Complete Text (Part 10)

Does not affect all the limbs. 8. No bulbar paralysis as a nile. 9. No fibrillary contractions of the muscles. Progressive Muscular Atrophy. See Polio-myelitis Cerebro-spinal Sclerosis. (Multiple Sclerosis.) 1. No tremor when patient is at rest. 2. Disease of young adults. 3. Shaking of the head. 4. Change in voice and speech. 5. Tendon reflex greatly increased. 6. Patient lias no tendency to run forward. 7. Disease usually begins in the lower extremities. DISEASES TO BE DIFFERENTIATED. Amyotrophic Lateral Sclerosis. 4. "Bird-claw" contractions of fin- gers and toes. 5. No reaction of degeneration. 6. Increased tendon reflex. Amyotrophic Lateral Sclerosis. 1. Atrophy follows the paralysis. 2. Rigidity of paralyzed parts. 4. Disease progresses quite rapidly. 4. Increased tendon reflex. 5. Electro-contractility of muscles preserved. 6. Usually begins in muscles of lower extremities. 7. Affects both extremities. 8. Usually bulbar paralysis toward the last. 9. Fibrillary contractions of the affec- ted muscles. Polio-myelitis Anterior. Anterior, page 149 Paralysis Agitans. 1. Continued muscular tremor. 2. Disease of the aged. 3. No violent shaking of the head. 4. Speech slow. 5. Normal tendon reflex. 6. Patient has a tendency to run for- ward when starting to walk. 7. Usually first noticed in the hands. DISEASES OF THE NERVOUS SYSTEM. 151 NAME OF DISEASE. Cerebro-spinal Sclerosis. 8. No rigidity of the limbs. g. No peculiar physiognomy. 10. Voluntary motion beyond control. 11. Patient peevish and childish. 12. Periods of marked improvement. Cerebro-spinal Sclerosis. 1. Tendon reflex greatly increased. 2. Muscular atrophy not marked. 3. Voluntary motion beyond control. 4. No fibrillary contractions. 5. No claw -like appearance of fin- gers, etc. 6. Mental disturbance. 7. No rigidity of affected parts. 8. Periods of marked improvement. Cerebro-spinal Sclerosis. 1. Disease of young adults. 2. Voluntary motion beyond control. 3. Increased tendon reflex. 4. No tremor when quiet. 5. Patient can keep quiet if he tries. 6. Both sides affected alike. 7. Movements the same in character. DISEASES TO BE DIFFERENTIATED. Paralysis Agitans. 8. Limbs become rigid. 9. Features present a peculiar physi- ognomy. 10. Voluntary motion can be accom- plished, but with trembling. 11. Intellect remains good. 12. Disease steadily progressive. Amyotrophic Lateral Sclerosis. 1. Tendon reflex slightly increased. 2. Well-marked muscular atrophy. 3. Coordinate voluntary motion. 4. Fibrillary contractions of muscles. 5. Claw -like contractions of fingers and toes. 6. Intelligence good. 7. Rigidity of affected parts. 8. Disease steadily progressive. Chorea. 1. Disease of childhood. 2. Voluntary motion under control, but incoordinate. 3. Normal tendon reflex. 4. Jactitations when quiet and often during sleep. 5. Choreic movements more marked when patient tries to appear quiet. 6. No symmetrical distribution of symptoms ; often confined to one side. 7. Movements irregular and rapidly changing. 152 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. Locomotor Ataxia. 1. No headache or vertigo. 2. No vomiting. 3. Paraplegic symptoms. 4. Gait abrupt and jerky. 5. Cutaneous sensibility greatly im- paired. 6. Walking much more difficult with eyes closed. 7. Absence of knee-jerk. 8. Lightning-like pains. Locomotor Ataxia. DISEASES TO BE DIFFERENTIATED Cerebellar Disease. Headache and vertigo common. Frequent vomiting. Hemiplegia. Drunken gait. Normal cutaneous sensibility. 6. Patient walks much better wdtb the eyes closed. 7. Normal reflexes. 8. No severe neuralgic pains. Polio-myelitis Anterior. See Polio-myelitis Anterior, page 149. Amyotrophic Lateral Sclerosis. Progressive Muscular Atrophy. See Progressive Muscular Atrophy, page 150. Amyotrophic Lateral Sclerosis. Polio-myelitis Anterior. See Polio-myelitis Anterior, page 149. Amyotrophic Lateral Sclerosis. Cerebro-spinal Sclerosis. See Cerebral-spinal Sclerosis, page 150, FUNCTIONAL NERVOUS DISEASES. Epilepsy. Apoplexy. See Apoplexy, page 91. Epilepsy. Uraemia. See Urcemia, page 91. Epilepsy (Coma). 1. History of epilepsy. 2. Corna preceded by convulsions. 3. Pupils dilated. 4. Temperature elevated. 5. Tongue bitten, Opium Poisoning. 1. History usually negative. 2. No convulsive seizures. 3. Pupils contracted. 4. Temperature normal or sub- nonnal, 5. No injury to tongue. DISEASES OF THE NERVOUS SYSTEM. 153 NAME OF DISEASE. Epilepsy (Coma). 6. Respiration normal or rapid. 7. No odor to breath. 8. Skin hot and dry. 9. Pulse rapid. 10. Bloody froth about mouth. Epilepsy. 1. History of epilepsy, 2. Temperature elevated. 3. General muscular rigidity. 4. Aura epileptica. 5. Anaesthesia. 6. Attacks both sexes. 7. No apparent cause. 8. Highly-colored urine. 9. No ovarian tenderness. 10. Face cyanosed. 11. Complete loss of consciousness. 12. Biting of tongue. 13. Pupils insensible to light. 14. Countenance distorted. 15. Convulsions tonic, then clonic. 16. Paroxysms of short duration. 17. Paroxysms followed by sleep. 18. Eyelids half-open. Epilepsy. 1. Loss of consciousness sudden. 2. Coma preceded by convulsions. DISEASES TO EE DIFFERENTIATED. Opium Poisoning. 6. Slow, shallow respiration. 7. Odor of opium about patient. 8. Skin cool and moist. 9. Pulse slow. 10. No frothy mucus about mouth. Hysteria. 1. History of hysteria. 2. Temperature normal. 3. No general muscular rigidity. 4. Globus hystericus. 5. Hypersesthesia. 6. Attacks females. 7. Caused by menstrual disorders. 8. Urine abundant, clear, and lim- pid. 9. Ovarian tenderness. 10. Face flushed. 11. Loss of consciousness incomplete, and accompanied with sobbing, grinding of teeth, etc. 12. Tongue not bitten. 13. Pupils sensitive. 14. No distortion of countenance. 15. Clonic convulsions. 16. Paroxysms often of some length. 17. Paroxysms followed by wakeful- ness. 18. Eyelids closed. Syncope. 1. Loss of consciousness comes on slowly, 2. Coma preceded by a weak, faint feeling. 154 DIFFERENTIAL DIAGNOSIS OF THE NAME OF DISEASE. DISEASES TO BE DIFFEREN HATED. Epilepsy. Syncope. 3. Rapid recovery. 3. Slow recovery. 4. Loss of consciousness of short 4. Patient remains unconscious for duration. some time. 3. No recollection of the attack. 5. Patient can recall the facts con- nected with the attack. 6. Pulse not greatly affected. 6. Pulse very weak, hardly felt at the v/rist. 7. Hands warm. 7. Hands and feet very cold. Epilepsy. Convulsions Due to Organic Brain Disease. 1. History of epilepsy. i. History of a brain disorder. 2. Advent sudden. 2. Advent slow. 3. Attack followed by sleep. 3. Attack often followed by impaired intellect. 4. Apparently a complete recovery 4. Symptoms of brain disorder usually from the attack. more marked after an epilepti- form attack. 5. Attack preceded by a well-marked 5. No aura epileptica. <iura. Hysteria. Myelitis. See Myelitis, page 147. Hysteria. Epilepsy. See Epilepsy, page 153. Hysteria. Uraemia. See Urcemia, page 91. Hysteria. Acute Peritonitis. See Acute Peritonitis, page 69. Hysteria. Hydrophobia. See Hydrophobia, page 123. DISEASES OF THE NERVOUS SYS7EM. 155 NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Hysteria. Chronic Laryngitis. See Chronic Laryngitis, page 16. Hysteria. Angina Pectoris. See Angina Pectoris, page 42. Hysteria. Cancer of the CEsophagus. See Cancer of the (Esophagus, page 54. Chorea. Cerebro-Spinal Sclerosis. See Cerebro-Spinal Sclerosis, page 151. Chorea. 1. Disease usually of young people. 2. Spasmodic contraction of muscles. 3. Loss of muscular control. 4. No general disturbance. 5. Symptoms usually more marked upon one side. 6. No muscular rigidity. 7. No peculiar physiognomy. 8. No tendency to run forward. Tetanus. Paralysis Agitans. 1. Disease of adults. 2. Great muscular weakness. 3. Muscular tremor. 4. Signs of general decay. 5. Both sides of body alike affected. 6. Muscular rigidity well marked. 7. Physiognomy peculiar. 8. Patient loses balance when about to walk and runs forward. Spinal Meningitis. See Spinal Meningitis , page 145. Tetanus. Hydrophobia. See Hydrophobia, page 123. Tetanus. 1. History of traumatism. 2. Arms and legs last affected. 3. No epigastric pain. 4. Slow development of disease. 5. Spasms affect the jaws first. Strychnine Poisoning. 1. No traumatic history. 2. Extremities first affected. 3. Severe epigastric pain. 4. Advent sudden. 5. Jaws secondarily affected. 156 DISEASES OF THE NERVOUS SYSTEM. DISEASES TO BE DIFFERENTIATED. Strychnine Poisoning. 6. Complete muscular relaxation in NAME OF DISEASE. Tetanus. 6, Some spasmodic ligidity constant- ly preser.t. 7. Disease lasts usually for several days. Paralysis Agitans. See Cerebro- Spinal Sclerosis, page 1 50. Paralysis Agitans. Chorea. See Chorea, page 155. interval betvv'een spasms. 7. Attack of short duration. Cerebro-Spinal Sclerosis. Paralysis Agitans. 1. Voice slov/. 2. Intelligence remains good until late in the disease. 3. Physiognomy peculiar. 4. Peculiar gait. 5. No trembling of the head. 6. Tremor constantly present. 7. Disease of long duration. 8. Unaltered cutaneous sensibility. General Paralysis of the Insane. 1. Voice tremulous. 2. Intelligence early affected. 3. Dull expression to face. 4. No peculiar gait. 5. Head unsteady. 6. Inconstant tremor. 7. Rapid progressive disease. 8. Altered cutaneous sensibility. DIFFERENTIAL DIAGNOSIS OF COMA, DIFFERENTIAL DIAGNOSIS OF COMA. FORMS OF COMA TO BE DIFFERENTIATED. Uraemic. Hysterical. Apoplectic. Congestive (sunstroke.) Narcotic (opium.) Asphyxia!. Alcoholic. Anaemic (syncope.) Diabetic. Cerebral, due to injury to brain. Epileptic. NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Ursemic Coma. Apoplectic Coma. See Urcemia, page 91. Urasmic Coma. Narcotic Coma. See Urcemia, page 92. Ursemic Coma. Alcoholic Coma. See Urcemia, page 92. Uraemic Coma. Hysterical Coma. See Urmmia, page gl. Uraemic Coma. Epileptic Coma. See Urcemia, page 91. Uraemic Coma. Diabetic Coma. 1. History of Bright's disease. i. History of diabetes. 2. Albumen and casts in urine. 2. Sugar in urine. 3. Begins with delirium or convul- 3. Begins with somnolency and great sions. oppression. i$9 i6o DIFFERENTIAL DIAGNOSIS OF COMA, NAME OF DISEASE. Uraemic Coma. 4. Urine scanty and retained. 5. General oedema. 6. Uriniferous odor about patient. 7. Pulse strong and full. Uremic Coma. I History of Bright's disease. 2. General oedema. 3. Urine albuminous. 4. Face waxy. 5. Breathing stertorous. 6. Uriniferous smell about patient. 7. Heart's action usually good. Uraemic Coma. 1. History of Bright's disease. 2. Temperature low. 3. Coma and repeated conviilsions. 4. Breathing stertorous. 5. Urine scanty and albuminous. 6. General oedema. 7 Urine retained, b. No diarrhoea. 9. Coma complete. 10. Pulse not very rapid. DISEASES TO BE DIFFERENTIATED, Apoplectic Coma. 4. Urine abundant and passed in voluntarily. 5. Emaciation. 6. Sweet odor to breath and urine, 7. Pulse weak and small. Asphyxia. 1. Of exposure to foul air. 2. CEdema of lungs. 3. Urine negative. 4. Tongue and lips livid and blue. 5. Breathing embarrassed. 6. Breath contains large amount of carbonic acid. 7. Heart action greatly embarrassed. Congestive Coma. (Sunstroke.) 1. Of exposure to heat. 2. Temperature high. 3. Coma without or with slight con- vulsions. 4. Breathing usually quiet. 5. Urine negative. 6. No oedema. 7. Urine passed involuntarily. 8. Involuntary diarrhoeal discharges. 9. Coma yields readily to treatments 10. Pulse rapid. Apoplectic Coma. Alcoholic Coma. See Alcoholism t P^-g^ 132. Apoplectic Coma. Narcotic Coma. See Apoplexy, page 143. DIFFERENTIAL DIAGNOSIS OF COMA. I6l NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Apoplectic Coma. Hysterical Coma. See Apoplexy, page 143, Apoplectic Coma. Epileptic Coma. See Apoplexy, page 143. Coma, Result of Injury. (Meningeal hemorrhage.) Apoplectic Coma. (Cerebral hemorrhage.) Apoplectic history. No signs of injury. No oozing from nose or ears. Stupor intense from first. Hemiplegia. Remissions infrequent. No headache. Vaso-motor disturbance on affected side. Convulsions and paralysis limited to one side. Apoplectic Coma. Hemiplegia. Begins suddenly. Slow, full pulse. Respiration slow and stertorous. Urine negative. Urine often retained. Temperature elevated, especially on paralyzed side. Pupils irregular. Deviation of head and eyes. 1. History of injury. 2. Signs of head injury. 3. Blood or serous discharge common, 4. Gradually increasing stupor. 5. Hemiplegia comes on late, if at all. 6. Frequent remissions. 7. Headache. 8. Vaso-motor mon. 9. Both sides may be affected. disturbance uncom- Diabetic Coma. 1. No true paralysis. 2. Slowly, v,dth somnolency. 3. Rapid, v/eak pulse. 4. Rapid respiration. 5. Sugar in urine. 6. Passed involuntarily in quantities. 7. Temperature normal. 8. Pupils regular. 9. No deviation. large Apoplectic Coma. See Apoplexy, page 144. Asphyxia. 1 62 DIFFERENTIAL DIAGNOSIS OF COMA, NAME OF DISEASE. Apoplectic Coma. 1. Apoplectic history. 2. Appears suddenly. 3. Temperature higher on paralyzed side. 4. Hemiplegia. 5. Pupils irregular. 6. Breathing loudly stertorous. 7. Deviation of head and eyes. 8. Retention of faeces. g. Increasing coma. 10. Pulse slow and full. Alcoholic Coma. See Alcoholism DISEASES TO BE DIFFERENTIATED. Congestive Coma. (Sunstroke.) Exposure to heat. Usually comes on gradually. Temperature very high on both sides. No true paralysis. Pupils contracted. Stertor absent or lov/. 7. No deviation. 8. Involuntary diarrhceal discharges. 9. Coma diminishes on appropriate treatment. Pulse rapid and often feeble. 10. Narcotic Coma. , page 133. Alcoholic Coma. 1. History of alcoholism. 2. Breath smells of alcohol. 3. Alcohol in urine. 4. Temperature low. 5. Tongue negative. 6. Face flushed and swollen. 7. No loss of semen. 8. "Steamboat" respiration. 9. Can be aroused by inhalation of ammonia. 10. Coma lasts for hours. 11. Not preceded by convulsions. Epileptic Coma. 1. History of epilepsy. 2. No odor to breath. 3. Urine negative. 4. Temperature high. 5. Tongue bitten. 6. Face cyanotic with froth about mouth. 7. Frequently is. 8. No stertorous breathing. 9. Cannot be aroused. 10. Coma of short duration. 11. Coma follows convulsions. Alcoholic Coma. Congestive Coma. (Sunstroke.) See Alcoholism, page 133. DIFFERENTIAL DIAGNOSIS OF COMA. 163 NAME OF DISEASE. Alcoholic Coma. 1. History of alcoholism. 2. Can be aroused. 3. Pulse full and strong. 4. Pupils dilated. 5. Alcohol in urine. 6. Face flushed and red. 7. Steamboat respiration. 8. Breath smells of alcohol. Alcoholic Coma. 1 . Breath smells of alcohol. 2. Pulse full 8-nd strong. 3. Alcohol in urine. 4. Urine retained. 5. Can be aroused. 6. Begins with delirium. 7. Respiration slow and steamboat quality. 8. Coma gradually lessens. Alcoholic Coma. History of alcoholism. Usually seen in males. Stertorous breathing. Vomiting common. Coma continuous. 6. Urine retained. 7. Urine high-colored and contains alcohol. 8. Breath smells of alcohol. DISEASES TO BE DIFFERENTIATED. Asphyxia. 1. Of breathing impure air. 2. Cannot be aroused. 3. Pulse small and v/eak. 4. Pupils contracted. 5. Urine negative. 6. Face and lips blue. 7. Shallov/ and embarrassed breath- ing. 8. Frequently of gas. Diabetic Coma. Sweet odor to breath. Pulse rapid and weak. Sugar in urine. Urine passed involuntarily and in large amounts. Cannot be aroused. Begins with somnolency. Respiration shallow and rapid. 8. Coma deepens. Hysterical Coma. 1. History of hysteria. 2. Occurs in females. 3. No stertor. 4. No vomiting. 5. Coma alternates with hysterical delirium. 6. Incontinence of urine. 7. Urine abundant and clear. 8. No odor to breath. Epileptic Coma. Hysterical Coma, See Epilepsy, P^-ge 153. 164 DIFFERENTIAL DIAGNOSIS OF COMA. NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. Epileptic Coma. Narcotic Coma. See Epilepsy, page 152. Epileptic Coma. Syncope. See Epilepsy, page 153. Epileptic Coma. I, 2. 3- History of epilepsy. Preceded by convulsions. Coma of short duration. I. 2. 3- 4- 5- 6. Temperature elevated. Pulse not greatly affected. Face covered with foam. 4. 5. 6. 7- Breathing not restrained. 7. 8. Face pale. Epileptic Coma. 8. I. Begins with convulsions. I. 2. 3- Face cyanotic. Pulse not affected. 2. 3- 4- 5- 6. Temperature elevated. Breathing normal. Urine negative. 4- 6. 7- Coma of short duration. 7. 8. Seminal emissions. Opium Coma. 1. Comes on gradually. 2. Pupils contracted. 3. Pupils insensible. 4. Coma deepens gradually. 5. Breathing very slow and irregulai 6. Surface cool and perspiring. 7. Opium in breath and urine. Asphyxia. Of breathing impure air. May end in convulsions. Profound coma. Temperature low. Pulse weak, rapid, and small. No saliva about the mouth. Breathing embarrassed. 8. Face and lips very blue. Diabetic Coma. Begins with somnolency. Face pale. Pulse weak and rapid. Not affected. Breathing very rapid. Urine contains sugar. Coma ends in death. Incontinence of urine. Hysterical Coma. Appears suddenly. Pupils normal. Pupils sensitive to light. Coma alternates with hysterical delirium. Breathing sighing and rapid. Surface flushed and hot. Incontinence of limpid urine, DIFFERENTIAL DIAGNOSIS OF COMA. 165 NAME OF DISEASE. Opium Coma. I. Pupils contracted. 1. Face pale. 3. Breathing very slow and irregular. 4. Opium in breath and urine. 5. Surface cool and perspiring. 6. Heart negative. Opium Coma. 1. Breath smells of opium. 2. Opium in urine. 3. Pulse sloAv. 4. Breathing slow and irregular. 5. Urine retained. 6. Pupils contracted. 7. Surface cool and perspiring. Diabetic Coma. 1. History of diabetes. 2. Respiration rapid. 3. Urine contains sugar, 4. Urine passed involuntarily. 5. Face pale. 6. Sweet smell to breath. 7. Convulsions uncommon. 8. Coma deepens. Diabetic Coma. 1. History of diabetes. 2. Temperature normal. 3. Urine contains sugar, 4. Incontinence of urine. DISEASES TO BE DIFFERENTIATED. Asphyxia. 1. Pupils dilated or normal. 2. Face cyanosed. 3. Breathing rapid and embarrassed. 4. Urine and breath negative or smell of coal gas. 5. Surface dry and hot. 6. Heart's action greatly interfered with. Diabetic Coma. 1. Sweet breath. 2. Sugar in urine. 3. Rapid, weak pulse. 4. Rapid breathing. 5. Incontinence of urine. 6. Pupils negative. 7. Surface dry and hot. Asphyxia. 1. Breathing impure air. 2. Greatly embarrassed breathing. 3. Urine negative or suppressed. 4. Retention of urine. 5. Face and lips blue. 6. Smells of gas frequently. 7. Occasional convulsions. 8. Coma diminished by treatment. Congestive Coma. (Sunstroke.) 1. Of exposure to heat. 2. Temperature elevated. 3. Urine negative. 4. Incontinence of fteces, — diarrhoea. i66 DIFFERENTIAL DIAGXOSIS OF COMA. NAME OF DISEASE. Diabetic Coma. 5. Pupils normal. 6. Breathing rapid. 7. Coma deepens. Congestive Coma. (Sunstroke.) 1. History of exposure to heat. 2. Coma well-marked. 3. Temperature slightly elevated. 4. Pupils contracted 5. Cannot be aroused. 6. Incontinence of faeces. 7. Diarrhoea. Syncope. 1. Advent sudden 2. Face pale. 3. Coma of short duration. 4. Breathing weak but not restricted. 5. Surface cold and perspiring. 6. Heart principally affected. 7. Pulse not felt at vmst. DISEASES TO BE DIFFERENTIATED. Congestive Coma. 5. Pupils contracted. 6. Respiration normal. 7. Coma lessens by proper treatment. Hysterical Coma. 1. Hysterical history. 2. Coma alternates with hysterical symptoms. 3. Temperature very high. 4. Pupils negative or dilated. 5. Can be aroused. 6. Incontinence of urine. 7. No diarrhoea. Asphyxia. 1. Advent slow. 2. Face and lips blue. 3. Coma lasts for hours. 4. Breathing greatly embarrassed. 5. Surface hot and dry. 6. Lungs. 7. Pulse weak and rapid. INDEX. Abscess of the brain, 144 ' perinephritic, 103 ' in abdominal wall, 79 *' psoas, 62 " of the lung, 26 " of the liver,