Complete Text (Part 5)

Intestinal Obstruction ^ page 63. Intestinal Colic. 1. No vomiting. 2. No jaundice. 3. Pain most severe in the umbiUcal region. 4. Bowels irregular. 5. Pain colicky in character, 6. No gall stones in f^ces. ". Urine normal. Hepatic Colic. 1. Vomiting. 2. Jaundice. 3. Pain most severe in epigastric re- gion, shooting toward back. 4. Stools clay-colored. 5. Pain tearing in character. 6. Gall stones in f^ces. 7. Urine contains bile pigment. 68 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Intestinal Colic. 1. Urine normal. 2. No pain in testicles. 3. Pain most severe in umbilical region. 4. Pain colicky in character. 5. No vomiting. 6. No numbness of thigh. Intestinal Colic. 1. Pain paroxysmal. 2. Pain relieved by pressure. 3. Pain of greatest intensity in um- bilical region. 4. History of indigestion, exposure to cold, etc. 5. No spots of extreme tenderness. 6. Pain deep-seated. Intestinal Colic. 1. Occurs at any time. 2. Pain intermittent. 3. Pain in umbilical region most se- vere. 4. No vomiting. 5. No bladder symptoms. 6. Pain relieved by pressure. DISEASES TO BE DIFFERENTIATED. Renal Colic. 1. Urine passed frequently and con- tains blood. 2. Testicle retracted and painful. 3. Pain shoots along ureters into testicle to penis. 4. Pain tearing and shooting. 5. Frequent vomiting. 6. Marked numbness of thigh. Abdominal Rheumatism. 1. Pain constant. 2. Pain increased by pressure. 3. Pain of greatest intensity over the origin and insertion of muscles. 4. Plistory of rheumatism. 5. Spots of Hypersssthesia. 6. Pain superficial. Uterine Colic. 1. At menstrual period. 2. Pain remittent. 3. Pain most severe in the hypogas- tric or pelvic region. 4. Vomiting common. 5. Irritability of the bladder. 6. Pain increased by pressure. Acute Peritonitis. Acute Enteritis. See Acute Enteritis, page 58. Acute Peritonitis. Intestinal Colic. See Intestinal Colic , page 67. Acute Peritonitis. Intestinal Obstruction. See Intestinal Obstruction, page 63. DISEASES OF DIGESTIVE TRACT AND PERITONEUM, 69 NAME OF DISEASE. Acute Peritonitis. 1. Temperature elevated. 2. Harder the pressure more severe the pain. 3. Pulse tense and wiry. 4. Great prostration. 5. Peritonitic countenance and posi- tion. 6. Spinach-green vomiting. Acute Peritonitis. 1. Pain increased by pressure. 2. Patient very quiet. 3. Temperature elevated. 4. No change in color of faeces or urine. 5. Great tympanites. 6. Severe collapse and prostration. Acute Peritonitis. 1. No vomiting at first. 2. Vomiting inconstant and spinach- green in color. 3. Pain diffuse. 4. Great tympanites. 5. Peritonitic countenance and posi- tion. 6. Constipation. Acute Peritonitis. I. Temperature elevated. .1. Begins with chill and pain in ab- domen. 3. Spinach-green vomiting. DISEASES TO BE DIFFERENTIATED. Hysteria. 1. Temperature normal. 2. A light touch causes as much pain as deep pressure. 3. Pulse normal. 4. Prostration only apparent. 5. Hysterical countenance and rest- lessness. 6. Globus hysterica. Renal or Hepatic Colic. 1. Pain diminished by pressure. 2. Great restlessness. 3. Temperature normal. 4. Fasces or urine has an abnormal color. 5. Tympanites absent or slight. 6. Prostration but temporary. Acute Gastritis. 1. Begins with vomiting. 2. Vomiting constant and bilious. 3. Pain limited to gastric region. 4. Tympanites moderate or absent. 5. Countenance pale, position not characteristic. 6. Bowels normal or irregular. Acute Poisoning. 1. Temperature normal or subnor- mal. 2. Begins with vomiting and pain in the stomach. 3. Vomited matter contains blood and mucus. 70 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Acute Peritonitis. 4. Obstinate constipation. 5. No cramps in legs. 6. Mouth and pharynx normal. 7. Abdomen tympanitic. 8. No poison in vomited matter. Chronic Peritonitis. 1. History of an acute attack. 2. Temperature irregular — 99** to 104°. 3. Ascitic fluid clear. 4. Anaemia, 5. Occasional chills. 6. No tumefaction of the omentum. 7. No cancer cells in ascitic fluid. Chronic Peritonitis. 1. History of an acute attack, 2. Constipation alternating with diar- rhoea, 3. No redness around umbilicus. 4. Ascitic fluid clear, 5. No tubercle bacilli in fluid. 6. No sign of tubercular disease in other organs, as the lungs. 7. Frequent chills. 8. Moderate ascites. 9. Typhoid symptoms appear late. Chronic Peritonitis. 1. History of an acute attack. 2. No general oedema. 3. Abdomen painful. DISEASES TO BE DIFFERENTIATED. Acute Poisoning. 4. Diarrhoea. 5. Severe cramps in legs. 6. Mouth and pharynx red and glazed. 7. Abdomen retracted. 8. Vomited matter contains poison. Cancerous Peritonitis. 1. History of hereditary cancer. 2. Temperature usually normal. 3. Ascitic fluid bloody. 4. Cancerous cachexia. 5. No chills. 6. Tumefaction of the omentum. 7. Ascitic fluid contains cancer cells. Tubercular Peritonitis. 1. History of tuberculosis. 2. Constant diarrhoea. 3. Redness and oedema around um- bilicus. 4. Ascitic fluid hemorrhagic. 5. Fluid contains tubercle bacilli, 6. Lungs and other organs frequently tuberculous, 7. Frequent profuse sweating. 8. Ascites well-marked. 9. Typhoid symptoms appear early. Ascites. 1 , History of kidney, liver, and heart disease. 2, General oedema. 3, No pain in abdomen. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 7 1 NAME OF DISEASE. Chronic Peritonitis. 4 Tenderness upon pressure. 5. Temperature irregular. 6. Abdominal veins not dilated. Tubercular Peritonitis, 1. History of tuberculosis. 2. Tubercular disease of other organs. 3. Ascites well-marked. 4. Profuse sweats. 5. Temperature elevated, especially at night. 6. Redness and oedema around um- bilicus. 7. Abdomen has a doughy feeling. Tubercular Peritonitis. DISEASES TO BE DIFFERENTIATED. Ascites. 4. No tenderness on pressure. 5. Temperature normal. 6. Dilatation of abdominal veins. Cancerous Peritonitis. History of hereditary cancer. Surrounding organs frequently can- cerous. Ascites usually not well-marked. No profuse sv/eats. 5. Temperature about normal — can- cerous cachexia. No redness or oedema about um- bilicus. Abdomen feels tumorous. Chronic Peritonitis. 6. See Chronic Peritonitis, page 70. Tubercular Peritonitis. Tubercular Enteritis. See Tubercular Enteritis, page 64. Ascites (Abdominal Dropsy). Chronic Peritonitis. See Chronic Peritonitis, page 70. Ascites. 1. Uniform enlargement. 2. Begins in dependent portion of abdomen. 3. Line of dulness changes with po- sition of patient. 4. Fluctuation well-marked. 5. History of liver, kidney, or heart disease. 6. Fluid serous in character. 7. No well-defined outline of dul- 9^5S. Ovarian Dropsy. 1. Irregular abdominal enlargement. 2. Begins in one iliac fossa. 3. Line of dulness stationary. 4. Fluctuation indistinct. 5. No history of previous disease. 6. Fluid albuminous and contains characteristic cells. 7. Distinct outline of cyst wall, whidi limits the area of dulness. ^2 DISEASES OF DIGESTIVE TRACT AND PERITONEUM. NAME OF DISEASE. Ascites. 1. No bladder symptoms. 2. Line of dulness changes with po- sition of patient. 3. No pain on pressure. 4. No uniform outline of dulness. 5. Symptoms not relieved by passing catheter. Ascites. 1. Line of dulness changes with po- sition of patient. 2. Fluctuation well-marked. 3. No mammary changes. 4. No well-defined outline to dul- 5. ness. No foetal heart. 6. No ballotement. Ascites. 1. Flatness begins below. 2. Line of dulness changes with po- sition of patient. 3. No fremitus on percussion. 4. Tympanites above the flat area. 5. No booklets in fluid. DISEASES TO BE DIFFERENTIATED. Distended Bladder. 1. Retention or incontinence of urine. 2. Line of dulness uniform. 3 Pain produced by pressure. 4. Dulness has a rounded outline. 5. Distention relieved by passing catheter. Pregnancy. 1. Line of dulness constant. 2. Fluctuation indistinct. 3. Well-marked mammary signs. 4. Uterus has a well-defined outline. 5. Foetal heart. 6. Ballotement. Hydatids of Liver. 1. Flatness begins above. 2. Line of dulness constant. 3. Hydatid fremitus on percussion, 4. Tympanites below the flat area. 5. Hooklets found in the fluid. Ascites. Cirrhosis of the Liver. See Cirrhosis of the Liver, page 78. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE LIVER, DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF THE LIVER. NAME OF DISEASE. Acute congestion of the liver Cirrhosis of the liver Abscess of the liver . Acute yellow atrophy Fatty liver DISEASES TO BE DIFFERENTIATED. Abscess of the liver. Fatty liver. Catarrh of the bile ducts. Fatty liver. Cancer of liver. Ascites due to other causes. Hydatids of the liver. Cancer of the Uver. Acute congestion of the liver. Abscess in abdominal walls. Enlarged gall-bladder. Perihepatitis. Empyema. Pylephlebitis. Yellow fever. Pysemia. Bilious remittent fever. Simple jaundice. Remittent fever. Waxy Hver. Acute congestion of liver. Cancer of liver. r^ 76 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cancer of Liver Hydatids of liver Perihepatitis DISEASES TO BE DIFFERENTIATED. Cirrhosis of liver. Fatty liver. Abscess of liver. Hydatids of liver. Cancer of stomach. Cancer of kidney. Ascites. Cancer of liver. Abscess of liver. Enlarged gall-bladder. Abdominal aneurism. Cyst of kidney. Abscess of liver. Intercostal neuralgia. Acute pleurisy. Hepatic colic Hepatogenous jaundice Acute Congestion of Liver. Uniform enlargement of liver. Rapid enlargement of liver. Pain diffuse over liver. Pain not severe. 5, Pulse slow or normal, 6, JSJo chill, fever, or sweating. 7, But slight tenderness on pressure. Renal colic. Intestinal colic. Acute peritonitis. Cardialgia. Hematogenous jaundice. Acute yellow atrophy. Acute congestion of liver. Abscess of Liver. 1. Irregular enlargement of liver. 2. Enlargement takes place slowly. 3. Pain localized. 4. Pain quite severe. 5. Pulse rapid. 6. Chills, fever, and profuse sweats. 7. Well-marked tenderness on pres- sure. DISEASES OF THE LIVER. 77 NAME OF DISEASE. Acute Congestion of Liver. 1. History of alcoholism, gout, syph- ilis, etc. 2. Pain over liver, 3. Dyspeptic symptoms. 4. Skin dingy and rough. 5. On palpation liver feels hard and resistant. t^ Some tenderness on pressure. 7, Hemorrhoids common. Acute Congestion of Liver. 1. Jaundice slight. 2. Gastro-duodenitis succeeds the hepatic symptoms. 3. Hemorrhoids common. 4. Liver consideraoly enlarged. 5. Tenderness on pvessure. 6. Marked dizziness at times. Cirrhosis cf Ljver. 1. History of alcoholism, sypliilis, etc. 2. Skin dingy and rough. 3. Liver hard and resistant on palpa- tion. 4. Some tenderness on pressure. 5. Emaciation. 6. Spleen enlarged. 7. Ascites. 8. Liver usually diminished in size. Cirrhosis of Liver. 1. Liver usually small. 2. If nodular, the nodules are ii\9i, well marked. DISEASES TO BE DIFFERENTIAT'ED. Fatty Liver. 1. History of high living or phthisis. 2. No pain over liver. 3. Dyspeptic symptoms uncommon. 4. Skin yellow and greasy. 5. Liver feels soft and doughy. 6. No tenderness on pressure. 7. Hemorrhoids uncommon. Catarrh of Bile Ducts. 1. Jaundice well-marked. 2. Gastro-duodenitis precedes the hepatic symptoms. 3. Hemorrhoids unfrequent. 4. Liver slightly enlarged, 5. No tenderness upon pressure. 6. Patient stupid and drov/sy. Fatty Liver. 1. History of high living, phthisis. etc. 2. Skin yellow and greasy. 3. Liver soft and doughy. 4. No tenderness on pressure. 5. Obesity. 6. Spleen normal. 7. No ascites. 8. Liver always large. Cancer of Liver. 1. Liver always enlarged, 2, Nodules well marked. 78 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Cirrhosis of Liver, 3. Spleen enlarged. 4. Ascites. 5. Sliglit pain over liver. 6. But slight tenderness on pressure. 7. Skin has a dingy hue. 8. Gastric and intestinal hemorrhages common. 9. Enlarged abdominal veins. Cirrhosis of Liver. 1. Liver small, 2. Gastric and intestinal hemorrhages common. 3. Spleen enlarged. 4. Dropsy begins as ascites. 5. Enlarged abdominal veins. 6. Hemorrhoids common. 7. Absence of disease in other organs. Abscess of Liver. 1. Occurs most frequently in those who have lived in hot climates. 2. Rapid and acute disease. 3. Severe pain. . Chills, fever, and sweating. 5. Well-marked gastric symptoms. 6. No peculiar fremitus produced on percussion. 7. Exploring needle v/ithdraws pus. Abscess of Liver. 1. Primar)' disease. 2. Rapid enlargement of liver. DISEASES TO BE DIFFERENTIATED. Cancer of Liver. 3. Spleen not enlarged. 4. No ascites. 5. Severe pain over liver. 6. Marked tenderness on pressure. 7. Cancerous cachexia. 8. Hemorrhages rare unless the dis- ease is complicated. 9. Adominal veins not enlarged. Ascites due to other Causes. 1. Liver normal size. 2. Hemorrhages rare. 3. Spleen normal size. 4. Dropsy begins in extremities or face. 5. Abdominal veins not enlarged. 6. Hemorrhoids unfrequent. 7. Disease of heart, kidneys, peri- toneum, etc. Hydatids of Liver. 1. Occurs most frequently in cold cli- mates. 2. Slow and chronic disease. 3. Little or no pain, 4. No chills, fever, or sweating. 5. No gastric disturbance. 6. Hydatid fremitus or thrill produced by percussion. 7. Fluid contains booklets. Cancer of Liver. 1 . Disease hereditary or secondary. 2. Liver enlarges slowly. DISEASES OF THE LIVER. 79 NAME OF DISEASE. Abscess of Liver. 3. Fever, chills, and sweating. 4. No nodular feel on palpation. 5. Patient hectic in appearance. 6. Ascites uncommon. 7. Exploring needle withdraws pus. Abscess of Liver. DISEASES TO BE DIFFERENTIATED. Cancer of Liver. 3. No chills or sweating. 4. Liver distinctly nodular. 5. Cancerous cachexia 6. Ascites not infrequent. 7. Exploring needle withdraws blood. Acute Congestion of Liver. See Acute Congestion of Liver , page 76. Abscess of Liver. Line of liver dulness well marked. Line of dulness corresponds to the hepatic area. Shiny, oedematous skin over liver appears late in the disease. Superficial tenderness over liver appears late. The tumor has an up and down movement, due to respiration. Abscess of Liver. History of injury, dysentery, etc. Abscess tumor broad and fiat. Timior not movable. Chills, fever, and sweating. 5. Jaundice uncommon. 6. Melancholia. 7. Exploring needle withdraws pus. Abscess of Liver. 1. Chills, fever, and sweating. 2. Temperature, 103" to 105°, 3. Gastric s}T3iptoms. 4. Deep fluctuation on palpation. 5. Abscess in Abdominal Wall. 1. Line of dulness indistinct. 2. Line of dulness does not corre- spond to liver dulness. 3. Inflammation of the skin appears early in the disease. 4. Superficial tenderness appears early. 5. The tumor has no up and down movement. Enlarged Gall Bladder. 1 . History of jaundice or biliary colic. 2. Tumor globular and pear-shaped. 3. Tumor movable. 4. No chills or sweating. 5. Jaundice common. 6. No depression of spirits. 7. Exploring needle withdraws bile. Perihepatitis. 1. No chills or sweating. 2. Temperature rarely over 101°, 3. No gastric disturbance. 4. No fluctuating tumor. 8o DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE, Abscess of Liver. 5. Increased area of liver dulness on percussion. 6. Patient has a hectic appearance. 7. Melancholia. Abscess of Liver. 1. Diarrhoea uncommon. 2. Jaundice infrequent. 3. Fluctuation on palpation. 4. Spleen normal size. 5. No enlargement of abdominal veins. 6. Stools clay-colored. 7. Exploring needle withdraws pus. Abscess of Liver. 1. Gastric disturbance. 2. Stools clay-colored, 3. Needle thrust into liver abscess has an up-and-down movement. 4. Area of dulness corresponds to that of enlarged liver. 5. Dulness seldom reaches above the fourth rib, 6. Disease preceded by signs of he- patic inflammation, 7. Marked tenderness over liver area, 8. No pulmonary symptoms. 9. Exploring needle will bring away he]iatic tissue. Acute Yellow Atrophy. 1, Begins as simple jaundice. 2. No chill v/ith sudden rise of tem- perature. DISEASES TO BE DIFFERENTIATED. Perihepatitis. 5. Liver not enlarged. 6. Patient has a normal appearance. 7. Buoyant spirits. Pylephlebitis. 1. Diarrhoea, 2. Jaundice. 3. No fluctuating tumor. 4. Spleen enlarged. 5. Abdominal veins distended. 6. Stools watery and dark, 7. Exploring needle withdraws blood. Empyema. 1 , No gastric symptoms. 2, Stools normal color. 3, Needle thrust into plural cavity has no up-and-down movement, 4, Area of dulness changes with the position of patient. 5, Flatness often extends higher than the fourth rib. 6, Disease preceded by pleurisy or pleuro-pneumonia, 7, No tenderness on pressure, 8, Cough, dyspnoea, and expectora- tion. 9, Exploring needle withdraws pus. Bilious Remittent Fever. 1, Begins with a chill, 2, Chills followed by fever and sweating. DISEASES OF THE LIVER, 8i NAME OF DISEASE. Acute Yellow Atrophy. 3. No regular remissions of symp- toms. 4. No pigmentation of blood. 5. Jaundice appears early. 6. Liver diminishes in size. 7. Leucin and tyrosin in urine. Acute Yellow Atrophy. 1. Temperature elevated. 2. Liver diminishes in size. 3. Stupor, coma, and convulsions. 4. Severe headache. 5. Leucin and tyrosin in urine. 6. Pulse rapid from 140 to 160. Acute Yellow Atrophy. Begins as simple jaundice. Spleen increased in size. Liver diminishes in size. Urine acid. Urine contains leucin and tyrosin. 6. Pulse 140 to 160. 7. " Black vomit " appears late. Acute Yellow Atrophy. Begins as simple jaundice. No chills or exhaustive sweats. Stools clay-colored and formed. Liver diminishes rapidly in size. Leucin and tyrosin in urine. 6. No lung complications. DISEASES TO BE DIFFERENTIATED. Bilious Remittent Fever. 3. Regular remission of symptoms. 4. Free pigment in blood. 5. Jaundice appears late. 6. Liver increases in size. 7. Urine normal. Simple Obstructive Jaundice. Temperature normal. Liver shghtly increased in size. Mind dull. Dull frontal headache. Bile pigment in urine. Pulse full and slow. Yellow Fever. 1. Begins with a chill. 2. Spleen normal in size. 3. Liver increases in size. 4. Urine alkaline. 5. Urine contains m.any urates. 6. Pulse gaseous and rarely over no. 7. " Black vomit " appears early. Pyaemia. 1. Begins with a chill. 2. Irregular chills and sweating, 3. Diarrhoea. 4. Liver normal in size. 5. Urine albuminous. 6. Abscess of lungs. Acute Yellow Atrophy. Remittent Fever. See .Remittent Eez'ej', page 80. 82 DIFFERENTIAL DIAGNOSIS OF THE NAI^IE OF DISEASE. DISEASES TO BE DIFFERENTIATED. Fatty Liver. Acute Congestion of Liver. See Acute Congestion of Liver, page 77. Fatty Liver. 1. History of high living or phthisis. 2. Skin shiny and greasy. 3. Blood hydroaemic. 4. Urine normal. 5. Liver feels soft and flabby. 6. Spleen normal in size. Fatty Liver. 1. History of high living or phthisis. 2. Liver uniformly enlarged. 3. No pain over liver. 4. Skin shiny and greasy. 5. Slovv^ progress of disease. 6. No enlarged glands. Cancer of Liver. Waxy Liver. 1. History of suppuration or syphilis. 2. Skin pale and dry with indigo odor. 3. Blood leuksemic. 4. Urine albuminous. 5. Liver feels hard and well defined. 6. Spleen increased in size. Cancer of Liver. 1. History of hereditary or secondary cancer. 2. Nodular enlargement of liver. 3. Severe pain over liver. 4. Skin dry and straw-colored. 5. Disease rapid in progress. 6. Abdominal and cervical glands en- larged. Cirrhosis of Liver, See Cirrhosis of Liver, page 77. Cancer of Liver. Fatty Liver. See Fatty Liver, above. Cancer of Liver. Abscess