Complete Text (Part 8)

disease. 3. Temperature rarely over 104°. 4. Pulse slow and irregular. 5. No intermissions or remissions. 6. Attacks usually end in coma and death. 7. No pigment in blood. Cholera. 1. History of epidemic cholera. 2. Temperature subnormal. 3. Rice-water evacuations. 4. Urine albuminous, 5. Vomiting regurgitative. 6. Comma bacilli in discharges. Yellow Fever. 2. Pernicious Malarial Fever. (Bilious remittent fever.) See Yellow Fever, page 113. Scarlet Fever. :. Begins with headache, vomiting, sore throat, and chilliness. I. Eruption appears beginning of Small-Pox. Begins with a chill and severe pain in head and back. Eruption appears on third day around the edges of the hair. second day about the neck and chest. ACUTE GENERAL DISEASES. ii; NAME OF DISEASE. Small-Pox. 3. Eruption changes from day to day — macular, papular, vesicular, and lastly, pustular. 4. Eruption spreads slowly. 5. Remission on occurrence of erup- tion. 6. Relapse or secondary fever about the eighth day. 7. Scabbing and pitting Small-Pox. 1. Begins with a chill and a severe pain in head and back. 2. Eruption appears about the hair on third day. 3. Eruption macular, then papular, vesicular, and lastly pustular. 4. Remission on occurrence of erup- tion. 5. Secondary fever and relapse during suppuration. 6. Scabbing and pitting. Small-Pox. 1. Pustules maturate on eighth day. 2. Secondary fever. 3. Deep suppuration. 4. Many pustules. 5. Pustules burst, then dry, forming scabs. 6. Cicatrices well marked. Small-Pox. 1. Begins with high temperature, etc. 2. Vesicles terminate in pustules. DISEASES TO BE DIFFERENTIATED. Scarlet Fever. 3. Eruption erythematous with inter- spersed, minute, elevated, dark red points. 4. Eruption spreads rapidly. 5. No remission in symptoms. 6. No secondary fever. 7. Well-marked scaly desquamation. Measles. 1. Begins with the symptoms of a severe cold. 2. Eruption appears on the face on the fourth day. 3. Eruption papular, and appears in crescentic patches. 4. Temperature rises on appearance of eruption. 5. No secondary fever. 6. Bran-like desquamation. Varioloid. 1. Pustules maturate from fourth to sixth day. 2. No secondary fever. 3. Superficial suppuration. 4. Few pustules. 5. Pustules dry up without bursting. 6. Cicatrices not well marked. Chicken-Pox. 1. Fever, etc., follow the eruption. 2. Vesicles dry up without pustulating. n8 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Small-Pox. 3. Eruption complete on eighth day. 4. Eruption begins about the hair. 5. Vesicles umbilicated. 6. Remission on occurrence of erup- tion. 7. Secondary fever. Small-Pox. r. Frontal headache. 2. Face flushed. 3. Temperature liigh. 4. Pulse rapid. 5. Sore throat. 6. Vomiting retching. 7. Temperature falls with the appear- ance of the eruption. Etc., etc., etc. Small-Pox. 1. No great muscular prostration. 2. Sore throat. 3. Eruption appears on third day. 4. Eruption appears first about hair. 5. Characteristic eruption of small- pox. Etc., etc., etc. Scarlet Fever. 1. Begins with chilliness, vomiting, headache, and sore throat. 2. Eruption appears on the second day. 3. Eruption erythematous with minute, interspersed, elevated dark red spots. DISEASES TO BE DIFFERENTIATED. Chicken-Pox. 3. Eruption complete on fourth day. 4. Eruption begins on the trunk. 5. Vesicles globulai-. 6. No remissions. 7. No secondary fever. Cerebro-Spinal Meningitis. 1. Occipital headache. 2. Face pale and anxious. 3. Temperature rarely over 104'. 4. Pulse not very rapid. 5. No sore throat. 6. Vomiting projectile. 7. No fall in temperature on appear- ance of eruption. Etc., etc., etc. Typhus Fever. 1. Severe muscular prostration. 2. No sore throat. 3. Eruption appears on fifth day. 4. Eruption appears first on tnmk. 5. Characteristic typhus emption. Etc., etc., etc. Measles. 1. Begins as a severe cold in the head. 2. Eruption appears on the fourth day. 3. Eruption papular, and is arranged in crescentic patches. ACUTE GENERAL DISEASES. 119 NAME OF DISEASE. Scarlet Fever, 4. Strawberry tongue. 5. Severe sore throat. 6. Albumen in urine. 7. Eruption appears first on neck and chest. 8. Eruption spreads rapidly. 9. Desquamation scale-like. 10. Sequelae Bright's disease. I. Scarlet Fever. Diffuse redness of tonsils and pharynx. 2. Exudation mucous and easily re- moved. 3. Strawberry tongue. 4. Temperature very high. 5. Erythematous eruption followed by desquamation. 6. Sequelae, Bright's disease. DISEASES TO BE DIFFERENTIATED. Measles. 4. Tongue coated. 5. Bronchitis. 6. Urine normal. 7. Eruption appears first on face. 8. Eruption spreads slowly, g. Desquamation bran-like. 10. Sequelae broncho-pneumonia. Diphtheria. 1. Dark local redness of throat. 2. Exudation membranous and ad- herent. 3. Tongue dry and cracked. 4. Temperature rarely over 104.° 5. No eruption, if any, roseola not followed by desquamation. 6. Sequelae, paralysis. Scarlet Fever. Small-Pox. See Small-Pox, page 116. Scarlet Fever. 1. High temperature. 2. Eruption covers the body. 3. Sore throat. 4. Enlarged cervical glands. 5. Urine albuminous. 6. Strawberry tongue. 7. Eruption interspersed with minute dark red, elevated spots. 8. Desquamation. Measles. Erythema (Simple). 1. Temperature slightly elevated. 2. Eruption irregularly distributed. 3. No sore throat. 4. Glands not enlarged. 5. No albumen in urine. 6. Tongue normal. 7. Eruption uniform. 8. No desquamation. Typhus Fever, See TypJncs Fever, page 1 12. I20 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Measles. 1. Eruption confluent. 2. Coryza and bronchitis well marked. 3. Temperature high. 4. Eruption dark, elevated and cres- centic. 5. Eruption appears first on the face. 6. No sore throat. 7. Desquamation. Measles. DISEASES TO BE DIFFERENTIATED. Roseola. 1. Non-confluent eruption. 2. Slight coryza and bronchitis. 3. Temperature slightly elevated. 4. Eruption bright, smooth, and not crescentic. 5. Eruption appears first on trunk. 6. Some sore throat. 7. No desquamation. Scarlet Fever. See Scarlet Fever ^ page 118. Measles. Small-Pox. See Small-Pox, page 117. Cholera. Acute Poisoning. 1. Mouth and pharynx normal. i. Mouth and pharynx glazed and congested. 2. Vomiting painless and regurgita- 2. Vomiting painful and retching. tive. 3. No burning pain in oesophagus or 3. Intense burning sensation in stom- stomach. ach and oesophagus. 4. Rice-water discharges. 4. Discharge bloody and mucous. 5. Comma bacilli in discharges. 5. Poison found in discharges. Cholera. Cholera Morbus. See Cholera Morbus, page 59. Cholera. Pernicious Malarial Fever. See Pernicious Malarial Fever, page 116. Diphtheria. Membranous Croup. 1. Preceded by sore throat. I. Preceded by cough and hoarseness. 2. Attacks any one. 2. Attacks children. 3. Cervical glands greatly enlarged. 3. Glands but slightly enlarged. ACUTE GENERAL DISEASES. 121 9- 10. NAME OF DISEASE. Diphtheria. Great prostration from the first. Exudation deep — cannot be readi- ly detached. Exudation if detached leaves an ulcer. Temperature rarely over 104°. Exudation of a gray-color, and contains characteristic bacteria. Death due to blood-poison. Sequelse, paralysis. Diphtheria. DISEASES TO BE DIFFERENTIATED. Membranous Croup. 4. Prostration follows the throat-ob- struction. 5. Exudation superficial — can be readily detached. 6. No ulcer produced by detaching the exudation. 7. Temperature often 104° to 106''. 8. Exudation of a white color, and does not contain characteristic bacteria. 9. Death usually due to suffocation. 10. No paralysis. Scarlet Fever. Seg Scarlet Fever, page iig. Diphtheria. 1. Begins with sore throat and slight fever. 2. Constitutional symptoms well- marked. 3. Inflammation localized at first. 4. Pulse feeble and rapid. 5. Cervical glands greatly enlarged. 6. Exudation cannot be easily re- moved. 7. Laryngeal symptoms common. Diphtheria. 1. Tongue coated. 2. Throat not greatly swollen. 3. Cervical glands greatly enlarged. 4. Exudation membranous. 5. Throat has a grayish appearance » Diphtheritic Sore Throat. 1. Begins with a chill and high range of temperature. 2. No severe depression or prostra- tion. 3. General inflammation of throat. 4. Pulse rapid and strong. 5. Glands slightly enlarged. 6. Exudation easily removed or picked off. 7. Usually no complicating laryn- gitis. Erysipelas of Throat. 1. Tongue brown and fissured. 2. Throat greatly swollen. 3. Cervical glands slightly enlarged. 4. Exudation serous in character. 5. Mucous membrane of throat vivid or dusky in color. 122 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Epidemic Cerebro-Spinal Menin- gitis. 1. History of epidemic. 2. Muscular rigidity appears early. 3. Pain and tenderness along spine. 4. No peculiar cry. 5. Delirium often wild. 6. Disease begins suddenly. 7. Herpetic eruption common. 8. Pulse moderately slow. 9. Incoordinate movements. DISEASES TO BE DIFFERENTIATED. Tubercular Meningitis. 1. History of tuberculosis. 2. Muscular rigidity appears late. 3. No marked spinal symptoms. 4. Hydrocephalic cry. 5. Mild delirium. 6. Disease develops slowly. 7. No herpetic eruption. 8. Pulse very slov/ at first. 9. Automatic movements. Small-Pox. Epidemic Cerebro-Spinal Menin- gitis. See Small-Pox ^ page 118. Epidemic Cerebro-Spinal Menin- Typhus Fever. ^ gitis. See Typhus Fever, page 112. Epidemic Cerebro-Spinal Menin- gitis. Pernicious Fever. See Pernicious Fever, page 116. Pyaemia. 1. Begins with a chill. 2. Recurrent chills, fever, and sweat- ing. 3. Jaundice well marked. 4. Sweetish odor to breath. 5. Temperature irregular — lOO" to 105°. 6. Diarrhoea moderate if present. 7. Formation of metastatic abscesses in lungs, joints, etc. Septicaemia. 1. Begins with chilly sensations. 2. No recurrent chills and sweating. 3. Slight jaundice. 4. Odor to breath not peculiar. 5. Temperature less fluctuating. 6. Obstinate diarrhoea. 7. No metastatic abscesses. ACUTE GENERAL DISEASES. 123 NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Pyaemia. Intermittent Fever. See Intermittent Fever, page 115. Pyaemia. Acute Yellow Atrophy. See Acute Yellow Atrophy, page 81. Pyaemia. Ulcerative Endocarditis. See Ulerative Endocarditis, page 40. Pyaemia. See Suppurative Hydrophobia, 1. History of dog or cat bite. 2. Delirium. 3. Fear of liquids. 4. Clonic convulsions. 5. Marked hypersestliesia. 6. Special senses involved. 7. Much frothy mucus about mouth. 8. Spasms occur at intervals. Hydrophobia. 1. History of dog or cat bite. 2. Spasms clonic. 5. Delirium. 4. Special senses affected. 5. Fear of liquids, caused by (he ina- bility to swallow without produc- ing convulsions. 6. Occurs usually in men. 7. Moral treatment has no effect. Suppurative Nephritis. N'ephritis, page 98. Tetanus. 1. History of injury. 2. Mind clear. 3. No fear of liquids. 4. Convulsions tonic. 5. Slight hyperaesthesia. 6. Special senses normal. 7. Risus sardonicus, 8. Severe tonic spasms all the time. Hysteria. 1. Hysterical history. 2. Spasms hysterical. 3. Mind clear. 4. Special senses normal. 5. Fear of liquids imaginary, as pa- tient can swallow without caus- ing spasms. 6. Occurs usually in hysterical young v/omen. 7. Moral treatment curative. DIFFERENTIAL DIAGNOSIS OF THE CHRONIC GEN- ERAL DISEASES. DIFFERENTIAL DIAGNOSIS OF THE CHRONIC GEN- ERAL DISEASES. NAME OF DISEASE. Acute articular rheumatism Arthritis deformans . Diabetes . . . . Pernicious anaemia Anaemia .... Leucocythgemia Scurvy . • . , Trichinosis Alcoholism f • DISEASES TO BE DIFFERENTIATED. j Acute gout. ( Gonorrhceai rheumatism. j Chronic articular rheumatism, ( Chronic gout. Glycosuria. ( Simple anaemia. < Chlorosis. ' Leucocythsemia. ( Chlorosis. I Pernicious anaemia. ( Pseudo-Ieuksemia. ( Pernicious anaemia. Purpura. j Myalgia. ( Typhoid fever. ' Apoplexy. Ursemia. Meningitis. Opium poisoning. Sunstroke. 127 128 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Myalgia * Syphilis (chancre) . . . . Acute Articular Rheumatism. 1 . History of exposure to wet or cold. 2. Begins with a chill and fever. 3. Large joints first attacked. 4. Pain constant. 5. Temperature high. 6. Profuse sweats. 7. Attacks young people usually. 8. Joint swollen, but not greatly in- flamed. 9. No pruritis or desquamation. 10. Urine abundant. 11. Frequent cardiac complications. 12. Tophi never formed. Acute Articular Rheumatism. 1. History of exposure to cold, etc. 2. Begins usually with a chill. 3. Many joints attacked. 4. Eyes rarely inflamed, 5. Copious sweating. 6. Temperature high. 7. Disappears rapidly under treat- ment. DISEASES TO BE DIFFERENTIATED, Neuralgia. Intestinal colic. Trichinosis. Spinal meningitis. Chancroid. Acute Gout. I. History of high living or heredi> taiy tendency. 2. Begins at night with severe pain in some small joint — as the great toe 3. Small joints first attacked. 4. Pain paroxysmal, 5. Temperature rarely over 103°. 6. No profuse sweats. 7. Attacks adults. 8. Joints greatly inflamed with sur- rounding veins enlarged. 9. Desquamation and itching of skin about joint attacked. Urine scanty and highly colored. No cardiac complications. Frequent formation of tophi. 10. II. 12. Gonorrhoea! Rheumatism. I. History of gonorrhoea. Begins with pain and lameness in one joint, usually the knee. Usually but one or two joints at- tacked. 4. Eyes frequently inflamed. 5. No profuse sweats. 6. Temperature rarely over 102°. 7. Treatment has but little effect. 2. 3. CHRONIC GENERAL DISEASES. 129 NAME OF DISEASE. Acute Articular Rheumatism. 8. Frequent cardiac complications. 9. Pain very severe and acute. Arthritis Deformans. 1. Not hereditary. 2. Disease progressive. 3. Usually attacks females. 4. No kidney complications. 5. No chalky deposits. 6. Marked deformity and ankylosis. 7. No excess of uric acid. Arthritis Deformans. 1. No history of acute rheumatism. 2. Disease progressive. 3. Marked deformity. 4. Small joints first involved. 5. Weather has no effect upon the disease. Diabetes. 1. Occurs at all ages. 2. Causes unknown. 3. Amount of sugar varies but little from day to day. 4. Polyuria and polyphagia well- marked. 5. Well-marked nervous and skin symptoms. 6. Fehling's method of analysis easy. 7. Complications, as phthisis, etc., common. DISEASES TO BE DIFFERENTIATED. Gonorrhceal Rheumatism. 8. Heart rarely attacked. 9. Subacute inflammation of joint. Chronic Gout. 1. Hereditary. 2. Disease periodic. 3. Usually attacks males. 4. Frequent kidney comphcations. 5. Chalky deposits in joints, etc. 6. Marked deformity and ankylosis uncommon. 7. Excess of uric acid. Chronic Rheumatism. 1. History of acute rheumatism. 2. Disease periodical. 3. Deformity not well-marked. 4. Large joints first attacked. 5. Disease worse in damp, cold weather. Simple Glycosuria. 1. Common in aged people. 2. Caused by insanity, injuries, medi- cine, etc. 3. Amount of sugar varies greatly from time to time. 4. Polyuria and pol}'phagia less severe. 5. Obscure nervous and skin s}Tnp- toms. 6. Method of analysis obscure from presence of keratinine. 7. Complications rare. I30 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Pernicious AnsBmia. 1. Disease of adults. 2. Dropsy. 3. Hemorrhages common. 4. Purpura. 5. Fever. 6. Face has a straw color. Pernicious Anaemia. 1. No severe emaciation. 2. Fever. 3. Hemorrhages common. 4. Purpuric spots. 5. Persistent dropsy and cardiac mur- murs. 6. Severe dyspnoea. 7. Does not yield to treatment. Pernicious Anseniia. 1. Spleen normal. 2. Glands not enlarged. 3. Bones not painful or tender. 4. No pain in sternum. 5. Hemorrhages occur early. 6. Fever. 7. No actual increase in the number of white blood corpuscles. Simple Anaemia. 1. Emaciation. 2. Skin pale. 3. Attacks any one 4. No mental disturbance. 5. No uterine complications. 6. No cough or severe dyspncea. C/\J DISEASES TO BE DIFFERENTIATED. Chlorosis. 1. Disease of girls at puberty. 2. No dropsy. 3. Hemorrhages uncommon- 4. No purpuric eruption. 5. No fever. 6. Face has a greenish hue. Anaemia. 1. Quite rapid emaciation. 2. No fever. 3. Occasional hemorrhages. 4. No purpuric eruptions. 5. Occasional slight dropsy and blow- ing murmurs. 6. Slight dyspncea. 7. Yields readily to treatment. Leucocythaemia. 1. Spleen greatly enlarged. 2. Lymphatic glands enlarged. 3. Bones painful and tender. 4. Pain ia sternum. 5. Hemorrhages occur late. 6. No fever. 7. White blood corpuscles greatly in- creased, often one in twenty. Chlorosis. 1. No emaciation. 2. Skin has a greenish hue. 3. Disease of girls at puberty. 4. Mental disturbance. 5. Frequent uterine complications, 6. Severe cough and dyspncea. CHRONIC GENERAL DISEASES. 131 4. 5- NAME OF DISEASE. Leucocythaemia. Spleen greatly enlarged. Lymphatic glands somewhat en- larged. Pain in bones, especially sternum, well marked. White blood corpuscles greatly in- creased (i to 20). Progressive ansemia and rapid loss of health. DISEASES TO BE DIFFERENTIATED. Pseudo-Leuksemia. 1. Spleen somewhat enlarged. 2. Lymphatic glands greatly enlarged. 3. Pain in bones less marked. 4. Number of white blood corpuscles not actually increased. 5. Anaemia and loss of health less marked. Leucocythaemia. Pernicious Ansemia. See Perniciofts Anceniia, page 130. Scurvy. 1. Hemorrhages not confined to free surfaces. 2. Disease of long duration. 3. History of faulty nutrition. 4. CEdema well marked. 5. Muscles swollen. 6. Great depression and despondency. 7. Gums spongy. 8. Attacks numbers of people. 9. Treatment dietetic. Trichinosis. 1. Abdominal pain. 2. Fever. 3. Diarrhoea. 4. History of eating raw meat. 5. Trichinas found in muscle. 6. CEdema of eyelids, feet, etc. Purpura. 1. Hemorrhages confined to free sur- faces. 2. Disease of short duration. 3. No faulty dietetic history. 4. No oedema. 5. No swelling of muscles. 6. No mental prostration. 7. Gums normal. 8. Seen in isolated cases. 9. Dietetic treatment of no effect. Myalgia. 1. No deep abdominal pain. 2. No fever. 3. No diarrhoea. 4. History of exposure to wet or strain. 5. Examination of muscle negative, 6. No oedema. n2 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Trichinosis. DISEASES TO BE DIFFERENTIATED. Typhoid Fever. See Typhoid Fever, page iii. Alcoholism (Coma). 1. Patient can be aroused. 2. Pupils equal. 3. Pupils dilate by slapping face. 4. Reflexes normal. 5. Odor of alcohol about patient. 6. Steamboat respiration. 7. No paralysis or convulsions. 8. Pulse rapid. 9. Temperature equal on both sides. Alcoholisni (Delirium). 1. Delirium wild but coherent. 2. Temperature normal. 3. Surface cool and sweaty. 4. Pupils normal. 5. Patient sees animals and objects. 6. Does not complain of pain. 7. Pulse rapid. 8. Marked tremor. g. Eyes wild but otherwise no pecul- iar appearance of body. Alcoholism (Coma). 1. Pupils about normal. 2. Pupils dilate by slapping face. 3. Surface hot and often congested. 4. Respiration hurried and deep. 5. Respirations regular and blowing in character. U-\J Apoplexy. 1. Cannot arouse patient. 2. Pupils unequal. 3. Pupils do not respond. 4. Reflexes often absent on one side. 5. No peculiar odor about patient. 6. Stertorous respira.tion. 7. Paralysis and convulsions common, 8. Pulse slow. 9. Temperature elevated on paralyzed side. Acute Meningitis. 1. Delirium incoherent and not very wild. 2. Temperature elevated. 3. Surface hot and dry. 4. Pupils contracted. 5. Patient continually trying to get out of bed. 6. Patient complains of headache. 7. Pulse slow. 8. No tremor. 9. "Boat-belly" and strabismus, or photophobia common. Opium Poisoning. 1. Pupils " pin-head." 2. Pupils do not respond. 3. Surface cool and perspiring. 4. Respiration very slow. 5. Respirations irregular and shallow in character.