning. Onset sudden. Very severe gastric symptoms. Gastric symptoms first to make their appearance. Temperature often subnormal. Vomiting of bloody mucus. Great prostration. Vomited matter contains poison. Mouth and pharjnix often congested and glazed. Acute Peritonitis. Onset sudden — usually with a chill. Temperature moderate. Obstinate constipation. Abdomen very tympanitic. Pulse tense and wiry. Vomited matter spinach green. Thoracic breathing. Great prostration and collapse. Cholera Morbus. Onset sudden — usually at night. Temperature normal or subnor- mal. Constant vomiting and purging. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. $9 NAME OF DISEASE. Acute Enteritis. 4. No severe cramps in legs. 5. No rapid prostration or collapse. 6. Disease lasts a week or more. Acute Enteritis, 1. Gastro-intestinal symptoms precede the febrile movement. 2. Temperature not characteristic. 3. No nose bleed. 4. No eruption. 5. Pain most severe in umbilical re- gion. 6. No gurgling in iliac fossa. 7. Recovery at the end of a week. Cholera Morbus. Disease sporadic. Stools have a fsecal or mouse-like odor. Stools contain bile. Evacuations contain undigested food, mucus, faecal matter, etc. Pain with vomiting and purging. Urine not albuminous or sup- pressed. Temporary prostration. No comma bacilli. DISEASES TO BE DIFFERENTIATED. Cholera Morbus. 4. Severe cramps In legs. 5. Sudden prostration and collapse, 6. Disease lasts a day or two. Typhoid Fever, r. Gastro-intestinal symptoms follow the febrile movement. 2. Temperature characteristic. 3. Frequent nose bleed. 4. Eruption on the seventh day. 5. Pains most severe in right iliac fossa. 6. Gurgling in right iliac fossa. 7. Disease lasts four weeks or more. Asiatic Cholera. 1. Disease epidemic. 2. Stools have no faecal odor. No bile in stools. " Rice water " evacuations often from the first. Painless vomiting and purging. Urine albuminous and often sup- pressed. Prostration greater and prolonged. Presence of comma bacilli. Cholera Morbus. Acute Enteritis. See Acute Enteritis ^ page 58. Cholera Morbus. Acute Poisoning. 1. Begins with vomiting and purging. 2. Pain not limited to epigastric region. 1. Vomiting precedes the purging. 2. Pain limited at first to the epigas- tric region. 6o DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cholera Morbus. 3. No morbid appearance of mouth or pharynx. 4. No blood in vomited matter. 5. Pain colicky in character. 6. No poison in vomited matter. Cholera Infantum. 1. Temperature but slightly elevated. 2. Abdomen retracted. 3. Rapid emaciation and prostration. 4. Vomiting and purging excessive. 5. Great thirst. 6. Diarrhoea very watery. 7. Movements have a musty odor. 8. Urine albuminous and often sup- pressed. g. Tendency toward coma and con- vulsions. Cholera Infantum. 1. Diarrhoea. 2. Pupils dilated and regular. 3. Pulse rapid and regular. 4. Abdomen retracted. 5. Surface cold and perspiring. 6. Tearless cry. Dysentery. 1. Begins acutely. 2. Temperature elevated. DISEASES TO BE DIFFERENTIATED. Acute Poisoning. 3. Mouth and pharynx often con- gested and glazed. 4. Bloody mucus mixed with vomited matter and stools. 5. Pain constant v/ith severe exacer- bations. 6. Poison detected in the vomited matter. Acute Enteritis of Children. 1. Temperature high. 2. Abdomen tympanitic. 3. Less rapid emaciation and prostra- tion. 4. Vomiting and purging occur at intervals. 5. Thirst not excessive. 6. Diarrhoea — fseces containing undi- gested food. 7. Movements have a ftecal odor. 8. Urine not suppressed or albumin nous. 9. Coma and convulsions rare. Acute Hydrocephalus. 1. Constipation usually. 2. Pupils contracted and irregular. 3. Pulse slow and irregular. 4. Abdomen tympanitic. 5. Surface dr}' and hot. 6. Hydrocephalic cry. Diarrhcea with Hemorrhoids.- 1. History of hemorroids. 2. Temperature normal. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 6 1 NAME OF DISEASE. Dysentery, 3. Constitutional symptoms well marked. 4. Stools scanty in amount. 5. Stools contain mucus and blood. 6. On examination find absence of hemorrhoids. Dysentery. 1. Begins acutely with chill, etc. 2. Constitutional symptoms well marked. 3. Severe pain in abdomen. 4. Temperature elevated. 5. Diarrhoea. 6. Abdomen tympanitic and tender. Chronic Dysentery. 1. History of an acute attack. 2. Bearing down pains in rectum. 3. Diarrhoea common. 4. Faeces pasty and mixed with mu- cus and blood. 5. Anssmia and debility. 6. Rectal examination shows disease of mucous membrane. Perityphlitis. I. Presence of tumor before intestinal symptoms are developed. a Pain deep-seated. 3. Pain increased upon motion of thigh. 4. Presence of fluctuation. DISEASES TO BE DIFFERENTIATED. Diarrhcea with Hemorrhoids. 3: No severe constitutional symptoms. 4. Stools copious. 5. Stools contain blood and fspcal matter. 6. Examination shows presence of en- larged veins. Acute Proctitis. 1. Begins with uneasy feeling in rectum. 2. No constitutional symptoms. 3. Pain limited to rectum. 4= Temperature about normal. 5. Constipation. 6. Abdomen not tympanitic or tender. Cancer of Rectum. 1. History of hereditary cancer. 2. Pain lancinating. 3. Constipation. 4. Fasces ribbon-Uke and covered with mucus and blood. 5. Cancerous cachexia. 6. Rectal examination shows presence of tumor. Typhlitis. 1. Begins with colicky pains and ir- regular action of bowels. 2. Pain superficial. 3. Pain not increased by moving thigh. 4. No fluctuation. 62 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Perityphlitis. 5. Tumor irregular and deep-seated. 6. Dulness on percussion over tumor has a tympanitic character. 7. Fever, chills, and sweats. Perityphlitis. 1. Usually the result of t}'phlitis. 2. Tumor develops rapidly. 3. Pain throbbing in character. 4. Pain increased by movement of thigh. 5. Tumor fluctuating. 6. Fever, chills, and sweating. Perityphlitis. 1. History of typhlitis. 2. Fever, chills, and sweating. 3. Tumor fluctuates. 4. Pain increased by moving the right thigh. 5. Symptoms not relieved by an ene- ma or cathartic. DISEASES TO BE DIFFERENTIATED. Typhlitis. 5. Tumor superficial and regular. 6. No tympanitic character to tli> dulness. 7. Absence of chills and sweating. Cancer of Caecum. 1. History of hereditary cancer. 2. Tumor develops slowly. 3. Pain lancinating. 4. Pain not increased by movement of thigh. 5. Tumor solid. 6. No chills or sweating. Distension of Csecum. 1. History of constipation. 2. No fever, chills, or sweating. 3. No fluctuation. 4. No pain produced by movements of thigh. 5. Symptoms relieved by an enema 01 cathartic. Perityphlitis, 1. History of typhlitis. 2. Intestinal symptoms well marked. 3. No pain in spine. 4. Fluctuating tumor appears gradu- ally. 5. Constitutional symptoms are wpU marked. 6. The pus has a faecal odor. Psoas Abscess. 1. History of disease of spine. 2. No well-marked intestinal symp toms. 3. Aching pain in back. 4. Tumor often appears suddenly. 5. No severe constitutional symp toms. 6. No faecal odor to the pus. DISEASES OP DIGESTIVE TRACT AND PERITONEUM. 63 NAME OF DISEASE. Perityphlitis. 1. Tumor develops slowly. 2. Simple constipation. 3. No blood or mucus with stools. 4. Irregular chills and sweating. 5. No stercoraceous vomiting. 6. Tumor irregular in shape. 7. No severe collapse or prostration. Intestinal Obstruction. 1. Obstinate constipation. 2. Pain persistent. 3. Pain not relieved by pressure. 4. Stercoraceous vomiting. 5. Symptoms of profound collapse. Intestinal Obstruction. 1. Temperature normal or subnor- mal. 2. Pulse feeble and rapid. 3. Stercoraceous vomiting. 4. Pain localized. 5. Some tenderness upon pressure. 6. Abdomino- thoracic breathing. Intestinal Obstruction. 1. Fcecal vomiting. 2. Pain localized and constant. 3. Obstinate constipation. 3. Urine lessened in amount. 5. No jaundice. 6. Pressure increases the pain. DISEASES TO BE DIFFERENTIATED. Intussusception, 1. Tumor develops suddenly. 2. Complete intestinal obstruction. 3. Small, bloody, and mucous pas- sages. 4. No chills or sweating. 5. Stercoraceous vomiting. 6. Tumor sausage-shaped. 7. Sudden collapse and prostration. Intestinal Colic. 1. Bowels irregular. 2. Pain intermittent. 3. Pain relieved by pressure. 4. No vomiting. 5. No collapse. Acute Peritonitis. 1. Temperature elevated. 2. Pulse tense and wiry. 3. Spinach-green vomiting. 4. Pain general over abdomen. 5. Great abdominal tenderness. 6. Thoracic breathing. Hepatic Colic. 1. Vomiting not stercoraceous. 2. Pain paroxysmal and radiating from gall bladder to back. 3. Stools clay-colored. 4. Urine contains bile pigment. 5. Jaundice common 6. Pressure relieves the pain. 64 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Intestinal Obstruction. 1. Fcecal vomiting. 2. Pain localized and constant. 3. Urine diminished in amount. 4. Complete constipation. 5. No pain in testicles. 6. Pressure increases the pain. Intestinal Obstruction. 1. Onset sudden. 2. Faecal vomiting. 3. TympaniLic distension of abdo- men. 4. Cathartics increase the severity of the symptoms. 5; No scybala felt through the ab- dominal wall. 6. Great prostration and collapse. Tubercular Enteritis. (Ulcer of intestine.) 1. Abdomen distended. 2. Diarrhoea. 3. Pulse accelerated. 4. Pupils normal. 5. Vomiting rare. 6. Inordinate hunger. Tubercular Enteritis. (Ulcer of Intestine.) 1. Abdomen distended and flaccid. 2. Pain moderate and not increased upon pressure. 3. Rapid emaciation. 4. Cervical glands enlarged. DISEASES TO BE DIFFERENTIATED. Renal Colic. 1. No stercoraceous vomiting. 2. Pain paroxysmal and extends along ureters to penis of testicle. 3. Urine bloody. 4. Bowels normal. 5. Testicles painful and retracted. 6. Pressure relieves the pain. Chronic Constipation. 1. History of constipation. 2. Absence of vomiting. 3. No tympanites. 4. Cathartics relieve the symptoms. 5. Scybala felt through the abdom- inal wall. 6. No severe constitutional symptoms. Tubercular Meningitis. 1. Abdomen retracted. 2. Constipation. 3. Pulse retarded. 4. Pupils contracted and irregular. 5. Vomiting frequent and projectile. 6. Loss of appetite. Tubercular Peritonitis. 1. Abdomen distended and rigid. 2. Pain severe and increased by pres- sure. 3. Emaciation less rapid. 4. Glands not enlarged. DISEASES OF DIGESTIVE TRACT AND PERITONEUM, 65 NAME OF DISEASE. Tubercular Enteritis. 5. No ascites. 6. Tympanitic percussion note. 7. No redness around umbilicus. Cancer of Intestine. 1. History of hereditary cancer. 2. Cancerous cachexia. 3. Pain lancinating. 4. Tumor irregular in shape. 5. Tumor in front of intestines. 6. Pain not much increased by ma- nipulation. DISEASES TO BE DIFFERENTIATED. Tubercular Peritonitis. 5. Ascites common. 6. Dulness on percussion. 7. Redness and oedema around um- bilicus. Floating Kidney. 1. No hereditary tendencies. 2. No cachexia. 3. Pain dull. 4. Tumor kidney shape. 5. Tumor behind intestine. 6. Sickening pain produced squeezing tumor. by Cancer of Intestine. Perityphlitis. See Perityphlitis, page 62. Cancer of Intestine. I. History of hereditary cancer. Cancerous cachexia. Bloody mucus with stools. Faeces ribbon like. Pain lancinating in character. 6. By examination find a tumorous mass in rectum. Hemorrhoids. 1. History of sedentary habits, dis- ease of the liver, etc. 2. No cachexia. 3. Occasional hemorrhage from bowel. 4. Fseces normal in shape. 5. Dragging pain in rectum. 6. On examination find enlarged veins in rectum. Cancer of Intestine. Abdominal Aneurism. See Abdominal Aneurism, page 47. Proctitis. Begins with tenesmus. Stools contain gelatinous m.ucus and blood. Periproctitis. Begins with pain and tenderness in anal region. Stools do not contain blood or mucus. 66 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Periproctitis. 3. Chills, fever, and sweating. 4. External signs of inflammation. 5. Presence of fluctuating tumor. 6. On examination an abscess is found in neighborhood of rectum. Hemorrhoids. Pain greater than the tenesmus. Stools contain pure blood. Hemorrhoids often appear exter- nally. Examination shows enlarged veins in rectum. Proctitis. 3. No chills, fever, or sweating. 4. No external signs of inflammation. 5. No fluctuating tumor. 6. Examination shows diseased con- dition of rectal mucus membrane. Proctitis. 1. Tenesmus severe. i. 2. Stools contain mucus and blood. 2. 3. No external appearance of disease. 3. 4. Examination shows diseased con- 4. dition of the rectal mucous mem- brane. Proctitis. Dysentery. See Dysentery ^ page 61. Proctitis. Cancer of Intestine. See Cancer of Intestine, page 65. Hemorrhoids. Proctitis. See Proctitis ^ above. Hemorrhoids. Dysentery. See Dysentery, page 60. Hemorrhoids. Cancer of Intestine. See Cancer of Intestine, page 65. Hemorrhoids. Intestinal Hemorrhage. 1. Tenesmus. i. No tenesmus. 2. Bearing down pain in rectum. 2. Abdominal pain. 3. Constipation. 3. Usually diarrhoea. 4. Blood bright red and covers faeces. 4. Blood tarry and mixed with faeces. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 6/ NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Hemorrhoids. Intestinal Hemorrhage. 5. No constitutional symptoms. 5. Well-marked constitutional symp- toms. 6. Rectal examination shows presence 6. Rectal examination negative. of enlarged veins. Intestinal Colic. 1. No fever. 2. Pulse slow and full. 3. Great restlessness. 4. Pressure relieves the pain. 5. Pain paroxysmal. 6. No vomiting. Intestinal Colic. 1. Pain paroxysmal. 2. Temperature normal. 3. Pulse slow and full. Pressure relieves the pain. No marked tympanites. No real prostration or collapse. Acute Peritonitis. 1. High temperature. 2. Pulse rapid and wiry. 3. Patient perfectly still. 4. Pressure increases the pain. 5. Pain constant. 6. Spinach-green vomiting. I. Perforation cf Intestine. with paroxysmal No hemorrhage from bowels. Intestinal Colic. Pain constant aggravations. Temperature often subnormal. Pulse rapid and feeble. Pressure increases the pain. Tympanites. 6. Great prostration and collapse, 7. Hemorrhage from bowel common. Intestinal Obstruction. See