Complete Text (Part 7)

No superficial signs of inflamma- tion. 5. Kidneys tender on pressure. 6. No fluctuation. 7. Temperature continues elevated. Pyaemia. 1. Profuse sweats. 2. Urine normal. 3. Fever very high at times. 4. Large joints affected. 5. Pulmonary symptoms. 6. Kidneys not enlarged or tender. 7. Pain not referred to lumbar region. Perinephritic Abscess. 1. Urine normal. 2. A distinct tumor in lumbar region. 3. No casts in urine. 4. Superficial tenderness and cedema. 5. Kidneys painful on pressure. 6. Fluctuation. 7. Irregular chills, fever, and sweat- ing. DISEASES OF THE KIDNEYS AND BLADDER. 99 NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Suppurative Nephritis. Cystitis. 1. Urine contains much pus and little i. Urine contains much ropy mucus mucus. and little pus. 2. Pain in lumbar region. 2. Pain in bladder and penis. 3. Pus casts in urine. 3. No casts in urine. 4. Typhoid symptoms well marked, 4. No severe constitutional symptoms. 5. No constant desire to urinate. 5. Constant desire to micturate. 6 Affected kidney enlarged and 6. Kidneys not enlarged or tender, tender. Hematuria. Vesical Hemorrhage. 1. History of kidney disease, blood 1. History of disease of the bladder. disease, poisoning, etc. 2. Blood mixed with the urine. 2. Blood follov/s the passage of urine. 3. Urine contains albumen and blood 3. Urine contains blood clots. casts. 4. Pain in the lumbar region. 5. Renal epithelium in urine. 4. Pain located in bladder or penis. 5. Vesical epithelium in urine. Hematuria. Urethral Hemorrhage. 1. History of kidney trouble, blood i. History of urethritis, prostatic disease or poisoning. trouble, etc. 2. Blood is mixed with the urine. 2. Blood precedes the urinary dis- charge. 3- Urine contains albumen and blood 3. Blood casts of urethra in the urine, casts. 4. Pain in the lumbar region. 5. Renal epithelium in urine. 6. Blood is passed with urine. Hematinuria. 4. Pain in penis or prostate. 5. No renal or vesical epithelium in urine. 6. Blood discharged without emptying the bladder. Acute Bright's. See Acute Bright'' s, page 93, 100 DIFFERE]^TIAL DIAGNOSIS OF THE NAME OF DISEASE. Hematinuria. 1. Often the result of malaria. 2. Few red blood corpuscles in urine. 3. Abundance of blood pigment in urine. 4. Often preceded by chilliness, slight jaundice, and gastric disorder. 5. Coloring matter not deposited on standing. 6. Urine often suddenly changes color on standing. Hydronephrosis. 1. Urine normal. 2. May afifect both kidneys. 3. No fremitus on percussion. 4. Tumor single. 5. Tumor grows rapidly. 6. Tumor seldom of great size. 7. Exploring needle withdraws a watery uriniferous fluid. Hydronephrosis or Hydatids of Kidney. 1. Tumor grows from lumbar region. 2. Colon lies in front of tumor. 3. Vaginal examination negative. 4. Absence of tympanitic percussion note in lumbar region. 5. Exploring needle withdraws a watery fluid, either with or M'ith- out hooklets. DISEASES TO BE DIFFERENTIATED. Hematuria. 1. The result of kidney disease. 2. Many red blood corpuscles in urine. 3. No free blood pigment in urine. 4. Preceded by pain in lumbar region. 5. Coloring matter deposited at bot- tom of vessel on standing. 6. Urine does not change color on standing. Hydatids of Kidney. 1. Urine contains hydatid vesicles. 2. Affects one kidney. 3. Hydatid fremitus on percussion. 4. Tumor multiple. 5. Tumor grows slowly. 6. Tumor often of large cize. 7. Exploring needle withdraws fluid containing hooklets. Ovarian Cyst. 1. Tumor starts from pelvic region. 2. Colon behind tumor. 3. Vaginal examination positive. 4. Tympanitic percussion in lumbar region. 5. Exploring needle withdraws albu- minous fluid containing character- istic cells. Hydronephrosis or Hydatids of Kidney. See Pyonephritis, page 9S. Pyonephritis. DISEASES OF THE KIDNEYS AND BLADDER, lOI NAME OF DISEASE. Hydronephrosis or Hydatids of Kidney. See Hydatids of Liver, page 84. DISEASES TO BE DIFFERENTIATED. Hydatids of Liver. Hydronephrosis or Hydatids ot Kidney. 1. Tumor not painful, 2. Tumor grows forward. 3. Superficial fluctuation. 4. No constitutional symptoms. 5. No signs of inflammation about the tumor. 6. Exploring needle withdraws wat- ery fluid, either with or without booklets. Hydronephrosis or Hydatids of Kidney. 1. Tumor not painful. 2. No constitutional symptoms. 3. Tumor smooth and fluctuating. 4. Urine normal. 5. No cachexia or history of cancer. 6. Exploring needle v/ithdraws watery fluid with or without booklets. Cancer of Kidney. Perinephritic Abscess, 1. Tumor painful. 2. Tumor grows backward. 3. Deep fl-uctuation. 4. Chills, fever, and sweating. 5. Tumor painful and tender, skin oedematous and sometimes red. 6. Exploring needle withdraws pus. Cancer of Kidney. 1. Tumor painful. 2. Constitutional symptoms. 3. Tumor hard and nodular. 4. Urine contains blood and cancer cells. 5. Cachexia and often history of can- cer. 6. Exploring needle withdraws blood and cancer cells. Tumor of Liver. See Tumor of Liver, page 83. Cancer of Kidney. Abdominal Aneurism. See Abdominal Aneurism, page 46. Cancer of Kidney. Hydronephrosis or Hydatids of Kidney. See Hydronephrosis or Hydatids of Kidney, above. 102 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cancer of Kidney. 1. History of hereditary or secondary cancer. 2. No fluctuation. 3. No chills or sweating. 4. No pain on pressure. 5. Slow growth. 6. Urine contains blood and cancer cells. 7. Exploring needle withdraws blood and cancer cells. Cancer of Kidney. 1. History of cancer. 2. Tumor stationary. 3. Outline of tumor irregular. 4. No blood changes. 5. Grows from lumbar region. 6. Cancerous cachexia. 7. Blood and cancer cells in urine. Cancer of Kidney. 1. History of cancer, 2. Blood in urine. 3. No tenderness over the tumor. 4. No disease of testicles or prostate. 5. No pulmonary symptoms. 6. Hectic appears late. 7. Tumor grows to a large size. DISEASES TO BE DIFFERENTIATED. Perinephritic Abscess. 1. Often a history of injury to lumbar region. 2. Fluctuation about tumor. 3. Irregular chills and profuse sweats. 4. Marked pain and tenderness on pressure. 5. Tumor of rapid growth. 6. Urine normal. 7. Exploring needle withdraws pus. Tumor of Spleen. 1. History of malaria, leucocythemia. 2. Tumor moves up and down with the breathing, 3. Outline of tumor presents the splenic notch. 4. Large increase of white blood cor- puscles. 5. Tumor grows from the left hypo- chondriac region. 6. Patient very anaemic. 7. Urine normal. Tubercular Kidney. 1. History of tuberculosis. 2. Cheesy debris in urine. 3. Tumor tender on pressure. 4. Tubercular disease of testicles or prostate. 5. Lungs phthisical. 6. Hectic appears early. 7. Tumor rarely of large size. DISEASES OF THE KIDNEYS AND BLADDER. IO3 NAME OF DISEASE. DISEASES TO EE DIEFERENTIATED. Perinephritic Abscess. Pyonephritis. See Pyonephritis, page 97. Perinephritic Abscess. Suppurative Nephritis. See Suppurative Nephritis, page 98. Perinephritic Abscess. Cancer of Kidney. See Cancer of Kidney, page 102. Perinephritic Abscess. Hydronephrosis. See Hydronephrosis y page loi. Renal Calculi. Acute PeritonitiSe See Acute Peritonitis, page 69. Renal Calculi. Hepatic Colic. See Hepatic Colic, page 85. Renal Calculi. intestinal Colic See Intestinal Colic^ page 68. Cystitis. Acute Bright's. See Acute Brighfs, page 94. Cystitis. Pyelitis. See Pyelitis, page 97. Cystitis. Suppurative Nephritis. See Suppurative Nephritis, page 99. Cystitis. Spasm of the Bladder. 1. Temperature elevated. i. Temperature normal. 2. Pain burning in character. 2. Pain lancinating. 3. Pain constant. 3. Pain paroxysmal. 4. Ropy mucus and pus in urine. 4. Urine normal. 5. No difficulty in passing water ex- 5. Great difficulty in passing any urin§ cept the pain. during the paroxysm. 6. Urine scalds, 6. Urine does not scald. DIFFERENTIAL DIAGNOSIS OF THE ACUTE GEN- ERAL DISEASES. DIFFERENTIAL DIAGNOSIS OF THE ACUTE GEN- ERAL DISEASES. NAME OF DISEASE. Typhoid fever , Typhus fever . Yellow fever . . Relapsing fever Intermittent fever DISEASES TO BE DIFFERENTIATED. Typhus fever. Typho-malarial fever. Acute tuberculosis. Septicaemia. Ulcerative endocarditis. Trichinosis. Acute enteritis. Typhoid fever. Relapsing fever. Measles. Meningitis. Small-pox. ' Acute yellow atrophy of Hver. Relapsing fever. Typho-malarial fever. Pernicious malarial fever. Yellov/ fever. Typhus fever. Remittent fever. Dengue fever. j Pyaemia. ( Remittent fever. X07 io8 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Remittent fever Pernicious malarial fever , Small-pox Scarlet fever Measles Cholera Diphtheria Epidemic cerebro-spinal meningitis DISEASES TO BE DIFFERENTIATED. Intermittent fever. Typhoid fever. Yellow fever. Relapsing fever. Meningitis. Cholera. Yellow fever. Scarlet fever. Measles. Epidemic cerebro-spinal meningitis. Varioloid. Chicken-pox. Typhus fever. Measles. Variola. Erythema. Diphtheria. ' Variola. Scarlet fever. Roseola. Typhus fever. Acute poisoning. Cholera morbus. Pernicious malarial fever. Diphtheritic sore throat. Membranous croup. Scarlet fever. Erysipelas of throat. Small-pox. Typhus fever. Tubercular meningitis. Pernicious fever. ACUTE GENERAL DISEASES. 109 NAME OF DISEASE. Pyaemia Septicaemia Hydrophobia ..... Typhoid Fever. 1. Disease endemic. 2. Advent slow, with general mala- ria, etc. 3. Chilly sensations. 4. Temperature characteristic for each week of the disease. 5. Lenticular rose-colored eruption limited to abdomen. 6. Eruption disappears on pressure. 7. Eruption appears from seventh to tenth day. 8. Eruption appears in crops. 9. Diarrhcea. 10. Gurgling and tenderness in right iliac fossa. 11. Epistaxis and intestinal hemor- rhage common. 12. Nervous symptoms appear in the second week. 13. Spleen enlarged. 14. Face flushed. DISEASES TO BE DIFFERENTIATED. Suppurative nephritis. Septicaemia. Intermittent fever. Acute yellow atrophy of liver. Ulcerative endo-carditis. Typhoid fever. Pysemia. Tetanus. Hyateria. Typhus Fever. 1. Epidemic. 2. Advent sudden. 3. Severe chill. 4. Temperature high from the first. and remains so until crisis. 5. Irregular, dark, mottled eruption appears about shoulders and spreading over body. 6. Eruption does not disappear on pressure. 7. Eruption appears on fifth day. 8. Eruption does not appear in crops. 9. Constipation. 10. No abdominal symptoms. 11. Hemorrhages very uncommon. 12. Nervous symptoms appear early. 13. Spleen not much enlarged. 14. Face mahogany color. I !0 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Typhoid Fever. 15. Lasts about four weeks. 16. No crisis. 17. Bed-sores. DISEASES TO BE DIFFERENTIATKD. Typhus Fever. 15. Lasts two weeks. 16. Crisis about tlie fourteenth day. 17. Glandular enlargements. Typhoid Fever. 1. Onset slow with chilly sensations. 2. Temperature rises slowly and reg- ularly. 3. Characteristic eruption. 4. No jaundice or hepatic tender- ness. 5. Spleen somewhat enlarged. 6. Abdomen tympanitic. 7. Tenderness and gurgling in the right iliac fossa. 8. Gastric symptoms not very severe. 9. Diarrhoea characteristic. 10. No free pigment in blood. Typho-malarial Fever. 1. Onset sudden with a chill. 2. Temperature rises suddenly and is periodical in character. 3. No eruption. 4. Jaundice and hepatic tenderness. 5. Spleen greatly enlarged. 6. No distension of abdomen. 7. No tenderness or gurgling in right iliac fossa. 8. Gastric symptoms especially marked. 9. No characteristic diarrhoea. 10. Free pigment in blood. Septicasmia. 1. Temperature very high and irregu- lar from first. 2. No eruption. 3. Typhoid symptoms appear early. 4. Jaundice. 5. No iliac symptoms. 6. No nose bleed. 7. History of exposure to typhoid 7. History of injury or infectious dis- poison. ease. Typhoid Fever. 1. Temperature characteristic. 2. Eruption. 3. Typhoid symptoms appear late. 4. No jaundice. 5. Gurgling, etc., in right iliac fossa. 6. Nose bleed. ACUTE GENERAL DISEASES. Ill NAME OF DISEASE. Typhoid Fever. 1. Disease endemic. 2. Temperature highest the end of second week. 3. Spleen enlarged. 4. Absence of dyspnoea, 5. Bronchitis. 6. Face flushed. 7. Characteristic eruption. 8. Choroid normal. 9. Sputum not characteristic. Typhoid Fever. 1. Temperature characteristic. 2. Eruption. 3.' No oedema. 4. No severe muscular pains. 5. No muscular tenderness. 6. Examination of muscle negative. Typhoid Fever. DISEASES TO BE DIFFERENTIATED. Acute Tuberculosis. 1. Disease hereditary' or secondar}'. 2. Temperature 106° - 107'' in first week. 3. Spleen not enlarged. 4. Severe dyspnoea. 5. Lung consolidation — subcrepitant rales. 6. Face cyanosed. 7. No eruption. 8. Tubercular ulceration of choroid. 9. Sputum contains tubercle bacilli. Trichinosis. 1. Temperature not characteristic. 2. No eruption. 8. CEdema of eyelids. 4. Severe muscular pains. 5. Extreme muscular tenderness. 6. Trichinae found in the muscle. Ulcerative Endocarditis. See Ulcerative Endocarditis, page 40. Typhoid Fever. Acute Enteritis. See Acute Enteritis, page 59. Typhus Fever. Typhoid Fever. See Typhoid Fever, page 109. 1 yphus Fever. 1. Early delirium. 2. Mulberry rash. 3. Great muscular weakness. 4. Spleen normal size. 5. Crisis on fourteenth day. Relapsing Fever. 1. No delirium. 2. No eruption. 3. Severe muscular and arthritic pains. 4. Spleen enlarged. 5. Intermission end of first week. 112 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Typhus Fever. 6. No relapse. 7. No profuse sweats. 8. Pulse not very rapid at first. 9. No abdominal symptoms. ID. Frequent glandular enlargement. Typhus Fever. DISEASES TO BE DIFFERENTIATED. Relapsing Fever. 6. Relapse end of second week. 7. Severe sweats. 8. Pulse 150 to 170 from the first. 9. Vomiting and abdominal pain. 10. No enlarged glands. Small-pox. See Small-pox, page 118. Typhus Fever. Measles. 1. Eruption preceded by cerebral i. Eruption preceded by symptoms of symptoms and great prostra- tion. 2. Eruption appears on the fifth day. 3. But little eruption about the head. 4. Eruption not crescentic in appear- ance. 5. Eruption dark-brown. 6. Eruption does not disappear on pressure. 7. Mucous membrane of throat nor- mal. Typhus Fever. 1. Frontal headache. 2. Headache disappears with the de- lirium. 3. No muscular rigidity. 4. Mulberry rash. 5. No strabismus. 6. No convulsions or paralysis. 7. Countenance blank. a severe cold. 2. Eruption appears on the fourth day. 3. Eruption well-marked about the face. 4. Eruption crescentic. 5. Eruption dark-red. 6. Eruption disappears on pressure. 7. Throat red and injected. Cerebro-spinal Meningitis. 1. Occipital headache. 2. Pain in head continues with the delirium. 3. Muscular rigidity appears early. 4. Herpetic eruption, if any. 5. Strabismus. 6. Convulsions and paralysis com., mon. 7. Face pinched and anxious. ACUTE GENERAL DISEASES. 113 9- 10. II. NAME OF DISEASE. Typhus Fever. Temperature remains high from first. Pulse rapid and compressible. No vomiting. Crisis. Yellow Fever. DISEASES TO BE DIFFERENTIATED. Cerebro-spinal Meningitis. 8. Temperature rises slowly seldom over 104°. 9. Pulse slow. 10. Frequent vomiting. 11. No critical days. Acute Yellow Atrophy of Liver. See Acute Yellow Atrophy of Live7', page 81. Yellow Fever. 1. Temperature rarely over 104°. 2. Pulse comparatively slow and gas- eous. 3. Jaundice well-marked. 4. Supra-orbital pain, 5. Remission about the fourth day. 6. Spleen not greatly enlarged. 7. Fiery eye. 8. Hemorrhages common. Yellow Fever. 1. Temperature constant until remis- sion. 2. Constipation. 3. Supra-orbital pain. 4. Countenance peculiar. 5. Jaundice well-marked. 6. Hemorrhages common. 7. Urine album.inous. 8. Spleen slightly enlarged. 9. Disease of short duration. Yellow Fever. 1. Temperature rarely over 104. 2. Pulse slow and gaseous. Relapsing Fever. 1. Temperature 105° to 107°. 2. Pulse very rapid. 3. Jaundice slight and late in appear- ing. 4. Arthritic and muscular pain. 5. Intermission end of first week. 6. Spleen much enlarged. 7. No change in face. 8. Hemorrhages uncommon. Typho-malarial Fever. 1. Periodicity in daily temperature. 2. Diarrhoea. 3. Pain in iliac fossa. 4. No peculiar countenance, 5. Slight jaundice. 6. Hemorrhages uncommon, 7. Urine normal, 8. Spleen greatly enlarged. 9. Disease of long duration. Pernicious Malarial Fever. 1. Temperature 104 to 106. 2. Pulse rapid. 114 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. YelloTv Fever. 3. Remission about the fourth day. 4. Hemorrhages common. 5. Tongue clean. 6. Mind clear. 7. Fiery eye. 8. Supra-orbital pain, g. Urine albuminous. 10. Vomiting projectile and severe. Relapsing Fever. See Typhus Relapsing Fever. See Yellow Relapsing Fever. 1. Continued high temperature until remission. 2. Pulse very rapid. 3. Intense arthritic pains. 4. Complete relapse. 5. Sweating without reduction of temperature. 6. Crisis. 7. Blood contains spirilli. Relapsing Fever. 1. Begins with a chill and high fever. 2. No swelling of joints. 3. No enlarged glands. 4. Complete intermission toward the end of first week. DISEASES TO BE DIFFERENTIATED. Pernicious Malarial Fever. 3. Remission within twenty-four hours. 4. Hemorrhages rare. 5. Tongue coated. 6. Delirium or stupor. 7. Countenance not peculiar. 8. No supra-orbital pain. 9. No albumen in urine. 10. Vomiting retching and moderate. Typhus Fever. Fever f page iii. Yellow Fever. Fever, page 113. Remittent Fever. 1. Daily remissions. 2. Pulse not very rapid. 3. No severe pain in muscles or joints. 4. No relapses. 5. Sv/eating with reduction of tem- perature. 6. No crisis. 7. Blood contains free pigment. Dengue Fever. 1. Begins as a rheumatism. 2. Joints swollen and tender. 3. Glands enlarged and tender, 4. Remission on third or fourth day. ACUTE GENERAL DISEASES. ii; NAME OF DISEASE. Relapsing Fever. 5. Vomiting. 6. Profuse sweats. 7. No eruption. Intermittent Fever. 1. History of exposure to malarial poisoning. 2. Paroxysms regular. 3. Temperature very high. 4. Jaundice uncommon. 5. No severe prostration. 6. Breath normal odor. 7. No pulmonary or joint symptoms. 8. No points of local infection. Intermittent Fever. 1. Many chills. 2. Complete intermissions. 3. Periods of no fever. 4- DISEASES TO BE DIFFERENTIATED. Dengue Fever. 5. Vomiting uncommon. 6. No profuse sv/eats. 7. Accompanying the relapse an eruption appears first on the hands. Pyaemia. 1. History of injury or infectious dis- ease. 2. Irregular paroxysms. 3. Temperature lower. 4. Jaundice. 5. Patient greatly prostrated. 6. Breath sweet and nauseous. 7. Abscess of lungs and joints. 8. Points of local infection. Remittent Fever. 1. One Chill. 2. Remissions. 3. Always fever. Regular development of parox- 4. Symptoms irregularly developed. ysms. Patient feels Avell during the inter- 5. Patient feels sick all of the time. missions. Remittent Fever. Typhoid Fever. See Typhoid Fever, page no. Remittent Fever. Yellow Fever. See Yellow Fever, page 113. Remittent Fever. Relapsing Fever, See Relapsing Fever, page 114. ii6 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Remittent Fever. Intermittent Fever. See Intermittent Fever ^ page 115. Pernicious Malarial Fever. (Cerebral form.) 1. Coma appears early. 2. History of malaria. 3. Temperature very high. 4. Pulse rapid and full. 5. Distinctly paroxysmal. 6. Attack ends in a few hours with sweating, fall in temperature, and sleep. 7. Free pigment in blood. Pernicious Malarial Fever. (Gastro-enteric form.) 1. History of malarial infection. 2. Temperature elevated. 3. Discharges bloody from first. 4. No albumen in urine. 5. Vomiting painful and retching. 6. Free pigment in blood. Cerebro-Spinal Meningitis. 1. Coma preceded by headache, de- lirium, etc. 2. History of injury and infectious