Complete Text (Part 9)

CHRONIC GENERAL DISEASES. 133 NAME OF DISEASE. Alcoholism (Coma). 6. Smell of alcohol about patient. 7. Pulse rapid. 8. Face flushed. DISEASES TO BE DIFFERENTIATED. Opium Poisoning. 6. Odor of opium about patient. 7. SloT/ pulse. 8. Face pale and cyanotic. Alcoholism. Sun-Stroke. 1. Temperature normal. 2. No diarrhoea. 3. Odor of alcohol about patient. 4. Reflexes normal. 5. Steamboat respiration. 6. Patient can swallow. I. 2. 3- 4. 5. 6. Temperature very high. Profuse diarrhoea. No peculiar smell about patient. Reflexes absent. Quiet or stertorous breathing. Patient cannot swallow. Alcoholism (Coma). Uraemia. See Urcemia, page 92. Syphilis (Chancre). Chancroid. 1. Incubation about twenty days. 2. Begins as a papule. 3. Single. 4. Ulceration superficial. 5. Edges of ulcer sloping. 6. Floor of ulcer copper-colored. I. 2. 3- 4. 5. 6. . Incubation from one to five days. Begins as a pustule or ulcer. Multiple. Deep ulceration. Edges of ulcer abrupt. Floor of ulcer worm-eaten in ap- 7. Scanty secretion. 8. No pain. 9. Indolent induration of glands. 10. Constitutional symptoms. 7. 8. 9- 10. pearance. Secretion purulent and abundant. Ulcer painful. Acute suppurative inflammation of glands. Disease purely local. Myalgia. 1. Skin normal. 2. Skin not sensitive to pressure. 3. Pain greatly increased by contrac- tion of muscle. Neuralgia. 1. Skin frequently inflamed. 2. Skin anesthesia or hypersesthesia. 3. Pain greatly increased by pressure. 134 DIFFERENTIAL DIAGNOSIS. NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Myalgia. Neuralgia. 4. Pain constant and tearing in char- 4. Pain paroxysmal and shooting. acter. 5. Pain most severe at points of at- 5. Pain most severe over course of tachment of muscle. nerve. 6. No eruptions. 6. Frequent herpetic eruptions. Myalgia. Trichinosis. See Trichinosis, page 131. Myalgia. Intestinal Colic. See Intestinal Colic, page 67. Myalgia. Spinal Meningitis, See Spinal Meningitis, page 146. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE NERVOUS SYSTEM. U\J DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE NERVOUS SYSTEM. DISEASES OF THE BRAIN. NAME OF DISEASE. Acute meningitis Chronic meningitis Tubercular meningitis Cerebral softening Cerebral-apoplexy, or embolus DISEASES TO BE DIFFERENTIATED. Uraemia. Typhus fever. Small-pox. Delirium tremens. Tubercular meningitis. Pachymeningitis interna. j Cerebral tvimor. ( Cerebral softening. Acute meningitis. Spurious hydrocephalus. Infantile remittent fever. Tubercular enteritis. Cerebro-spinal meningitis. Chronic meningitis. Cerebral tumor. Abscess of brain. Cerebral embolus. Uraemia. Alcoholism, Opium poisoning. Hysteria-. Asphyxia. Epilepsy. 137 138 DIFFERENTIAL DIAGNOSIS OF THE Abscess of the brain . Cerebral tumor Cerebral concussion Spinal meningitis Cerebral tumor. Cerebral softening. Abscess of the brain. Chronic meningitis. Cerebral softening. Cerebral compression. ■cy) DISEASES OF THE CORD. Myelitis Bulbar paralysis Polio-myelitis anterior Progressive muscular atrophy Cerebro-spinal sclerosis Locomotor ataxia Amyotrophic lateral sclerosi:; Tetanus. Myelitis. Muscular rheumatism. Spinal meningitis. Hysterical paralysis. Spinal apoplexy. Polio-myelitis anterior. [ Congestion of the cord. f Bulbar embolus or hemorrhage. Tumor of medulla. Progressive muscular atrophy. Myelitis. Progressive muscular atrophy. Amyotrophic lateral sclerosis. Locomotor ataxia. Polio-myelitis anterior. Amyotrophic lateral sclerosis. Paralysis agitans. Amyotrophic lateral sclerosis. Chorea. Polio-myelitis anterior. Cerebellar disease. Progressive muscular atrophy. Polio-myelitis anterior. Cerebro-spinal sclerosis. DISEASES OE THE NERVOUS SYSTEM. 139 FUNCTIONAL NERVOUS DISEASES. NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. r Epilepsy Apoplexy. Hysteria, Opium poisoning. Uraemia. Syncope. ^ Organic brain diseases. Angina pectoris. Cancer of oesophagus. Epilepsy. Ursemia. Acute peritonitis. Hydrophobia. Myelitis. Chronic laryngitis. Chorea S ^^^^^^o-spinal sclerosis. Hysteria . Tetanus Paralysis agitans Paralysis agitans. I Str}''chnia poisoning. • •< Spinal meningitis. ( Hydrophobia. [ Cerebro-spinal sclerosis. • -| Chorea. ' General paralysis of insane. DISEASES OF THE BRAIN. Acute Meningitis. Urasmia. See Urcemiay pa-ge 92. Acute Meningitis. Typhus Fever. See Typhus Eever, page 112. Acute Meningitis. Small-Pox. See Small- Pox, page 118. i40 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Acute Meningitis. See Delirium Acute Meningitis. 1. History of injury or acute disease. 2. Begins suddenly. 3. Temperature high and constant. 4. No peculiar cry. 5. Usually a disease of adults. 6. Convulsions appear early. 7. Active delirium. 8. Incoordinate movements. Acute Meningitis. 1. Begins acutely. 2. Temperature high. 3. General headache. 4. Active delirium. 5. No apoplectic seizures. 6. Marked paralysis uncommon. 7. Tdche ceribrale. Chronic Meningitis. 1. History of head injury or blood disease. 2. Headache dull and constant. 3. Paralysis not limited to certain nerves. 4. Marked general decline in mental and physical powers. 5. Symptoms of a general nature. 6. Speech usually unimpaired. 7. Great irritability of temper. 8. Choked discs appear late if at all. DISEASES TO BE DIFFERENTIATED. Delirium Tremens. Tremens, page 132. Tubercular Meningitis. 1. History of phthisis or tuberculosis. 2. Prodromata. 3. Temperature lower and very irreg- ular. 4. Hydrocephalic cry. 5. Disease especially of children. 6. Late convulsions, 7. Mild or passive delirium. 8. Automatic movements. Pachymeningitis Interna. 1. Prodromata. 2. Temperature slightly elevated. 3. Localized and vertical headache. 4. Passive delirium or simply im- paired intellection. 5. Periods of sudden loss of con- sciousness. 6. Paralysis comes on gradually. 7. No "cerebral trace." Cerebral Tumor. 1. Negative history. 2. Headache severe and paroxysmal. 3. Paralysis of certain nerves or set of nerves. 4. No rapid decline in mental or phy«!» ical powers. 3. Local symptoms. 6. Speech often impaired. 7. Temper not especially excitable. 8. Choked discs appear early. DISEASES OF THE NERVOUS SYSTEM. 141 NAME OF DISEASE. Chronic Meningitis. 1. History of head injury or blood disease. 2. No contraction of muscles. 3. Mental excitement. 4. Great irritability of tem.per. 5. Speech usually unimpaired. 6. No disease of heart or arteries. 7. Constant headache. 8. No well-marked paralysis. Tubercular Meningitis, 1. History of tuberculosis. 2. Vomiting projectile. 3. Constipation. 4. Abdomen retracted. 5. No special thirst. 6. Flushing of one cheek. 7. Pulse slow at first. 8. Pupils contracted. g. Fever irregularly remittent. Tubercular Meningitis. DISEASES TO BE DIFFERENTIATED. Cerebral Softening. 1. Often a history of apoplexy. 2. Muscular contraction. 3. Mental apathy. 4. Temper not excitable. 5. Speech frequently affected. 6. Heart or arterial disease common, 7. Inconstant headache. 8. Paralysis usually well marked. Infantile Remittent Fever. 1. History of gastro-enteritis. 2. Vomiting retching. 3. Diarrhoea. 4. Abdomen distended. 5. Great thirst. 6. Flushing of both cheeks. 7. Pulse rapid, 8. Pupils normal. 9. Fever regularly remittent. Acute Meningitis. See Actde Meningitis, page 140. Tubercular Meningitis. Spurious Hydrocephalus. See Spurious Hydrocephalus, page 64. Tubercular Meningitis. Tubercular Enteritis. See Ttibercular Enteritis, page 64. Tubercular Meningitis. Epidemic Cerebro-Spinal Menin- gitis. See Epidemic Cerebro-Spinal Meningitis, page 122. Cerebral Softening. Chronic Meningitis, See Chronic Meningitis, above. 142 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cerebral Softening. 1. History of apoplexy or heart dis- ease common. 2. Headache dull and diffuse. 3. Speech and intellect usually af- fected. 4. No facial paralysis. 5. Epileptiform convulsions uncom- mon. 6. Symptoms steadily progressing. 7. Limbs chiefly affected. Cerebral Softening. 1. History of apoplexy or heart dis- ease common. 2. Disease of months' duration. 3. No chills or fever. 4. Headache dull and diffuse. 5. Hemiplegia and muscular contrac- tions common. 6. Speech and intellect affected early. Cerebral Apoplexy. 1. Disease of old people. 2. Arteries usually diseased. 3. Aphasia uncommon. 4. Complete hemiplegia. 5. Frequent loss of consciousness. 6. No sudden improvement in tlie paralysis. 7. Pulse slow and full. DISEASES TO BE DIFFERENTIATED. \ Cerebral Tumor. 1. Negative history. 2. Local pain in head. 3. Speech and intellect not greatly implicated. 4. Facial paralysis common. 5. Frequent epileptiform convulsions. 6. Symptoms irregular and of long duration. 7. Cranial nerves affected ; choked discs. Cerebral Abscess. I. History of head injury or disease of ear. 2. Disease of weeks' duration. 3. Chills, fever, and sweating. 4. Headache local and acute. 5. Hemiplegia and contractions rare. 6. Speech, intellect, etc., not early affected. Cerebral Embolus. 1. Disease of young people. 2. History frequently of heart dis- ease. 3. Aphasia common. 4. Partial hemiplegia. 5. Loss of consciousness uncommon. 6. Improvement in symptoms often followed by a sudden relapse. 7. Pulse rapid and feeble. DISEASES OF THE NERVOUS SYSTEM. 143 NAME OF DISEASE. Cerebral Apoplexy. 8, Pupils unequal. 9. Vomiting common, ro. Breathing stertorous. DISEASES TO BE DIFFERENTIATED. Cerebral Embolus. 8. Pupils normal. 9. Rarely vomiting. 10. Breathing normal. Apoplexy or Embolus. See Urcemia^ p^-ge gi. Uraemia. 1. 2. 3- 4- 5- 6. 7. 8. 9- 10. Apoplexy or Embolus See Apoplexy or Embolus Pupils irregular. Convulsions common. Coma appears suddenly. Pulse irregular and full. Hemiplegia. Stertor. Face flushed. No odor to breath. Respirations hurried. Skin hot. Alcoholism. Alcoholism, page 132, Opium Poisoning. 1. Pupils " pin-head. " 2. No convulsive movements. 3. Coma deepens gradually. 4. Pulse slow and regular. 5. No paralysis. 6. Shallow, irregular breathing. 7. Face pale and cyanotic. 8. Odor of opium about patient. 9. Respirations slow. 10. Skin cool and perspiring. Apoplexy or Embolus. 1. History of heart or arterial dis- ease. 2. Pupils irregular, pulse slow. 3. Breathing stertorous and hurried. 4. Frequent loss of sensation. 5. Administration of ether gives a negative result. 6' Moral treatment has no effect. Apoplexy or Embolus. 1. History of heart or other arterial disease. 2. TonsTie never bitten. Hysteria. 1. History of hysteria. 2. Pupils regular, pulse rapid. 3. Breathing catching and sobbing. 4. Hyperesthesia common. 5. Paralyzed limbs moved during ether administration. 6. Moral treatment curative. Epilepsy. 1. History of epilepsy. 2. Tongue frequently bitten. 144 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Apoplexy or Embolus. 3. No permanent rapid improvement. 4. No bloody froth about mouth. 5. Pulse full a,nd slow. 6. Paralysis follo\ys the coma. 7. Coma deepening. 8. Paralyzed side hot and red. Apoplexy or Embolus. 1. Face pale or congested. 2. Breathing stertorous. 3. Hemiplegia common. 4. Pupils irregular. 5. Pulse full and strong. 6. Reflexes absent and temperature higher on paralyzed side. 7. Blood red. I. Cerebral Abscess. History of injury to the head or disease of the ear. Emaciation. Chills and sweatings. No local paralysis. No choked discs. Headache sudden in development. Epileptiform convulsions, and suc- ceeded by paralysis. 8. Rapid disease. Cerebral Abscess. DISEASES TO BE DIFFERENTIATED. Epilepsy. 3. Rapid improvement. 4. Bloody froth about mouth. 5. Rapid, irregular, and feeble pulse, 6. Sleep follows the coma. 7. Coma alternating with hysterical symptoms. 8. Both sides the same. Asphyxia. 1. Face turgid and cyanotic. 2. Distressed and embarrassed breath, ing. No paralysis. Pupils regular. Pulse small and rapid. Reflex and temperature the same on both sides. Blood blue. Cerebral Tumor. Negative history. No rapid emaciation. No chills or sweats. Local paralysis of long standing. Choked discs. Headache gradually increasing. Spasm of single muscles or group of muscles, and not followed by paralysis. Slow disease. Cerebral Softening. See Cereh'al Softening, page 144. Cerebral Tumor. Chronic Meningitis. See Chronic Meningitis, page 140. DISEASES OF THE NERVOUS SYSTEM. H5 NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Cerebral Tumor. Cerebral Softening. See Cerebral Softening, page 142. Cerebral Tumor. Cerebral Abscess. See Cerebral Abscess, page 144. Cerebral Concussion. 1. Symptoms appear immediately. 2. Power of speech retained. 3. Special senses retained. 4. Noiseless respiration. 5. Feeble and frequent pulse. 6. Sphincters relaxed. 7. Nausea and vomiting. 8. No paralysis. 9. Pupils contracted and regular. 10. Lids open and movable. 11. Skin cool and pale. 12. Mental faculties not abolished. Cerebral Compression. 1. Symptoms appear gradually. 2. Power of speech lost. 3. Special senses blunted. 4. Stertorous breathing. 5. Slow and full pulse. 6. Sphincters contracted. 7. No vomiting. 8. Hemiplegia common. 9. Pupils dilated and irregular. 10. Eyelids shut. 11. Skin hot and red. 12. Mental faculties abolished. DISEASES OF TPIE CORD. Spinal Meningitis. 1. No traumatic history. 2. Face not peculiar. 3. No jaw symptoms. 4. Great pain on motion. 5. Spasm produced by attempts to move. 6. Paralysis follows spasms. 7. Temperature elevated. Spinal Meningitis. 1. Fever. 2. Marked rigidity of spine. 3. Cutaneous hyperaesthesia. Tetanus. 1. History of traumatism. 2. Kisus sardonicus, 3. Lockjaw. 4. Intense hyperassthesia. 5. Spasm caused by external irrita- tion. 6. No paralysis. 7. Temperature nearly normal. Lumbago. 1. Temperature normal. 2. Apparent rigidity of spine. 3. No cutaneous hypersesthesia. 146 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Spinal Meningitis. 4. Spasms. 5. Paralysis. 6. No tenderness on pressure. 7. Shooting pains along the course of the spinal nerves. Spinal Meningitis. 1. Pain increased by moving. 2. Pain shoots in direction of spinal nerves. 3. Tonic spasm of back and other muscles. 4. Increased reflex irritation. 5. Urine normal until paralysis is well marked. 6. No constricting bands. 7. Sphincters not affected. 8. No bed-sores. 9. Moderate paralysis. 10. Short duration. 11. Temperature elevated. 12. Electro-contractility of preserved. 13. Hyperaesthesia of skin. muscle Myelitis. 1. Paralysis well-marked. 2. Urine alkaline. 3. Pain on pressure along cord. 4. Constricting band about waist. 5. Bed-sores. 6. Anaesthesia well marked. 7. Wasting of muscles affected. DISEASES TO BE DIFFERENTIATED. Lumbago. 4. No convulsions. 5. No paralysis. 6. Tenderness on pressure over origin and insertion of muscles. 7. No shooting pain along spinal nerves. Myelitis. 1. Pain increased by pressure. 2. No darting pains along nerves. 3. No tonic convulsions. 4. Diminished reflex action. 5. Urine alkaline. 6. Constriction about waist. 7. Constipation and incontinence or retention of urine. 8. Bed-sores form early, g. Paraplegia. 10. Disease of long duration. 11. Temperature normal usually. 12. Diminished electro-contractility of paralyzed muscles. 13. Anaesthesia of affected parts. Spinal Congestion. 1. Paralysis usually slight. 2. No urinary symptoms. 3. No pain in cord on pressure. 4. No constricting bands. 5. No bed-sores. 6. Usually hyperaesthesia. 7. No wasting of muscles. DISEASES OF THE NERVOUS SYSTEM. H7 NAME OF DISEASE. Myelitis. 8. Paralysis progressive. 9. Paralysis of sphincters. 10. Electro-contractility of muscles diminished. Myelitis. 1. Fever. 2. Paralysis usually appears gradually after exposure to cold, etc. 3. Bladder symptoms appear gradu- ally. DISEASES TO BE DIFFERENTIATED. Spinal Congestion. 8. Diminishing paralysis. g. Sphincters normal. 10. Electro-contractility of muscles preserved and sometimes in- creased. Spinal Apoplexy. 1. Temperature normal. 2. Paralysis comes on suddenly — often the result of injury. 3. Bladder symptoms appear sud- denly. 4. Subjective sensation in feet, etc. 5. No convulsions. 6. Pain in spine increased on pressure Myelitis. 1. Paralysis of sphincters. 2. Bed-sores. Anaesthesia. Constriction about waist Urine alkaline. Paralysis progressive. 4. No subjective sensations. 5. Tvritching of affected muscles com- mon. 6. No pain in cord on pressure. Spinal Meningitis. See Spinal Meningitis^ page 146. Myelitis. Polio-myelitis Anterior. 1. Sphincters normal. 2. No bed-sores. 3. Anaesthesia absent or slight, 4. No constricting bands. 5. Urine norma,!. 6. Symptoms improve under treat- ment. 7. Rapid wasting of affected muscles. 8. Temperature of affected hmbs higher than normal. Hysterical Paralysis. I. History of hysteria. 7. No rapid wasting of muscles. 8. Temperature of affected limbs lev.- er than normal. Myelitis. I. History of exposure to cold, syph ills, etc. 2. Urine scanty and alkaline. 2. Urine acid and abundant. 148 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Myelitis. 3. Urine cloudy. 4. Constriction about waist. 5. Reflexes diminished. 6. Diminished electro-contractiHty of muscles. 7. Pain on pressure along spine. 8. Disease of long duration. g. Moral treatment of no eft'ect. Bulbar Paralysis. 1. Bilateral disease. 2. Progressive paralysis of facial and lingual muscles. 3. Vomiting inconstant. 4. No severe neuralgic pains. 5. No epileptifonn attacks. 6. Special senses not especially af- fected. Bulbar Paralysis. 1. Bilateral disease. 2. Symptoms appear gradually. 3. Vomiting infrequent. 4. No convulsions. 5. No loss of consciousness. 6. Paralysis confined to cranial nerves usually. Bulbar Paralysis. i. Paralysis precedes atrophy. 2. Thenar and hypothenar eminences involved late if at all. 3. Atrophy confined to the muscles supplied by the cranial nerves. 4. Articulation affected early DISEASES TO BE DIFFERENTIATED. Hysterical Paralysis. 3. Urine clear and limpid^ 4. Globus hystericus. 5. Reflexes normal or increased. 6. Increased electro-contractility of muscles. 7. Pain on pressure over ovaries. 8. Disease of short duration. 9. Moral treatment curative. Tumor of Medulla. 1. Disease unilateral. 2. Convulsions usually precede the paralysis of muscles. 3. Frequent vomiting. 4. Facial neuralgia. 5. Epileptiform attacks common. 6. Special senses affected ; choked discs. Bulbar Embolus or Apoplexy. 1. Unilateral symptoms predominate. 2. Disease develops suddenly. 3. Frequent vomiting. 4. Epileptiform convulsions. 5. Frequent loss of consciousness. 6. Often hemiplegia or paraplegia. Progressive Muscular Atrophy. 1. Paralysis follows atrophy. 2. Thenar centres involved early. 3. Atrophy not confined to muscles supplied by the cranial nerves. 4. Articulation affected late if at all. DISEASES OF THE NERVOUS SYSTEM. H9, Polio-myelitis Anterior. T. Pain not severe. 2. Paralysis. 3. Normal balancing power. 4. Coordinate movements. 5. Loss of electro-contractility of muscles. 6. Muscular atrophy well marked. 7. No joint or eye symptoms. Polio-myelitis Anterior. See MyeUi'.s Polio=myeliti3 Anterior. 1. Paroxysmal increase of paralysis. 2. Paralysis precedes atrophy. 3. Reflexes im.paired early. 4. Early loss of muscular electro contractility. 5. Temperature highest in affected limbs. 6. General atrophy of affected parts. 7. No fibrillary contractions. 8. Pain not severe. 9. Rapid disease. 10. Begins in muscles of lower ex- tremity. Polio-myelitis Anterior. r. Large muscles early affected. 2. Begins in lovv'er ej:tremity. 3. No rigidity of affected limbs. Locomotor Ataxia. 1. Lightning-like pains. 2. No true paralysis. 3. Loss of balancing power. 4. Incoordinate movements especially marked when the eyes are closed. 5. Electro-contractility of the muscles preserved. 6. No muscular atrophy. 7. Joints sv/ollen, impaired eyesight, etc. Myelitis. page 146. Progressive Muscular Atrophy. 1. Steadily progressive paralysis. 2. Paralysis follows atrophy. 3. Reflexes not impaired until late. 4. Electro-contractility of muscles prescribed. 5. Low temperature in affected parts. 6. Atrophy of one muscle follows another. 7. Fibrillary contractions of muscles. 8. Fulminating pains. 9. Ver}' slovr disease. 10. Usual