POINTS 
ft ON 
PRACTICE 
COPYRIGHT 1890. TO THE STUDENT. 
This work is an outgrowth of the a athdrs' experience as stu- 
dents in the medical department of 1 le University of Buffalo, 
a common with many students, tht r felt the necessity of se- 
lecting, separating and collocating fo the purposes of quizzing 
and review the really essential poin j of the lectures given. It 
is believed that nothing intrinsically rnportant in the course of 
lectures delivered by Prof. C. G. Stoc ton, on "The Theory and 
Practiceof Medicine,'' has been omitt I with one exception, and 
that one is the subject of physica l di: gnosis, which is too com- 
prehensive au-1 complicated to admit bf adequate treatment in 
a work of this character. The student is advised to secure a 
copy of the excellent treatise recomntended by Dr. Stockton, 
" On Exploration of the Chest," by Stebhen Smith Burt, M.D. 
On the other hand,.nothing superfluous or non-essential has 
been retimed, it contain^ only those points which the stu- 
-■/ know. It is not intended as as ubstitute for attend- 
Thc lectures must be had to make this work 
, ,„ut is believed that it furnishes most important aid 
to rapid and effecti ve quizzing and review. 
GEORGE W. TONG, M.D. 
W. F. ELMENDORF, M.D. POINTS ON PRACTICE. 
ESSENTIALS OF THEORY AND PRACTICE, BASED UPON THE 
LECTURES DELIVERED AT THE UNIVERSITY 
OF BUFFALO. 
DEFINITIONS. 
Ideal health is the equilibrium of the internal forces of an 
organism and the resistance of its environment. 
Disease is any disturbance of the equilibrium of health. 
Death results from the exhaustion of the vital forces of an 
organism. 
Nosology treats of the classification of diseases. 
Diseases are structural or organic, and functional, or those 
without structural changes. 
Etiology is the doctrine of the causes of disease. 
Temperament is an inherited peculiarity of constitution 
which separates humanity into physical classes with dissimilar 
characteristics or tendencies. Temperament is divisible into 
four classes-the sanguine, the nervous, the bilious, and the 
lymphatic or phlegmatic. 
Idiosyncrasy is an individual peculiarity of constitution and 
susceptibility. 
Diathesis is any tendency, inherited or acquired, which is 
liable to cause an individual to suffer through life or for a long 
time from a particular form of disease. 
Cachexia is a diathesis developed into a disease. 
Causes of disease are internal; as over-study, worry, anger, 
uraemia, etc., or external, as wounds, infection, virus, etc. 
Causes are also divided into predisposing and exciting. 
Predisposing causes are those which increase the vulnera- 
bility of an individual to a disease: as age, sex, temperament, 
lactation, idiosyncrasy, etc. 4 
POINTS ON PRACTICE. 
Exciting causes are those which contribute directly to 
bringing on an attack of the disease; as cold, heat, exposure, 
etc. 
General causes operate in a number of affections; as cold, 
poor ventilation, dampness, etc. • 
Special or specific causes produce a particular form of 
disease; as the virus of syphilis. 
Contagion is an agent arising in a specifically diseased body 
which, when introduced into another body, will produce the 
same disease. 
Infection is any causative agent which, under certain con- 
ditions, will multiply indefinitely. 
Some diseases are both contagious and infectious; e. g., 
small-pox. 
Idiopathic diseases are those which are self-developing. 
Bacteria constitute the "contagion vivam," so called. 
Bacteria are divided into three general classes: the'bacillus, 
or rod shaped; the micrococcus, or berry shaped, and the spir- 
rilium, or spiral shaped. 
Semeiology or symptomatology is the doctrine of the signs 
and symptoms of disease. 
Symptoms accompany disease as shadows follow substance, 
and represent concurrent circumstances. 
. Signs are phenomena discovered by physical exploration; 
as bronchophony, or a crepitant rale from auscultation of the 
chest. 
Diagnostic symptoms are those which allow one to distin- 
guish between diseases. 
Pathogonomic symptoms are those peculiar to one disease; 
as rusty sputum in pneumonia. 
Disease may often conveniently be divided into three stages: 
that of invasion, course and convalescence. 
Prodromic symptoms are those found in the incubation of 
disease. 
Sequelae are morbid conditions resulting from disease. 
Diagnosis is the art of determining the character and loca- 
tion of disease. POINTS ON PRACTICE. 
5 
Diagnosis by exculsion is by proving the absence of all 
diseases except one which could give rise to the symptoms. 
Differential diagnosis is discriminating between diseases 
which give rise to somewhat similar symptoms. 
Physical diagnosis is the art of applying the special senses 
of the physician to the determination of disease. 
Prognosis is, forecasting the probable termination and 
course of the disease. 
Prognosis depends upon the race of the patient, family his- 
tory, personal history, diathesis, use of alcohol, complications, 
etc., as well as the severity of the disease. 
Inflammation is an interference with cell nutrition, marked 
by redness, heat, pain and swelling. 
Hyperaemia is of two classes, active and passive. 
Active hyperaemia is followed by passive hyperaemia, which, 
if it goes on, is succeeded by stasis and then exudation. 
(Edema is usually not of inflammatory origin, but the 
serum oozes through the blood vessels, owing to the weakness 
of their walls. 
Serum exudate is not normal serum. 
White blood corpuscles are also called leucocytes. 
An exudate is in character either serous, fibrinous, purulent 
or haemorrhagic. 
Fibrin is formed by the fibrinogen of the blood and fibrino- 
plastic qualities of the white cells meeting under certain con- 
ditions. 
Fibrin, invaded by bacteria, breaks down forming pus. 
Mucous membranes may undergo catarrhal or croupous 
inflammation. 
Catarrhal inflammations are acute, sub-acute or chronic in 
character. 
In croupous inflammation, beside a secretion of mucus, there 
is a formation of fibrin. 
Parenchymatous inflammation is an inflammation of the 
parenchyma, or functionating part of an organ, and may be 
acute, sub-acute or chronic. 6 
POINTS ON PRACTICE. 
Interstitial inflammation is an inflammation of the stroma 
or connective tissue of an organ. 
The products of inflammation, when invaded by bacteria, 
form pus. 
Pus terminates by being absorbed and passing off by lym- 
phatics, by burrowing out, or by undergoing caseation. 
Caseation, or caseous degeneration, comes about by the 
liquid portion of the pus being absorbed and the solid con- 
stituents hardening. The process may go on and the cheesy 
portion break down with the formation of a cavity, or it may 
become encrusted with lime salts, and thus undergo calcareous 
degeneration. 
PULSE. 
The pulse is an expansion of the artery, produced by a wave 
of blood set in motion by the injection of blood into the aorta 
from the ventricular systole, and is usually felt in the radial 
artery at the wrist. 
The tidal wave is the wave that passes through the artery, 
and is more rapid in progress than the blood itself. 
Dicrotic wave is a recoil wave from the closed aortic valves. 
Dicrotic pulse is found in fevers and those conditions in 
which t he artery is large, partly empty, with absence of pressure 
and tension. 
In palpating pulse examine for frequency, rhythm, magni- 
tude, tension, celerity, regularity and secondary wave. 
Normal pulse in males ranges from 60 to 80 beats per 
minute. There exists greater variation in females. 
An infant's pulse at birth will be found at from 110 to 140 
beats; during its first year from 110 to 120; at ten years of 
age about 90 beats. 
Short people have a more frequent pulse. Heat and exercise 
increase the pulse rate. 
FEVER. 
Fever, or pyrexia, is that disturbance of an organism marked 
by a rise of temperature. POINTS ON PRACTICE. 
7 
Fevers are classed in general as asthenic or adynamic, and 
sthenic or dynamic. 
A typical fever has four stages: the initial stage, the fas- 
tigium or course, the acme or height, and a period of defer- 
vescence or convalescence, which comes on by lyris or crisis. 
Some fevers, so called, are characterized by sub-normal 
temperatures. 
Temperature is taken in the axilla, under the tongue, in the 
rectum, or in the vagina. 
EXAMINATION OF THE TONGUE. 
The tongue is examined as to its form, surface, fissures, 
color, coating and sensibility. As to form, find whether it is 
large or small, long and slender, or broad and flabby. 
Impoverished blood gives a broad, flabby tongue, marked 
with indentations of the teeth. 
Nervous people are apt to have slender tongues of much 
consistency and quickly extended. 
Idiots and those suffering with acute diseases usually have 
broad and flabby tongues. 
In examining the surface 'of the tongue, find if it is very 
smooth, whether the papillae extend high or are wanting, if the 
epithelium is gone, and if the tongue has a velvety look. 
In wasting diseases the tongue is apt to be fissured. 
Color of the tongue is important, and the under surface of 
the tongue should always be examined for the true color. 
Coating of the tongue is distinct from the color, and is made 
up of mucus, saliva, etc. 
Movements of the tongue give an idea of the mental state of 
the patient. 
Sensibility of the tongue refers to its tactile and gustatory 
impressions. 
CORYZA. 
Description.-Also known as catarrh and rhinitis; is an 
inflammation of the mucous membrane lining of the nose and 8 
POINTS ON PRACTICE. 
communicating cavities, and may be acute, sub-acute or 
chronic. 
Etiology of the Acute Form.-Irritating vapors, micro- 
organisms, cold and exposure. 
Morbid Anatomy.-Hyperaemia of mucous membrane, 
attended by redness, swelling and dryness. Veins are turgid, 
oedematous. Infiltration follows with marked secretion, which 
is thin at first and becomes thick, purulent; if very severe, 
haemorrhagic. 
Symptomatology.-Lassitude, feverishness, dryness of nares, 
followed by abundant watery, acrid secretion. 
Treatment Acute Coryza.-Balance circulation, hot foot-bath, 
tincture aconite two drops every half hour, bromide potassium 
in full doses, quinine in large doses, Dover's powders ten 
grains at bedtime, cathartics early. 
Local Treatment.-Spray with cocaine; iodine or menthol 
vapor inhaled. 
Synonyms.-Catarrhal tonsillitis, angina catarrhalis, acute 
"sore throat." 
Description.-An acute catarrhal inflammation of the 
mucous membrane of the uvula, soft palate and pharynx. 
Etiology.-Same as that of acute coryza. 
Symptomatology.-Feverishness, thirst, dryness in the 
throat, painful deglutition, constant desire to clear the throat. 
Treatment.-Same as in parenchymatous tonsillitis. 
CATARRHAL PHARYNGITIS. 
PARENCHYMATOUS TONSILLITIS. 
Synonyms--Quinsy, true tonsillitis, amygdalitis. 
Description.-Acute parenchymatous, inflammation of one 
or both tonsils, with a tendency toward suppuration. 
Etiology.-Exposure, colds, etc., while system is below par. 
Symptomatology.-A chill, rise of temperature, dry skin, loss 
of appetite, marked prostration. On inspection whole side of 
throat appears swollen, uvula is pressed to one side, marked POINTS ON PRACTICE. 
9 
swelling under the jaw, sub-maxillary glands involved some 
times. Mouth opened with difficulty and pain. Smooth, 
swollen tonsil, may be felt with the finger. Fluctuation ante- 
riorily follows, patient becomes almost speechless, voice has 
peculiar tone called "sore-throat voice." 
Prognosis depends on the condition of the patient. 
Differential Diagnosis.-In syphilitic affections have deeper 
infiltration with punched-out look of ulcer of uvula or palate. 
In tuberculosis have a history of the case. In scarlet fever 
there is a cyanosed look to the skin, with characteristic fever 
and pulse rate. 
Treatment.-Prophylactic, prevent taking cold, avoid over- 
heated rooms, cold rooms at night, increase the tone of the 
vaso-motors by exercise, proper diet, rest. Accustom body to 
cold by cold baths. 
Treatment by Drugs.-Open the bowels with castor oil or 
salines or calomel, followed by saline cathartic. Open the skin 
by aconite, small doses of Dover's powders; act oh kidneys 
with sweet spirits of niter; as local treatment may use alkaline 
sprays, Seiler's solution, or inhale menthol. 
FALSE CROUP. 
Synonyms.-Spasmodic croup, catarrhal croup. 
Description.-An acute catarrhal inflammation of larynx, 
associated with spasmodic contraction of the glottis. 
Etiology.-Difficult dentition, diet, excesses, atmospheric 
changes, hereditary. 
Symptomatology.-Child awakened in night by suffocative 
paroxysm; harsh, ringing cough; throat dry, too hoarse to 
cry ; struggles for air. 
Prognosis.-Favorable, perspiration established, child falls 
asleep toward morning. 
Treatment.-Emetic at once; after emesis, 15 to ^20 drops 
of paregoric. To produce emesis use syrup ipecac 10 drops 
every 15 or 20 minutes. Antipyrine in 2 or 3 grain doses may 
be useful; hot applications on throat useful, but avoid wet 10 
POINTS ON PRACTICE. 
applications. The next day give a purgative; have the supper 
light; wake the child after the first half hour's sleep and give 
10 drops syrup ipecac. 
TRUE CROUP. 
Synonyms.-Croupous laryngitis, membraneous croup. 
Etiology.-Inherited tendency, age from 1. to 7 years most 
prone; climate, previous illness. 
Clinical History.-Conies on gradually, child hoarse, rough 
breathing during the night, harsh cough; next day febrile 
condition perhaps, constipation; at night peculiar, metallic 
cough; persisting development, aphonia, membrane formed. 
Prognosis.-Unfavorable. 
Treatment.-Sustain the patient; use emetics sparingly; 
spray lime water, use turpentine vapor, or dissolve membrane 
with papain. In cases not amenable to drugs resort to 
O'Dwyer's tubes or tracheotomy. 
TRUE CROUP. 
Begins any time. 
Symptoms slight at first. 
Cough harsh and rough. 
Aphonia.or voicea weak whisper. 
Membrane always. 
DIFFERENTIAL DIAGNOSIS. 
FALSE CROUP. 
Begins at 10 to 12 o'clock P. M. 
Severe at first. 
Cough loud and ringing. 
Voice harsh. 
No membrane. 
TRUE CROUP. 
Membrane lies on mucous membrane 
and is easily removed. 
No fetor to breath. 
Membrane invades larynx from 
below. 
DIPHTHERIA. 
Membrane Infiltrates surrounding 
membrane and is adherent. 
Breath fetid. 
Invades larynx from above. 
DIPHTHERIA. 
Description.-Specific, contagious, infectious disease, char- 
acterized by croupous exudate,fibrinous in character,involving 
mucous and sub-mucous surface and abraded surfaces in other 
parts of the organism. Exudate contains several kinds of 
bacteria. Exudate usually appears in pharynx and spreads 
rapidly. It forms as a thin pellicle, thickens, becomes leathery 
in appearance, varies in color from yellowish gray to black. POINTS ON PRACTICE. 
11 
Etiology.-Contagion vivam from filth or defective sewerage. 
Symptomatology.-General symptoms are malaise, a rigor, 
temperature 102 degrees to 101 degrees, pulse bounding, 
anorexia, backache, vomiting, marked prostration, character- 
istic odor. 
Local Symptoms.-Coated tongue, sore throat, exudate in 
pharynx rapidly spreading, cough, discharge from the nose, 
enlarged lymphatics, aphonia, difficult inspiration. 
Unfavorable Symptoms.-Pulse weak and rapid, convul- 
sions late on, coma and hyperemesis late in the course of the 
disease. 
Pathology.-Exudate spreads rapidly, thickens, sloughs, 
may become gangrenous; the blood is dirty brown in color, 
corpuscles rapidly destroyed with resultant anaemia; heart 
becomes soft, weak, fatty; spleen enlarged and softened; kid- 
neys subject to parenchymatous degeneration; neuritis com- 
mon. 
Sequelae.-Bright's disease, paralysis, albuminuria, neuritis, 
anaemia. 
Treatment.-Prophylatic regarding hygiene, sanitation, 
looking to sewage and disinfection. Actual treatment, balance 
circulation, full diet, stimulants, hypernutrition, using hot 
milk, oysters, eggs, wine, whisky, etc. Quinine in 3 or 4 grain 
doses several times daily, calomel to keep bowels open. 
Local Treatment.-Spray with officinal solution perman- 
ganate of potassium every hour, or bichloride mercury, grain 
1 to water 4 ounces with a little alcohol; or hydrogen 
peroxide one part to three of distilled water; may alternate 
with the sublimate solution, using each every three hours. 
Differential Diagnosis.-Croup-Absence of chill, no al- 
buminuria, exudate does not extend into nose and adjacent 
cavities, laryngeal symptoms before pharyngeal, no glandular 
involvement. Scarlet Fever-Characteristic eruption usually, 
"strawberry tongue," fever higher usually. Lacunar Tonsil- 
litis-Systemic disturbance light, ulceration limited to tonsils, 
no glandular enlargement, no palsies. 12 
POINTS ON PRACTICE. 
ACUTE BRONCHITIS. 
Description.-Inflammation of the trachea and larger bron- 
chial tubes, usually of both lungs. 
Etiology.-Exposure to cold when system is vulnerable, 
.microorganisms, irritating gases and vapors. 
Morbid Anatomy.-Hyperaemia of the part, constriction of 
the chest, dryness, followed by exaggerated secretion, expecto- 
ration of serum, becoming purulent, with some blood perhaps, 
and typical epithelium of the part. 
Clinical History.-Cold in the head, extending rapidly down 
ward; malaise, headache, loss of appetite, chill, fever about 
103 degrees, pulse may be 112, cough dry at first, afterwards 
copious secretion. 
Physical Diagnosis.-Percussion -Gives resonance of 
health. Auscultation-Respiration pulmonary with sonorous 
and sibilant breathing, sub-crepitant and mucus rales. 
Prognosis.-Favorable when uncomplicated or not following 
septic diseases, except in very young or old. 
Treatment.-Balance circulation with saline cathartics, sweet 
spirits niter and Dover's powders. Give carbonate ammonium 
for cough. In sthenic conditions give one-fifth grain of tartar 
emetic; repeat until depression produced, giving warm drinks. 
Later along may use bitter tonics, iron, arsenic, strychnine, 
hypophosphites, pulmonary gymnastics. 
ACUTE CAPILLARY BRONCHITIS. 
Description -Inflammation of the small bronchial tubes or 
bronchioles, involving the larger tubes only secondarily. 
Etiology.-From extension of acute bronchitis, or secondary 
to Bright's disease, typhoid, typhus fever, etc. 
Clinical History.-Dyspnoea greater than in simple bron- 
chitis, cyanosis, chill, fever 102 to 103 degrees usually, pulse 
120 to 160, respiration 4-0 to 60; cough hacking, painful and 
dry; marked restlessness, expectoration scanty. 
Unfavorable Symptoms.-Respiration growing more shal- 
low, pulse fluttering, cyanosis becoming more marked. POINTS ON PRACTICE. 
13 
Physical Diagnosis.-Percussion-Dullness at base of lungs, 
infra-clavicular resonance increased sometimes. Auscultation 
-But little pulmonary breathing, intense sibilant breathing, 
expiration prolonged, bronchial breathing at times, sub- 
crepitant rales. 
Differential Diagnosis.-Lobar Pneumonia-Crepitant rale, 
rusty sputum, dullness on percussion, cyanosis and dyspnoea 
less marked. Lobular - Pneumonia-Profuse expectoration, 
crepitant rale, dullness in patches or over whole lung, fremitus 
increased, bronchophony. Neurotic Bronchitis-History of 
neurosis; occurs in neurotic adults and in children. (Edema 
Lungs- Signs of oedema, profuse frothy expectoration. 
Treatment.-When sthenic, venesection or antimony tar- 
trate as depressent; for cough, ammonium carbonate, turpen- 
tine stupes on the chest ; for dyspnoea use by inhalation oxygen 
three volumes to nitrous oxide one volume. 
CROUPOUS BRONCHITIS. 
Description.-An inflammation of the bronchial tubes, 
marked by a fibrino-plastic exudate. 
Etiology.-Exposure to damp and cold; secondary to 
phthisis, asthma and emphysema. 
Symptomatology.-Much likesimple acute bronchitis; shreds 
of exudate and casts are coughed up; dullness exists in patches 
in lungs, and breathing is suppressed in parts where bronchi 
are plugged. 
Treatment.-Stimulation, balance circulation; inhalation 
of oxygen and lime vapor. 
CHRONIC BRONCHITIS. 
Description.-Disease of the large, medium and rarely small 
bronchi of both lungs, leading to atrophy, or may have exudate 
and new tissue formation. ' 
Etiology.-Diathesis, climate, occupation; secondary to rheu- 
matism, gout, phthisis, toxaemias, acute bronchitis. 14 
POINTS ON PRACTICE. 
Symptomatology.-Marked symptoms are cough, expectora- 
tion, dyspnoea and emaciation from failure of nutrition. 
Physical Diagnosis.-Inspection-Breathing somewhathur- 
ried. Percussion-Normal resonance. Auscultation-Sibilant 
and sonorous breathing, mucus rales, sometimes gurgling 
rales. 
Treatment.-Treat the cause. For the cough use sprays 
and the balsams; improve nutrition by tonics and alteratives. 
ASTHMA. 
Varieties.-Bronchial, reflex, cardiac, neurotic, renal and 
hay asthma. 
Etiology.-Diathesis, hepatic disorders, exanthemata, cli- 
mate. 
Clinical History.-Patient complains of dryness and tick- 
ling of respiratory tract, is awakened usually about midnight 
with suffocative paroxysm, constriction of the chest and intense 
dyspnoea, inspiration is shorter, expiration prolonged, difficult 
and wheezy. The extremities are cold, the pulse of high tension, 
a distressing cough is a usual concomitant, and expectoration 
often contains asthma crystals, so called. 
Morbid Anatomy.-The mucous membrane of bronchial 
tubes is injected, with spasm of muscular fiber, making inspira- 
tion difficult and expiration more difficult. 
Treatment.-Treat the cause; a change of climate or occu- 
pation often beneficial. During paroxysm a hypodermic of 
morphine or atropine; ipecac in full doses; nitrite amyl by 
inhalation; nitro-glycerine or nitrite sodium; sweet spirits 
niter with syrup poppy; belladonna, stramonium, cannabis 
indica, niter, etc. 
ATELECTASIS. 
Description.-A collapsed condition of the lung, or a por- 
tion of it, sometimes congenital; at times acquired by com- 
plete occlusion of bronchi. It is often found in the insane, who 
are prone to swallow foreign bodies. POINTS ON PRACTICE. 
15 
Symptomatology.-When complete the vesicular murmur is 
absent. If sufficient lung involved will have dullness on percus- 
sion ; may even in some cases get bronchophony. 
BRONCHIECTASIS. 
Description.-A bulging or sacculation of bronchial tubes 
from lack of tonicity; apt to follow atelectasis. 
Symptomatology.-When cavity is empty and sufficiently 
large have amphoric breathing, and amphoric or "cracked 
pot" resonance. When cavity is full or partly full of fluid have 
sounds accompanying those conditions. Cough more or less 
severe, at times profuse, fetid expectoration. 
Differential Diagnosis.-Phthisis-Dullness precedes cavity 
formation; area of dullness around the cavity; hectic fever; 
progressive symptoms; clinical history. Bronchiectasis-Area 
of dullness diminishes or disappears when contents of cavity 
are expectorated. 
Treatment.-For atelectasis use forcible respiration; the 
pneumatic cabinet good. For bronchiectasis improve general 
health, treat the bronchitis, use myrtol for fetid expectoration. 
EMPHYSEMA. 
Description -The term emphysema is used to indicate the 
presence of air in the system where it should not be. There 
are two general varieties, the interlobular, which is the pres- 
ence of air between the lobules of the lungs underneath the pul- 
monary plura, and the vesicular, which is subdivided into true 
and false varieties. 
True Emphysema.-This is where the dilatation of the air 
cells is, permanent, and results from the weakness, stretching or 
giving away of the walls of the air spaces. 
False Emphysema -Is a. temporary distension of the air 
cells, owing usually to loss of function in one lung, and over- 
straining of the other. 
True Vesicular Emphysema.-Is apt to involve both lungs; 
they are distended with residual air, and over-lap each other. 16 
POINTS ON PRACTICE. 
The diaphragm is pressed down, the ribs raised and the spaces 
between them bulge outward. 
Etiology.-Hereditary, straining, laborious occupation, 
chronic bronchitis and asthma. 
Symptomatology -Puffy respiration with slight chest expan- 
sion of one to one and one-half inches; emaciation, cyanosis of 
face and hands,.barrel-shaped chest, dyspnoea. 
Physical Diagnosis.-Percussion note is tympanitic, usually 
high pitched and of great intensity. Auscultation-Inspi- 
ration short and feeble; expiration prolonged and low-pitched; 
sibilant and sonorous breathing at times. Vocal Resonance 
is diminished. Vocal Fremitus is absent. 
Treatment-Preventive, passive exercise, relieve cough, 
check profuse expectoration with a solution of hydrobromate of 
quinine. 
Description.-Three varieties are recognized, viz., active, 
passive and hypostatic congestions. The active results from 
an accelerated circulation, with abnormal fullness of the capil- 
laries of the air cells; the passive is caused by an impeded out- 
flow from the capillaries; hypostatic, from lack of tone of the 
blood vessels, which in their relaxed condition fill with blood. 
It usually follows low fevers or Bright's disease, and is often 
associated with oedema. 
Active Congestion.-Etiology-From hypercardiac action 
vaso-motor paresis; influx of blood to the lungs; irritating 
vapors; exposure to cold, etc. 
Symptomatology.-Hurried respiration, dyspnoea, cough dry 
at first; after a time abundant expectoration of frothy mucus, 
often flecked with blood. 
Physical Diagnosis.-On percussion have relative dullness, 
and auscultation gives lessened pulmonary respiration, coarse 
and sub-crepitant rales. 
Differential Diagnosis.-In oedema have the clinical history, 
and from the beginning profuse expectoration of frothy, watery 
serum. 
CONGESTION OF THE LUNGS. POINTS ON PRACTICE. 
17 
Passive Congestion.-Etiology-Obstruction to venous 
circulation; valvular disease of the heart, dilated heart, 
Bright's disease, etc. 
Symptomatology.-Differs little from the active form, except 
that it develops much more slowly. 
Treatment.-In the active form, venesection, wet cups, 
aconite, veratrum; in the passive, caffeine, digitalis, alcohol, 
strychnine, hydrobromate quinine; balance circulation. 
PULMONARY CEDEMA. 
Etiology.-Always secondary from passive congestions, 
phthisis, pneumonia, general anasarca, etc. 
Symptomatology.-Much like symptoms of congestion with 
addition of profuse expectoration, and coarse, gurgling rales. 
Treatment.-Symptomatic, treat primary disease, carbon- 
ate ammonium, heat, stychnine, alcohol. 
BROWN INDURATION OF LUNGS 
Description.-Alsd termed splanification of lungs. The 
lungs undergo low type of inflammation, with cell proliferation : 
they become dark colored and specked and do not collapse on 
exposure to air. 
Etiology.-Obstruction of pulmonary circulation, atelectasis, 
essential fevers. 
Treatment.-Same as in passive congestion. 
PULMONARY APOPLEXY. 
Description.-Escape of blood into parenchyma of lungs, 
resulting usually from disease of the walls of the arteries. 
Etiology.-Arterial degeneration, Bright's disease, etc. 
Symptomatology.-Pain over region of ruptured vessel, 
dyspnoea, expectoration of blood. 
Physical Diagnosis.-Percussion. Dullness more or less 
limited. Auscultation-Cessation of respiratory murmur in the 
part; gurgling rales often present. 18 
POINTS ON PRACTICE. 
Treatment.-Symptomatic, rest, anodynes at the time, 
later pulmonary gymnastics. 
PULMONARY INFARCTION. 
Description.-Results from an embolus from the right side 
of the heart entering the lung and plugging part or a whole of 
a lobe. 
Symptomatology -Sudden pain, usually less severe than in 
apoplexy; cyanosis and dyspnoea if much lung involved. 
Physical Diagnosis. - Percussion - Localized dullness. 
Auscultation-Absence of respiratory sounds in the part. 
Vocal resonance increased. Vocal fremitus increased. 
Treatment.-Symptomatic, inhalation of oxygen. 
ABSCESS OF THE LUNGS. 
Etiology.-From traumatism, septic emboli, tuberculosis. 
Symptomatology.-Onset sudden, usually signs of septi- 
caemia, absence pulmonary sounds in the part, dullness or 
flatness on percussion. 
Treatment.-Remove cause, symptomatic. 
GANGRENE OF THE LUNGS. 
■Etiology.-Putrid bronchitis, pneumonia, foreign bodies, 
acute and chronic diseases. 
Symptomatology.-Foecal odor to the breath, fever, putrid 
expectoration, great in amount, with shreds of lung tissue. 
Physical signs are those of abscess. 
Treatment.-Antiseptic sprays, tonics, surgical operation 
perhaps. 
Description.-Also called frank pneumonia, croupous pneu- 
monia, lung fever, pleuro-pneumonia, is an acute, general, 
specific disease with local manifestations in the lungs. It is 
LOBAR PNEUMONIA. POINTS ON PRACTICE. 
19 
really an essential fever with lung complications. It is a 
disease of adult life, males being more liable, and prevails in 
warip rather than cold climates. 
Etiology-Specific microorganism; probably the pneumo- 
coccus of Friedlander. 
Pathology.-The morbid anatomy may be considered in 
three stages: that of congestion, red and gray hepatization, 
and that of resolution, or, in some cases, purulent infiltration. 
Stage of Congestion-Lasts from twelve to forty-eight hours; 
hyperamiia of vessels of alveoli,lung reddish brown, exudation 
of serum, epithelium and leucocytes into the air spaces; 
bronchioles engorged. Stage of Hepatization - Lung red 
colored and like liver, the affected part being solid, has a dry 
granular appearance, more engorged than in first stage, does 
not crepitate to the touch, fibrin in the air vesicles, exudate 
invades connective tissue, pleuritis frequently present. As the 
red hepatization passes into the gray, the lung becomes mot- 
tled and then gray, owing to existing anaemia, discoloration 
of corpuscles and the presence of pus and fibrin. Stage of 
Resolution-Lung begins to clear up, exudate liquified and is 
absorbed, cellular portion undergoes fatty degeneration and is 
absorbed or expectorated. If lung undergoes purulent infiltra- 
tion, it changes from gray to yellow, softens and breaks down 
and abscesses form. 
Symptomatology.-Prolonged malaise, or may have abrupt 
onset; severe chill; fever is high early, 104 degrees or 105 de- 
grees (in third stage, temperature may be sub-normal), cough 
shrill and suppressed; dyspnoea, shallow respiration, 50 to the 
minute sometimes; pulse rapid but not in proportion to the 
fever, pain in the affected region, characteristic sputum, small 
in amount, very sticky and tenacious and rusty colored; 
tongue dry and coated, urine high colored, contains uric acid, 
and with chlorides diminished or absent; face cyanosed and 
mahogany spot on the cheek. 
Variations.-May pass into typhoid state, or may simulate 
malaria; delirium may be present or lung symptoms absent. 20 
POINTS ON PRACTICE. 
Physical Diagnosis -First stage-On inspection, movement 
of affected side restricted; on palpation vocal fremitus in- 
creased; on percussion, slight dullness; on auscultation, 
marked diminution of respiratory murmur, and at latter part 
of the stage have the crepitant rale. Second stage-On inspec- 
tion, movement more restricted; on palpation, vocal fremitus 
increased; on percussion, dullness or flatness; on auscultation, 
bronchial breathing, first in expiration then also in inspiration; 
bronchophony and sometimes pectoriloquy. Third stage-Re- 
stricted movement of chest less, crepitant rale redux associated 
with bronchial breathing, then broncho-vesicular breathing, 
dullness disappearing in patches, sub-crepitant rale. In case 
of purulent infiltration, dullness is long continued, and if a 
cavity is formed there is amphoric breathing and other signs 
of a cavity. 
Prognosis.-Double pneumonia and pneumonia of drunk- 
ards are very serious. Unfavorable symptoms in general are a 
frequent feeble pulse, great dyspnoea, marked cyanosis, much 
delirium, expectoration of "bilious" or "prune juice" sputum 
and typhoid complications. 
Treatment.-Hypernutrition early, pure air, rest, balance 
circulation, saline purgatives, turpentine stupes, hot foot- 
baths. In sthenic cases venesection, wet cups, arterial seda- 
tives and the cold pack. In asthenic patients, stimulants, 
alcohol and heart tonics when indicated. 
LOBULAR PNEUMONIA. 
Description.-Also called catarrhal or broncho-pneumonia, 
affects the lobules of the lungs, or may be confined to one 
lobule. It is apt, however, to affect both lungs and be more 
disseminated than lobar pneumonia. 
Etiology.-It is always secondary to other diseases, as 
Bright's, diabetes, essential fevers, bronchitis, measles, or may 
result from traumatism. 
Morbid Anatomy.-The small, medium and large bronchial 
tubes are congested and become covered with a viscid secretion, POINTS ON PRACTICE. 
21 
the air sacs are inflamed; an exudate is poured out, filling the 
airspaces and plugging the bronchi; bronchiectasis and atelec- 
tasis often result. 
Symptomatology.-Comes on gradually. Sense of chilliness, 
irregular fever, hurried respiration, painful cough, expectora- 
tion soon becomes profuse, pulse rapid, symptoms of primary 
disease. Gastro-enteritis a frequent accompanimentin children. 
Physical Diagnosis.-Percussion gives dullness in spots. 
Auscultation-Absence of breathing in spots, in others bron- 
chial breathing, and in other spots vesicular breathing; bron- 
chophony present. Palpitation-Fremitus increased. 
Differential Diagnosis.-Distinguished from lobar pneu- 
monia by its secondary character, the absence of the pneumo- 
cocci, the presence of chlorides in normal quantity in the urine, 
its gradual onset, the irregular fever, the profuse expectoration, 
absence of the crepitant rale and presence of the sub-crepitant 
rale, the respiratory sounds disseminated in both lungs in 
patches, dullness in patches, its indefinite course as an inflam- 
matory fever in contrast with the essential fever character of 
lobar pneumonia. 
Treatment.-Treat the cause. Balance circulation, treat 
like lobar pneumonia, making allowance for its more chronic 
course. As expectorants may use apomorphine, ammonium 
salts or senega. 
PNEUMO-NO-CHONI ASIS. 
Description.-A condition of the lung resulting from habit- 
ually inhaling dust and foreign substances. Coal-heavers, 
grain-shovelers and axe-grinders are subject to this affection. 
Chronic irritation is caused by the dust inhaled, with resulting- 
growth of connective tissue. Pigmentation of the lung results 
from the coloring matter of the dust becoming imprisoned in 
the epithelium, or passing into the lymphatics and being- 
deposited. The lung becomes firmer in texture, and fibroid 
pneumonia is the result. 22 
POINTS ON PRACTICE. 
FIBROID PNEUMONIA. 
Description.- Also called interstitial pneumonia, results 
from pneumo-no-choniasis, or may follow any form of slow irri- 
tation in the lungs. 
Pathology.-There is an increased growth of stroma, the 
lu ng hardens and contracts, encroaching on air spaces, catarrhal 
inflammation is set up, the chest becomes retracted. Fibroid 
pneumonia is converted into fibroid phthisis by the presence 
of the bacillus tuberculosis. 
Treatment.-Change of occupation and climate, remove 
cause, treat symptoms as they arise. 
PLEURISY. 
Description.-A fibrinous inflammation of the pleura, either 
acute, sub-acute or chronic. 
Etiology -Secondary to acute and chronic lung diseases, 
Bright's disease, rheumatism, taxmmias; from traumatism 
sometimes. 
Morbid Anatomy-Hypereemia of pleural surfaces, exudate 
of fibrin and serum, infiltration of connective tissue, granula- 
tion tissue growth, pleura agglutinated usually, adhesive bonds 
of fibrin, sometimes of granulation tissue. 
Symptomatology.-Severe pain, increased on motion and 
respiration; fixed position; cough suppressed; painful and dry 
at first; fever 101 to 102 degrees usually; chill slight or ab- 
sent; onset slow, anorexia and constipation; tongue with 
white, frosty coating. 
Physical Diagnosis.-Inspection-Motion on affected side 
constricted; before effusion chest retracted; after effusion side 
distended; cardiac impulse displaced. Percussion-Lessened 
resonance at first, then dullness or flatness over site of effusion ; 
tympanitic note above thefluid. Auscultation-Friction sound 
on inspiration during stage of congestion; breathing vesicu- 
lar, but feeble and jerky; during stage of effusion vesicular 
murmur is feeble or absent, and above the fluid the breathing 
is puerile. Vocal resonance is diminished or absent over site of POINTS ON PRACTICE. 
23 
the fluid, with aegophony at the upper margin. During stage 
of absorption vesicular murmur returns, associated with a 
moist friction sound. 
Sub-acute Pleurisy.-The pain is less or may be absent, 
malaise, evening fever, short, harassing cough, night sweats, 
pulse small and frequent. 
Chronic Pleprisy.-Irregular chills, fever, night sweats, dysp- 
mea, embarrassed circulation. 
Treatment.-Balance circulation; purgative of calomel, fol- 
lowed with saline cathartic; rest; opiates for pain; venesection 
sometimes; aspiration when indicated; Martin's rubber band- 
age to secure rest of the part. 
PNEUMONIA. 
DIFFERENTIAL DIAGNOSIS. 
PLEURISY. 
Chill severe. 
Fever marked. 
Cough with rusty sputum. 
Heart impulse normal condition. 
Friction fremitus absent. 
Vocal fremitus increased. 
Crepitant rale. 
Bronchial breathing. 
Chill slight or absent. 
Fever low or absent. 
Cough dry or frothy sputum. 
Heart impulse displaced. 
Friction fremitus present. 
Vocal fremitus absent or slight. 
Friction sound. 
Vesicular breathing feeble or absent. 
PYOTHORAX 
Description.-Also called emphyema and purulent pleurisy, 
is where the effusion of pleurisy contains or is made up of pus. 
It may result from tubercular trouble or develop from acute, 
sub-acute or chronic pleurisy. 
Symptomatology -Irregular chills, hectic fever, emaciation, 
waxy look, septic symptoms, Physical examination gives the 
signs of effusion, and aspiration leads to the discharge of 
deeply stained matter, containing pus and microorganisms. 
Treatment-Free incision in chest, evacuate fluid; symp- 
tomatic. 
PNEUMOTHORAX. 
Description.-An accumulation of air in the pleural cavity, 
resulting from perforation of the pleura from the lungs or from 
chest wall, due to traumatism and tuberculosis, lung abscess, 
etc. 24 
POINTS ON PRACTICE. 
Symptomatology.-Intense dyspnoea, coming on suddenly; 
sudden pain; cyanosis; a feeling of distention; state of col- 
lapse sometimes. 
Physical Diagnosis.-Inspection - Chest on affected side 
distended, intercostal spaces bulging outward. Palpation.- 
Air cushion feel. Percussion-Tympanitic or amphoric reson- 
ance; if effusion of blood occurs, dullness over lower chest 
region. Auscultation-Obscure respiratory sounds or vesicu- 
lar murmur may be absent; amphoric breathing when the 
fistula is open; metallic tinkling is often present; when air 
and fluid both present in pleura cavity may get succussion 
sound. 
Differential Diagnosis.-Emphysema affects both sides and 
tumor does not change its place with change of position of the 
patient. 
Treatment.-Symptomatic, let case alone and watch: aspi- 
rate if necessary. 
HYDROTHORAX. 
Description.-Dropsy of the pleura, the result of general 
anasarca from renal, cardiac or liver disease. 
Symptomatology.-Symptoms of primary disease; following- 
ascites, a marked dyspnoea, with signs of deficient aeration of 
blood, 
Treatment.-Treat cause; aspirate when necessary. 
PHTHISIS PULMONALIS. 
Description.-Also called pulmonary tuberculosis, is a 
disease marked by mal-nu trition, fever, great tissue waste, 
emaciation and tendency toward death. It is acute, sub-acute 
or chronic. 
Etiology.-Predisposing cause, diathesis and debility; 
exciting cause, bacillus tuberculosis. 
Tubercular Process.-The bacillus finds a suitable nidus in 
the lungs, and grows and multiplies; a low form of inflamma- 
tion results from the irritation set up by the presence of the 
bacillus and the growth of tubercular tissue takes place. This POINTS ON PRACTICE. 
25 
is composed of a network or stroma, made up of a reticulated 
mass, delicate, fine and transparent at first, but afterwards 
becoming thick and opaque. The stroma is filled in with lym- 
phoid, epitheliod and giant cells,- the latter being peculiar to 
the tubercular process. The bacilli are disseminated through 
this tissue. Tubercular granules may exist separately or 
adhere and form large masses. Endarteritis results from irri- 
tation, the blood supply is cut off and the part becomes infil- 
trated with epitheliod cells and a pale, colored infarct results. 
This in time undergoes caseous degeneration, and may soften 
and break down with formation of a cavity, or undergo calcifi- 
cation and harden. 
Acute Phthisis.-Marked by more or less rapid emaciation, 
hacking cough, suppression of menses in females, chills, fever, 
profuse sweats. After a time anaemia becomes marked, cough 
with expectoration of muco-purulent matter, containing bac- 
illi of tuberculosis, night sweats, haemoptysis, hectic flush, hur- 
ried respiration. 
Physical Diagnosis.-Inspection - Breathing is hurried. 
Palpation - Vocal fremitus is increased. Percussion. Dull- 
ness, high pitched. Auscultation-Bronchial breathing, sibil- 
ant and sonorous breathing, bronchial rales, respiration high- 
pitched, expiration prolonged. Vocal resonance is increased, 
bronchophony and pectoriloquy sometimes. After cavity 
formation, percussion gives a tympanitic low note; auscul- 
tation gives cavernous breathing, if cavity is small; amphoric 
breathing if it is-large; moist gurgling rales; cracked pot 
sound is frequently obtained. 
Chronic Phthisis.-It is called chronic when it exists 
over six months. It is commonly divided into two stages: the 
first to the formation of a cavity, the second to the end of the 
disease. 
Symptomatology.-Headache, hacking cough, temperature 
rise at night, malaise with dry, scarfy skin, bright eyes with 
pearly conjunctiva, expectoration of frothy mucus, pulse accel- 
erated, emaciation, haemorrhages early, respiration more rapid 
at night, digestion bad, nervous disturbances; later on night 26 
POINTS ON PRACTICE. 
sweats, hoarseness, diarrhoea, oedema of the extremities. The 
physical signs«are similar to those of acute phthisis. 
Treatment. Begin early, change of climate or occupation, 
keep up nutrition, treat symptoms as they arise, cod liver oil, 
hypophosphites. 
PERICARDITIS. 
Description.-A fibrinous imflammation of the pericardium, 
acute, sub-acute or chronic. 
Etiology.-Usually secondary to rheumatism, Bright's dis- 
ease, scarlet fever, lobar pneumonia, pleurisy and toxaemias. 
Pathology.-Hyperaemia of the pericardium, rough and 
opaque surface; exudate of fibrin, then serum, or exudate 
may be purulent or haemorrhagic; adhesions are often present, 
which in separating leave strings of fibrin, which give an 
appearance which led to the designation of "hairy heart." 
Symptomatology.-Pain localized; dyspnoea; pulse rapid, 
irregular and intermittent; low fever, 101 degrees to 102 
degrees; cyanosis; cough, anorexia, constipation, taciturnity 
oftentimes; occasionally mania. 
Physical Diagnosis.-Inspection-Find the heart appar- 
ently enlarging daily; chest bulging. Percussion-Area of 
cardiac dullness increased. Auscultation-Fine friction sound, 
distinguished from that of pleurisy by not being affected by the 
respiration. 
Treatment.-Rest, low diet, heart sedatives, opium for 
pain, heart tonics; aspirate if necessary. 
ENDOCARDITIS. 
Description. - An inflammation of the endocardium of 
the heart, acute, chronic or ulcerative in character. 
Etiology.-Rheumatism, Bright's disease and toxaemias in 
general. 
Morbid Anatomy.-Hyperaemia of endocardium, exudate 
poured out, proliferation of endothelium, valves infiltrated, 
granulation tissue formed and so-called vegetations which 
may break loose, causing embolism. POINTS ON PRACTICE. 
27 
Symptomatology.-Symptoms of disease, pain in the heart, 
temperature rise, short cough, dyspnoea, cardiac action rapid 
and tumultuous, congestion of the lungs often present. 
Physical Diagnosis.-First or second sound of heart 
absent, heart sounds masked or cloaked sometimes; when first 
sound gone, pulse is soft and compressible, endocardial mur- 
murs, soft and cooing in character, slight thrill sometimes. 
Treatment.-Treat primary disease, rest, alkalies, opium 
for pain. 
Ulcerative Endocarditis.-Simple endocarditis may be 
converted into the malignant form by the presence of certain 
microorganisms. Symptomatology is somewhat obscure, but 
usually have tumultuous heart action, paralysis, albuminuria, 
intermittent fever, symptoms of septicaemia and embolism. 
MYOCARDITIS. 
Description.-An inflammation of the muscular tissue of the 
heart, acute or chronic in character, with sub-divisions of 
parenchymatous or interstitial myocarditis. 
Etiology.-Pericarditis, endocarditis, toxaemias. 
Morbid Anatomy-Small abscesses in the heart muscle, 
softening of cardiac substance, exudate of fibrin and serum. 
Symptomatology.-Pain, irregular and feeble cardiac action, 
pyrexia of a low type, typhoid condition sometimes. 
T reatment-Symptomatic. 
MITRAL STENOSIS. 
Diagnosis.-Pre-systolic murmur, heard best at apex; marked 
thrill an inch above apex, pulse feeble, left auricle dilated, with 
tricuspid insufficiency sometimes. 
MITRAL REGURGITATION. 
Diagnosis.-Thrill is not marked, systolic murmur, pulse 
with deep, dicrotic notch, murmur heard with greatest inten- 
sity at apex, and carried upward into the axilla and onward to 28 
POINTS ON PRACTICE. 
the inferior angle of scapula; hypertrophy of the left heart, 
dilation of the left ventricle, usually with frequent pulmonary 
complications. 
AORTIC OBSTRUCTION. 
Diagnosis.-Marked thrill near base of the heart; harsh, 
rasping systolic murmur heard with great intensity at the 
base of the heart and carried upward into the carotids; pulse 
small, cerebral anaemia, palor and giddiness. 
AORTIC REGURGITATION. 
Diagnosis.-Thrill not marked; a churning and blowing 
diastolic murmur heard best at the second right costal cartilage 
and down the sternum toward the apex; hypertrophy of left 
ventricle; pulsating vessels, Corrigan or "water-hammer" 
pulse. 
PULMONIC OBSTRUCTION. 
Diagnosis.-Thrill marked at the second left interspace; 
systolic murmur heard with greatest intensity close to the 
sternum, at the junction of the third left costal cartilage to the 
sternum; dyspnoea, cyanosis and palpitation. 
PULMONIC REGURGITATION. 
Diagnosis.-Diastolic murmur, heard with greatest inten- 
sity in the second left interspace, superficial in character, with 
no thrill; dyspnoea, cyanosis and palpitation. 
TRICUSPID OBSTRUCTION. 
Diagnosis.-Soft, presystolic murmur, superficial in char- 
acter, and heard best over ensiform cartilage. POINTS ON PRACTICE. 
29 
TRICUSPID REGURGITATION. 
Diagnosis.-Systolic murmur, soft and superficial, with 
greatest intensity over the ensiform cartilage and slightly to 
the left; pulsation of the jugular veins, vertigo, cerebral 
symptoms. 
CARDIAC HYPERTROPHY. 
Hypertrophy of the heart is an increase in its size and 
weight. Two varieties are commonly recognized, viz: simple 
and excen trie. Simple hypertrophy is a simple increase in heart 
substance without dilatation or valvular change. Excentric 
hypertrophy is an enlargement of the heart, with thickening of 
the walls and dilatation of the cavities. 
CARDIAC DILATATION. 
Description.-An increase in size of the chambers of the 
heart without a corresponding increase in muscular substance. 
The varieties are simple and hypertrophic. 
Symptomatology.-Weak heart, poor circulation, heart im- 
pulse diffused, dullness increased, heart sounds changed, weak, 
wavy, with distance between heats; cyanosis, sleep poorly, 
dyspnoea. 
ANGINA PECTORIS. 
Description.-Paroxysms in which sharp cardiac pains are 
felt, extending into the left shoulder and down the left arm, 
with constriction of the chest and fear of impending death. It 
may be functional or structural. 
Etiology.-Ischaemia from atheromatous changes, or vaso- 
motor spasm. 
Symptomatology-Sudden seizure, fixed position, expiration 
prolonged, pulse slow, feeble and high tension, fear of impend- 
ing death, vomiting,extremities cold, face pinched, pain extend- 
ing from heart to shoulder, arm and fingers; dyspnoea. 30 
POINTS ON PRACTICE. 
FALSE ANGINA. 
Description.-Also called neuralgia of the heart. The at- 
tacks are irregular in course and duration with no evidence of 
implication of heart and vessels. 
Etiology.-Anaemia, hysteria, neuresthenia, debility; usually 
early in life. 
Symptomatology.-Begins with some cardiac pain; dyspnoea 
not marked, cold extremities, accentuation of heart sounds; 
no atheroma. 
Treatment.-In either true or false angina, nitrite of amyl, 
nitrite of sodium, nitro-glycerine, Hoffman's anodyne, brandy, 
ammonia or morphine are indicated during paroxysm. Treat 
cause; keep up nutrition. 
PALPITATION OF THE HEART. 
Description.-A functional disturbance of heart with in- 
crease of its movements and rhythm more or less irregular. 
Etiology.-Over-exertion, dyspepsia, excess of all kinds, 
neuresthenia, grief, etc. 
Symptomatology.-Pain or oppression in the region of the 
heart; rapid, tumultuous beating, dyspnoea, choking, or full- 
ness in throat, fear of impending death. 
Treatment.-Heart stimulants, bromides and chloral, 
valerian, camphor. 
ENDARTERITIS. 
Etiology.-Syphilis, tuberculosis, alcoholism, toxaemias. 
Morbid Anatomy.-Tendency to new tissue growth; inflam- 
mation of inner coat of the artery extending to other coats, 
formation of "vegetations" in the vessel, thrombosis; soften- 
ing, afterwards calcification of the arterial coats; accompanied 
sometimes by obliteration of artery, softening of the brain, 
cirrhotic kidney, embolism. 
Treatment.-Treat the cause. POINTS ON PRACTICE. 
31 
ANEURISM. 
Description.-A tumor containing circulating blood. They 
are distinguished as external or internal, spontaneous or 
traumatic, true or false. The true are known as fusiform; the 
false are diffuse, sessoid or dissecting. 
Symptomatology.-Symptoms depend somewhat on loca tion 
of the tumor. When of the ascendiug aorta there is pain late 
or constant, and intense; increased on exertion; changes in 
circulation; sometimes aphonia, difficult deglutition, dilated 
pupil, apnoea. If of the descending aorta, there may be found 
a tumor in the back, with loss of respiratory murmur and gen- 
eral cyanosis. 
Physical Diagnosis.-When near the surface a systolic 
bruit; dullness on percussion, marked thrill, expansile feel. 
Aneurism Abdominal Aorta.-Pain boring and intense, 
tumor usually left of the median line, systolic pulsation, dias- 
tolic bruit, pulse of the femoral artery delayed and feeble. 
PAROTITIS. 
Etiology.-Infectious, contagious disease, caused probably 
by a microorganism. 
Symptomatology.-Malaise, a chill, fever usually not above 
102 degrees, vomiting; urine high color and specific gravity, 
peculiar stiff feeling at angle of the jaw, tongue with a silvery 
coat, enlargement of parotid gland. 
Treatment.-Purgative, hot fomentations for swelling, 
aconite or antipyrine for fever, chloral for headache. 
ACUTE GASTRITIS. 
Etiology.-Irritant and corrosive poisons usually. 
Symptomatology.-Localized pain, burning and thirst; vom- 
iting blood; fever, pulse rapid, skin covered with cold sweat; 
anxiety and depression. 
Treatment.-Symptomatic. 32 
POINTS ON PRACTICE. 
SUB-ACUTE GASTRITIS 
Description -Two varieties are recognized, the catarrhal, 
which is a comparatively mild inflammation of the mucosa of 
the stomach, frequently excited by partaking of strong alco- 
holic liquids undiluted; and the erythematous variety, which 
occurs usually in children in connection with acute central ner- 
vous disturbances. 
Symptomatology.-Malaise, anorexia, sense of weight in 
stomach, tenderness on pressure, dyspepsia, easily set up; in 
erythematous form apt to have duodenitis, vomiting, diarrhoea 
or constipation sometimes. 
Treatment-Calomel in srfaall doses; give stomach rest, 
emolient applications externally; leech applied over the 
stomach; keep bowels open. 
Etiology.-Chronic congestion from disturbed circulation 
from venous stasis; secondary to phthisis, asthma, malaria, 
gout; excesses in eating and drinking. 
Morbid Anatomy. -Chronic irritation producing slow inflam- 
mation, formation of connective tissue, gastric tubules 
encroached upon by tissue, over-secretion of mucus, stomach 
muscle weakened, pyloric obstruction and dilatation. 
Symptomatology.-Indigestion, vomiting in the morning of 
mucus, anorexia, coated tongue, sleep badly, peculiar taste in 
the mouth. 
Treatment.-Remove the cause, early supper at 4 p. m., 
wash out stomach about 8 p. m., breakfast at 10 a. m. 
Hydrastis, glycerine and bismuth at times useful. 
CHRONIC GASTRITIS 
SIMPLE GASTRIC ULCER. 
Description.-Also called perforating ulcer, most commonly 
found along posterior wall of stomach near the lesser curva- 
ture. Has apunched-out look, usually has no area of inflam- 
mation around it. POINTS ON PRACTICE. 
33 
Etiology.-Usually occurs early in life, as result of gastric 
catarrh, syphilis, etc. 
Symptomatology.-Pain after eating, abnormal quantity of 
hydrochloric acid present; vomiting of a partly digested acid 
mass; pain localized, hsematemesis. 
Treatment.-Rest in bed, rectal feeding, alkalies, antisep- 
tics. For haematemesis, ice bag to epigastrium, ergot, rest. 
GASTRIC CANCER. 
Description.-Occurs usually after middle life; apt to be 
located at the pylorus. May be felt ofttimes at the right of 
median line as a hard tumor. 
Symptomatology.-History of indigestion, pain if present of 
continuous character, not specially affected by eating; vomit- 
ing of tarry appearing material formed of changed blood; 
hydrochloric acid greatly decreased or absent; diminution of 
urea, cancer cachexia. 
Treatment.-Symptomatic, nourish with starchy foods, 
oysters peptonized, eggs, milk, etc. 
DIFFERENTIAL DIAGNOSIS. 
Neurotic young women most often 
subject. 
Pain intense, paroxysmal, worse af- 
ter eating. 
Pain Localized. 
Partial recoveries and then relapse. 
Hydrochloric acid in excessive quan- 
tities. 
Vomited blood, bright and comes 
in gushes. 
Tumor not present. 
GASTRIC ULCER. 
Either sex in middle life or old age. 
Pain may be absent; if present, con- 
tinuous ; not made worse by eat- 
ing. . 
Pain less localized. 
Disease progressive. 
Hydrochloric acid not present. 
Blood changed, tarry and steadily 
oozing. 
Tumor present. 
GASTRIC CANCER. 
GASTRIC DILATATION. 
Etiology.-From obstruction, atony of stomach muscle, 
excessive over-eating and drinking, adhesion to other organs. 
Symptomatology -History of indigestion, sense of weight, 
foul breath, vomiting food eaten a day or so before, diarrhoea 
occasionally. 34 
POINTS ON PRACTICE. 
Differential Diagnosis.-From spasm of pylorus by inflat- 
ing with air or water and percussing and auscultating. 
Treatment.-Lavage, nutritious diet, tonics, the Faradic 
current. 
ENTERITIS. 
Description.-Intestinal catarrh affects the mucosa and 
sub-mucosa, often resulting in ulceration. If long continued, 
it may result in hypertrophy from growth of cicatricial tissue, 
with destructive changes in the glands of the part. It is acute, 
sub-acute or chronic. 
Etiology.-Improper food, impure air, excessive heat. 
Symptomatology.-Loss of appetite, nausea and vomiting, 
borbyrygmus, diarrhoea sometimes. 
Ileo-Colitis.-When'the inflammation is in the ileum there is 
distension in the right iliac region and the stools are fluid, dark 
green or variegated in color. 
Colitis.-Pain in the left side, low down; frequent movement 
of the bowels; scanty evacuations of mucus streaked with 
blood; burning at the anus; micturition may be frequent, or 
there may be retention of urine; fever with great thirst 
sometimes. 
Treatment-Castor oil, or calomel followed by saline of 
soda salts; morphine with bismuth or codeine or old opium 
pills; turpentine stupes and poultices. Restricted diet, ice with 
little gruel at first, raw eggs in water, scraped beef, etc. 
CHOLERA MORBUS. 
Etiology.-Apt to occur during hot days and cold nights. 
A microorganism is the probable cause. 
Symptomatology.-Violent vomiting and purging, marked 
depression, cramps in the abdomen, then in the limbs, cold 
extremities, pulse feeble of high tension, head hot, temperature 
elevated, stools with green colored serum changing to "rice 
water" character. POINTS ON PRACTICE. 
35 
Treatment.-Morphine hypodermically, wrap patient in 
blanket wrung out of very hot water and cover with a dry one. 
After acute symptoms, rest, nux, quinine and claret are 
indicated. 
DYSENTERY. 
Etiology.-An acute, specific, infectious disease. 
Morbid Anatomy.-Great hypersemia of the part, infiltra- 
tion into the colon, circulation in the part sometimes cut off 
with formation of sloughs, or septic emboli may be sent to the 
liver. 
Symptomatology.-Malaise with coated tongue and loss of 
appetite, biliousness, constipation at first, followed by diar- 
rhoea, pain in left iliac region, stools large at first; stools con- 
tain mucus, blood, shreds of tissue and bile sometimes; 
tympanites. 
Treatment.-Purge with castor oil or calomel, use copious 
enema with antiseptics, opium or morphine injection, poul- 
tices, rest, mercury bichloride of a grain every hour, or 
ipecac 30 grains, preceded half an hour by 30 drops of lauda- 
num. Care in diet. 
ULCER OF DUODENUM 
Etiology.-Probably from same causes as gastric ulcer. 
Symptomatology.-Pain not made worse immediately by eat- 
ing but an hour or two after meals, pain severe in right side as in 
hepatic colic; seldom have direct hemorrhage, blood changed 
before evacuated and causes tarry stools. 
Treatment.-Rest, lavage at night, using an alkaline solu- 
tion, change of climate. 
TYPHLITIS. 
Etiology.-From accumulation of hardened faecal matter, 
inflammation, etc. 
Symptomatology.-H ard,sausage-shaped tumor in right iliac 
region, pain and soreness on pressure, fever, signs of obstruc- 
tion of bowels, as vomiting, accumulation of gas, etc. 36 
POINTS ON PRACTICE. 
PERITYPHLITIS. 
Etiology.-Often secondary to typhlitis and appendicitis. 
Symptomatology.-Fever, chill, marked pain, tenderness on 
pressure, septic symptoms. 
APPENDICITIS. 
Symptomatology.-Constipation, some fever, tenderness on 
pressure; sudden, intense pain with symptoms of shock follow 
perforation of the bowel. 
OBSTRUCTION OF INTESTINES. 
From Accumulation of Faeces.-History of chronic consti- 
pation, bowel with hard mass on palpation; symptoms of 
toxaemia, anorexia, coated tongue, headache, mental apathy; 
vomiting of mucus and bile and stercoraceous matter after a 
time; great prostration. 
From Stricture.-Symptoms intensified. 
From Volvulus.-Sudden onset, pain intense and localized; 
accumulation of gas; tenderness on pressure; local peritonitis 
with fever; symptoms of obstruction. 
From Strangulation.-Sudden attack; localized pain and 
tenderness, rapid distension of bowel, stercoraceous vomiting, 
symptoms of obstruction, fever. 
From Intussusception.-Usually in childhood, sudden onset, 
intense pain, symptoms of obstruction. Tenesmus-Stools 
contain blood and mucus; invagination sometimes found in 
rectum. 
Treatment of Obstruction -Injections of water; calomel or 
salines, opium for pain, laparotomy. 
PERITONITIS. 
Etiology.-Exposure to intensecold, traumatism, ulceration 
of liver, etc., pleurisy, rheumatism, Bright's disease, pyaemia. 
Description -Two varieties are recognized, the so-called 
idiopathic from toxaemia, and the traumatic form from sepsis. POINTS ON PRACTICE. 
37 
Symptomatology.-Sudden onset, intense pain, chill, fever 
103 to 104 degrees, patient lies on the back with legs flexed and 
motionless; abdomen tympanitic and hypersensitive, paresis 
of the intestines; green colored vomit; characteristic expres- 
sion of the face, pale and pinched, mouth drawn, alae of nose 
contracted, eyes sunken; pulse rapid, small and wiry; respira- 
tion shallow; constipation; abdomen evenly distended and 
very tender. 
Treatment.-In the general or idiopathic form, give opium 
enough to relieve pain, beginning with 4 grains of opium, or % 
to 1 grain of morphine. In the septic form, if lesion can be 
located, laparotomy. 
FEVERS. 
Description.-A simple or ephemeral fever is marked by 
chilliness, temperature rise, malaise and anorexia. Periodical 
fevers are simple and pernicious, and are further divided into 
intermittent and remittent fevers. The morbid anatomy of 
periodical fevers includes anaemia; pigmentation (the bronze 
liver), enlarged spleen (ague cake), and oftentimes acute jaun- 
dice and gastro-intestinal catarrh. 
Etiology.-A microorganism of the spirillium order, the 
plasmodium malariae. 
Intermittent Fever.-May be of the quotidian, tertian, 
quartan or mixed type. The course of the fever is marked by 
three stages: the algid, febrile and defervescence. 
Symptomatology.-Malaise with aching and yawning, rigor, 
patient with lips blue, hands and feet cold; fever, profuse per- 
spiration; pulse during the chill small and rapid, during the 
fever, large, rapid and bounding, and during defervescence slow, 
dragging and compressible; the tongue is broad, indented by 
teeth, and with a thin white coating. 
Pernicious Form.-The pernicious type of intermittent fever 
is marked by a terrific rigor, high temperature; profuse sweat, 
patient livid and pulseless, with delirium or coma and great 
depression. 38 
POINTS ON PRACTICE. 
Treatment.-For simple intermittent, 5 grains of quinine in 
acid solution, repeated in two hours, and again in two hours. 
The same treatment the next day; then 5 grains every morning 
until the seventh day, when 15 grains in divided doses are 
given. When quinine is abandoned, use arsenic, iron and 
simple bitters. In more serious forms of the disease give 
quinine hypodermically in large doses. Use calomel to keep 
bowels open. 
REMITTENT FEVER. 
Description.-The same etiology and pathology as inter- 
mittent fever, but differs from the latter in the fact that there 
is a periodical remission in the fever, but no intermission. 
Symptomatology.-Chill, fever with steady rise, and then a 
remission, no marked second chill, headache and backache, 
nausea and vomiting, at times jaundice and constipation. 
Treatment.-Warburg's tincture, quinine, calomel, careful 
diet; after convalescence sets in, arsenic, phosphorus and iron. 
RELAPSING FEVER. 
Description.-Also called famine fever. Spirilli are found 
in the blood during the paroxysm, the nervous system is dis- 
turbed, the spleen enlarged and softened and the liver enlarged. 
Symptomatology.-Abrupt onset, chill sometimes, fever with 
a progressive rise, 102 to 108 degrees in from 5 to 7 days and 
then drops suddenly to sub-normal; a week of health ensues, 
followed by another attack. It is also marked by a weak 
pulse, agonizing headache, pain in the limbs, and nausea and 
vomiting. 
Treatment.-Meet indications, opium for pain, antipy- 
retics, etc. 
TYPHOID FEVER. 
Description.-A specific, infectious disease whose efficient 
cause is a microorganism. POINTS ON PRACTICE. 
39 
Morbid Anatomy.-Peyer's glands the first week undergo 
catarrhal inflammation; the second week, infiltration, with, at 
times, ulceration at the end of the week; the third week ulcer- 
ation, possibly perforation ; the fourth week cicatrization. The 
spleen becomes enlarged and softened; heart softens, brain 
undergoes degeneration; nerves are inflamed, as are fre- 
quently the lungs, leading to bronchitis, pneumonia, etc. 
Symptomatology in General.-Malaise, slight chill; fever 
low, increasing, reaching height at end of the week, with slight 
morning decline; headache with nosebleed; apathy,diarrhoea; 
tenderness of right iliac region; gurgling on pressure; tympa- 
nites; tongue with double stripes; eruption at end of first week 
of red spots, usually on abdomen, disappearing on pressure; 
blue spots, the tachesbleuatresof the French writers; delirium at 
end of second week ; ataxia, sub-sultus; coma; pulse soft, then 
dicrotic; sordes on teeth; great prostration; special senses 
affected. 
Symptomatology by Weeks.-First week- Pulse soft and 
frequent; temperature low at first, gradually increasing, 
striped tongue, diarrhoea, headache, red spots on abdomen. 
Second week-Pulse softer, Relatively slow; fever continuous, 
abdomen tympanitic, tender and gurgling; nocturnal delirium; 
headache and stupor, lung complications, sub-sultus, sordes 
on teeth, diarrhoea, carphology. Third week- Fever remit- 
ting, dicrotic pulse, fissured, bleeding tongue, sordes on teeth, 
circulation low. Fourth week-Temperature about normal 
mornings, pulse slow, heart weak, pulmonary symptoms im- 
proved, diarrhoea stopped. Fifth week-Convalescence. 
Treatment. - Hypernutrition, stimulation when indicated, 
opium in small and frequent doses, alcohol, digitalis, strych- 
nine to grain hypodermically; cold sponging; cold 
baths and mustard foot-baths for the fever; ice bag and ergot 
for haemorrhage. 
TYPHUS FEVER. 
Description.-An infectious, contagious disease, usually 
epidemic in character. The morbid anatomy is not specially 40 
POINTS ON PRACTICE. 
characteristic. Period of incubation is from one to two weeks. 
Symptomatology.-Onset sudden, headache ; dull, stupid feel- 
ing, chill, darkened skin, pulse rapid, frequent, small; temper- 
ature, usually 104 to 105 degrees; ataxia,sub-sultus; delirium, 
low and muttering during the day, maniacal at night; consti- 
pation; marked failure of circulatory and nervous systems; 
rose-colored eruption, at first disappearing on pressure; becomes 
mulberry-colored, not disappearing on pressure, and remains to 
end of the case; sordes on teeth, lung complications, jaundice, 
albumen in the urine. Second week-Temperature lower, pulse 
rapid and feeble; on 14th day, usually,is a rise of temperature, 
called the "critical rise." Coma vigil is common before death. 
Treatment.-The same as in typhoid, except stimulation 
should be resorted to much earlier in the case. 
CEREBRO-SPINAL MENINGITIS. 
Description.-Also called spotted fever; is supposed to be 
due to a microorganism, and is most commonly encountered in 
children. 
Morbid Anatomy.-Begins in pia mater, perivascular in- 
flammation, vessels dilate, exudate of leucocytes, pus, etc., 
poured out; adhesion of membranes, extension of inflamma- 
tion to brain substance, ecchymosis into heart muscles, etc., 
the general changes common to essential fevers. Rigor mortis 
sets in early and persists long. 
Symptomatology.-Cases are rarely typical; sudden onset, 
intense headache early, with vomiting, chill, high fever very 
irregular; semi-unconsciousness, head drawn back, retention of 
urine, pulse irregular, delirium, parts of the body hyperaesthetic, 
herpetic eruptions in 50 per cent, of cases, special senses 
affected, blindness, deafness and delusions. 
Sequelae. - Insanity, blindness, deafness and dumbness, 
paraplegia ; trophic nerve changes. 
Treatment.-Opium for headache, pain and delirium; 
antipyretics, bromide potassium,counter-irritation, ice to nape 
of neck, hypernutrition early. To control emesis use morphine 
hypodermically, chloroform water, hot fomentations, blisters. POINTS ON PRACTICE. 
41 
YELLOW FEVER. 
Description.-An acute, infectious, not strictly contagious 
disease, marked by three stages, a febrile, a stage of calm and 
of collapse. Period of incubation is from 48 hours to 2 weeks. 
Symptomatology.-Onset sudden, chill not usually very 
severe; fever moderate, may reach 104 degrees gradually; 
pulse frequent, soft; cyanotic look; glistening, bright eyes, 
sensitive epigastrium, marked backache, headache and pain in 
the limbs. In from 24 hours to four days fever declines by 
crisis, pain subsides, patient feels well. This is a stage of calm 
and lasts about 24 hours. It is followed by secondary fever 
and convalescence by lysis. May have tendency to haemorrhage 
as stage of calm closes, livid color replaced by haematogenous 
jaundice, bleeding gums, haemorrhage from bowels, nose, vagina, 
or internally into heart, kidneys, etc. Gastric haemorrhage 
gives rise to the so-called "black vomit." Castsand albumen 
are found in the urine. 
Treatment.-Do not overdose. Castor oil or calomel to 
relieve bowels, then stop; no food for three days, fourth day 
minute feeding; ice-cold water may be given; opium per orum 
or hypodermically for pain; quinine for backache; morphine 
grain, or creosote or chloroform water for emesis; 
tincture iron, or wet or dry cups for haemorrhage. Care in 
diet for weeks. 
Description.-An acute, infectious, contagious disease from 
a microorganism. Three varieties are recognized, the scarla- 
tina simplex, scarlatina anginosa and scarlatina maligna. 
Symptomatology of Scarlatina Simplex.-Incubation is 
about one week. Invasion sudden; chill may be slight or 
marked, vomiting with chill, fever high early, increasing with 
the eruption; rapid pulse, sore throat, tongue with thin white 
coat with protruding red papillae, coat peels off and have 
" strawberry tongue," so called; throat red and with a 
croupous exudate, elevated eruption early of red points, becom- 
ing a scarlet blush, pallor around the mouth, no paresis. 
SCARLET FEVER. 42 
POINTS ON PRACTICE. 
Scarlatina A nginosa.-Little or no eruption, cervical 
glands tender, great swelling of soft parts, sensibility extreme, 
foetid odor to breath. 
Scarlatina Maligna. - Symptoms already described, in great 
intensity, eruptive inflammation extends deep. 
Sequelae.-Purulent otitis media, catarrhal and glomerular 
nephritis, pericarditis, endocarditis. 
Treatment.-Support with fluids, milk, beef peptonoids, 
shaved ice, cold water; for emesis use chloroform water, bis- 
muth, oxalate cerium, cherry laurel water, sinapisms; for 
throat, peroxide hydrogen, solution chlorinated soda, perman- 
ganate potash; internally, mercury bichloride, grain 
doses; for restlessness, chloral, sulphonal, urethane; locally, 
vaseline or lanolin, with thymol or eucalyptol or boric acid; 
sponge with mercuric chloride solution (i-^) once a day. 
RUBEOLA 
Description.-Also called measles; is a disease of youth 
usually. Its period of incubation is about ten days. * 
Symptomatology. - Sudden rise of temperature, may or may 
not be preceded by a chill; 'temperature may be 104 degrees at 
first and drop to 102; runs about three days after appearance 
of eruption and disappears, unless lung complications are 
present; marked coryza; irritable cough; eruption on third 
day, macular, dull red ; doesn't change in character; fever rises 
on appearance of eruption ; photophobia. 
Treatment.-Look out for lung complications, take care of 
the eyes, excluding the light; treat indications. 
ROTHELN. 
Description.-Also called "German measles;" is an acute, 
self-limited disease, usually with mild, general symptoms, and 
having some of the characteristics of scarlatina and measles. 
Symptomatology.-Invasion gradual, slight chill usually; 
may have fever, vomiting and sore throat, or they may be POINTS ON PRACTICE. 
43 
absent; enlarged cervical glands, coryza; eruption is brighter 
red than that of measles, but spreads like that of measles. 
Treatment.-Symptomatic. 
VARIOLA. 
Description.-Commonly called small-pox; is an acute,in- 
fectious, extremely contagious disease. Three varieties are 
recognized-the discrete, confluent and haemorrhagic. 
Symptomatology.-Incubation is from 10 to 14 days. Onset 
abrupt; severe chill or series of rigors; fever, with rapid rise of 
temperature, 104 to 106 degrees; very rapid pulse, intense 
headache, backache very marked; at end of second day erythema 
appears; at end of third day usually eruption appears, and 
fever declines. On the fourth day eruption on face and scalp 
spreads rapidly; headache, malaise and fever less severe; 
throat sore, oppression in breathing, nose and eyes irritable, 
coryza not marked. On the ninth day (or sixth of eruption) 
pus is absorbed and fever rises high, nervous system depressed, 
maniacal delirium, pulse feeble and frequent, deglutition difficult, 
characteristic odor. Eruption is at first papular, round spots 
with "shot-like feel." They vary in size and soon become 
elevated. Color at first a dull red, becomes copper-colored in 
24 hours, and more so in 48, hours. After three days eruption 
becomes vesicular, with little dew-like points, which enlarge. 
It then becomes umbilicated, and on sixth day of eruption is 
pustular. 
Sequelae. -Otitis media, affections of the eye, alopoecia, 
neurotic diseases. 
Diagnosis.-History of exposure, lapse of ten to fourteen 
days, high fever early, 104 degrees perhaps first day; eruption 
end of third day on face and scalp, round, dull-red in oolor, 
macular, becoming papular in a few hours, and the fever 
declining, eruption becoming vesicular on sixth day and pustular 
on the ninth. In Measles, eruption is irregular, criscenttic, etc. 
Fever rises with the eruption. Varicella-Systemic disturb- 
ance slight, eruption not papular and pustules rarely formed. 44 
POINTS ON PRACTICE. 
Treatment.-Preventive by means of vaccination. Keep 
patient in darkened room, well ventilated and perfectly clean, 
hypernutrition when fever declines. 
EPIDEMIC CHOLERA. 
Description.-An acute, infectious disease, supposed to be 
due to the comma bacillus of Koch. It is of short incubation, 
and is not specially modified by climate, heat or cold. 
Symptomatology.-Diarrhoea with sudden, large, very fluid 
discharge, not accompanied by pain or naus'ea. Discharges 
become numerous and may persist a week. This is the period 
of invasion. The diarrhoeal discharges suddenly change and 
become pale, of yellow "rice water" character, of alkaline 
reaction, low specific gravity and contain comma baccilli. 
Vomiting often occurs, and pain becomes severe at end of this 
stage, which lasts about twelve hours. The heart is weak, 
pulse 120 to 140, surface of body cool and sticky, urine scanty 
and albuminous. Convalescence may begin now, or the algic 
stage may set in, in which case it will continue from 12 to 48 
hours. The body is cold, the arteries contracted and veins full, 
urine suppressed, pulse faint and flickering, muscular cramps in 
the legs, thighs and abdomen with severe pain; stools contain 
blood, mucus and epithelium; bile-stained vomit, skin dry and 
cold, or covered with a sticky sweat. If the algic stage is 
severe, the stage of reaction or "typhoid stage" sets in and 
there is a fever 102 to 104 degrees, a diarrhoea resembling 
colitis, uraemic convulsions sometimes, stupor and frequently 
delirium. 
Morbid Anatomy.-Changes in the blood are promoted by 
ptomaines'; all the tissues are anaemic, and all the organs 
undergo rapid degeneration. 
Post Mortem Changes.-Rapid rigor mortis, colornatural, 
heat remains in body, may even have a rise of temperature; 
body shrunken, eyes sunken, tissue may remain unchanged for a 
long time, and body be moist. POINTS ON PRACTICE. 
45 
Treatment.-Vigorous and prompt before real choleraic 
diarrhoea sets in, keep quiet, careful diet, opium and astringents. 
During an attack, morphine hypodermically % grain, or as large 
as dare give; stimulants, camphor and krameria; hot water 
blanket, keep warm and quiet. 
ACUTE ARTICULAR RHEUMATISM. 
Description.-A specific disease, specially liable to recur- 
rence. 
Morbid Anatomy.-Affects joints, fibrous portions, synovial 
membranes, tendons of sheaths, etc.; joints remain irritable 
after an attack from latent poison, muscles are stiff, lactic acid 
is found in the blood. There is a localized synovitis, the 
synovial fluid is cloudy and contains floculi of fibrine, there is 
hyperplasia of the joints, with swelling, and with pain increased 
by pressure. 
Symptomatology.-Malaise, chilliness, high fever, worse at 
night; sweating, eruption sometimes; urine dark and scanty, 
of high color and specific gravity. 
Complications. - Endocarditis, pericarditis, pneumonia, 
pleurisy. 
Treatment.-Salicylic acid 20 grains every hour until pain 
and fever disappear; lessen acidy urine; hot baths and local 
applications. 
MYALGIA. 
Description.-Commonly called muscular rheumatism, but 
is not in any true sense a rheumatism at all. According to its 
location, it is termed lumbago, torticollis, pleurodynia, etc. 
Symptomatology.-Pain in the muscles, with stiffness and 
difficulty of movement, and occasionally spasm. 
Treatment.-Rhus toxicodendron is of considerable value; 
local applications. 46 
POINTS ON PRACTICE. 
ARTHRITIS DEFORMANS. 
Description.-Also called rheumatoid arthritis ; is a chronic, 
progressive disturbance affecting the joints; of trophic nerve 
origin, and most commonly found in women during or following 
the menopanse. 
Morbid Anatomy.-Articular cartilages involved, rapid 
proliferation of cells, degeneration and calcareous infiltration, 
dryness of parts, with crepitus, or may have hypersecretion, 
in which case there is fluctuation; nodes under the skin, great 
deformity, especially of the hands. 
Treatment.-Improve general nutrition, arsenic,iron,bitter 
tonics. 
PODAGRA. 
Description.-Commonly called gout; is a constitutional 
disease, usually inherited, and excited by high living and little 
exercise. It affects the smaller joints, the great toe in par- 
ticular, and is marked by presence of uric acid in the blood and 
the deposit of urate of sodium in the joints. 
Symptomatology.-Irritability of temper, patient awakes 
early in the morning with agonizing pain in great toe; fever, 
rapid, bounding pulse; about 8 or 9 o'clock A. m. the fever and 
pain subside, but the attack is repeated every morning for 
eight or ten days. Urine is scanty, with high color and specific 
gravity, and decrease of uric acid before and during attack, fol- 
lowed by a great excess of uric acid afterward. 
Treatment.-Regulated diet, exercise, no stimulants or 
malted liquors; wine of colchicum seed 15 to 30 minims every 
two hours during attack. 
ANEMIA. 
Description.-A condition marked by deterioration in 
quality or diminution in quantity of the blood. The former is 
called a primary, the latter a secondary anaemia. Ischaemia is 
a localized anaemia. POINTS ON PRACTICE. 
47 
Symptomatology.-Pallor, weakness, indigestion, vertigo, 
syncope, irritable heart, oedema of eyelids and ankles. 
Treatment.-Iron, pure air, exercise and nutritious diet. 
CHLOROSIS. 
Description.-Also called "green sickness;" a pronounced 
anaemia occurring in young women from 15 to 25 years of age, 
marked by paleness of red blood corpuscles and greenish cast 
of the skin. 
Symptomatology.-Melancholia, broken and disturbed sleep, 
anorexia, disturbed menstruation, cachexia. 
Treatment.-Improve general health; Blond's pills. 
PERNICIOUS PROGRESSIVE ANAEMIA. 
Description.-Also called amematosis; a pernicious, pro- 
gressive form of anaemia, usually accompanied by fever. If the 
spleen is enlarged it is called splenic anaemia. 
Symptomatolog..-Languor, depression, pall or .palpitation, 
dyspnoea, syncope, dyspepsia, remittant fever sometimes. 
Treatment.-Symptomatic. 
LEUCOCYTH2EMIA. 
Description.-Also called leukaemia; a condition in which 
there is an enormous increase of white blood corpuscles. When 
there is a moderate increase of white corpuscles the condition is 
termed leucocytosis. 
Morbid Anatomy.-Spleen enlarged, lymphatics involved, 
sternum tender to pressure, enormous increase in leucocytes. 
PSEUDO-LEUCOCYTH^MI A. 
Description.-Also termed Hodgkin's disease; is a disease 
marked by enlarged lymphatics, marked anaemia, and usually 
some increase in white corpuscles. 
Treatment.-Iron, arsenic, oxygen, hypophosphites. 48 
POINTS ON PRACTICE. 
JAUNDICE. 
Description.-Two general classes of jaundice are recog- 
nized, the haematogenous, which is due to the coloring matter 
of the blood, and the hepatoganous, which is due to the reten- 
tion of bile in the system. The latter is divided according to 
its causes into catarrhal, obstructive, syphilitic and jaundice, 
due to changes in hepatic cells, to cancer, to tumors, to gall- 
stones, or to diffused hepatitis. In jaundice the sclerotics of the 
eye are first discolored, and then the skin. 
Catarrhal Jaundice.-Is marked by languor,apathy, malaise, 
headache, drowsiness, or sometimes sleeplessness, indigestion; 
stools are pale from the presence of soaps of magnesium and 
the absence of bile; urine is scanty, of high color and specific 
gravity, with albumen sometimes; pruritis of the skin. 
Obstructive Jaundice has a sense of weight or severe painin 
right hypogastriuiti, spasms of pain sometimes, indigestion, 
vomiting, constipation, clay-colored stools, dark colored urine 
and discolored skin and conjunctiva. 
Treatment.-Saline cathartics, especially sulphate sodium, 
diet of albuminoids, no fats, sinapisms, rest; if pain is severe, 
morphine and hot water fomentations. 
BILIARY CALCULI. 
Description.-Also called gall-stones; are concretions formed 
in gall-bladder or biliary ducts, composed of cholesterine and 
lime, magnesium and sodium salts. They may be round or 
irregular, and single or multiple. They usually become lodged 
in the most constricted portion of the duct where it opens into 
intestines, and if it closes the passage, jaundice results. 
Symptomatology.-Pain may last an hour or a longer time, 
often accompanied by vomiting, diarrhoea sometimes, tender- 
ness over the liver on pressure, gall-bladder often distended, 
great prostration, urine and stools characteristic, jaundice. 
Treatment.-Relieve pain with hypodermic of morphine % to 
1 grain, hot applications over liver and back, carbonated 
waters, careful ,<]iet, meat juices, etc., saline cathartics, rest. POINTS ON PRACTICE. 
49 
CANCER OF THE LIVER. 
Symptomatology.-Jaundice appears early; comes on grad- 
ually and persists; diminished excretion of urea, an indurated 
tumor in the liver, cancer cachexia, ascites sometimes. 
ACUTE YELLOW ATROPHY. 
Description.-Sometimes called malignant jaundice; an 
acute inflammation of hepatic cells, characterized by rapid 
diminution in size of the liver, profound disturbance of the 
nervous system, and terminating in death in a few days, to 
two weeks. 
Morbid Anatomy.-Hyperaemia of the liver, with exudation 
and softening ; becomes diminished in bulk and of a yellow color; 
spleen is enlarged and kidneys undergo degeneration. 
Symptomatology.-Debility, slow pulse, moderate tempera- 
ture, constipation, headache, mental confusion, delirium, coma, 
haemorrhage sometimes, jaundice continuous but not pro- 
gressive, rapid progress of other symptoms. 
NUTMEG LIVER. 
Description.-A chronic congestion of the liver accompany- 
ing emphysema, asthma and valvular heart disease, caused by 
obstruction to the flow of venous blood. 
Morbid Anatomy.-Liver mottled, its lobules pale with 
dark central points caused by congestion of the radicles of the 
hepatic vein, the connective tissue replaces degenerated tissue, 
liver hardens, connective tissue contracts and the liver grows 
smaller. 
Symptomatology.-Jaundice sometimes with marked cya- 
nosis, headache, constipation, urine high colored, duodenitis. 
Treatment.-Remove the cause, balance circulation, pro- 
mote action of the kidneys by digitalis, caffeine, vapor baths. 
Cirrhosis of the Liver.-Also called "hob-nailed liver" and 
" gin drinker's liveris a chronic inflaminatioim^^^oimgctive 
tissue of the liver, resulting in atroph^MjTfl^!refiiflfRi^fc> 50 
POINTS ON PRACTICE. 
and hardening of the liver. Two varieties are recognized, the 
simple and hypertrophic. 
Morbid Anatomy.-Hyperaemia of Glisson's capsule, marked 
increase of connective tissue, contraction of connective tissue, 
secreting cells encroached upon, liver decreased in size, with 
rough, irregular surface, spleen enlarged. 
Symptomatology.-Gastro-enteritis, ascites always, unless 
there is inosculation of the systemic veins: pain, haemorrhage 
from stomach and intestines; no jaundice usually. 
Hypertrophic Cirrhosis.-Occurs usually in children and is 
marked by enlargement of the liver. 
Symptomatology.-Transcient jaundice usually, indigestion, 
anaemia, haemorrhage from stomach and bowels, delirium, 
sudden coma, debility and ascites. 
AMYLOID LIVER. 
Description.-Also called waxy or lardaceous liver; is a 
peculiar infiltration of the substance of the liver with an 
albumenoid material. It results from long continued suppu- 
ration. 
Morbid Anatomy.-Liver greatly enlarged, waxy in appear- 
ance and anaemic; spleen, kidneys and intestines involved. 
Symptomatology.-Jaundice slight and slight ascites, hep- 
atic dullness increased, disordered digestion, amyloid changes 
in other organs. 
Description.-Also called dropsy of the abdomen; is a col- 
lection of serous fluid in the peritoneal cavity, resulting from 
cirrhosis of the liver, periphlebitis of the portal vein, syphilitic 
gummata, cancers and tumors; it is also secondary to general 
anasarca and tuberculosis of the peritoneum. 
Treatment.-Aspiration when necessary; treat the cause. 
ASCITES. 
FATTY DEGENERATION OF THE LIVER 
Description.-Results from cutting off supply of oxygen 
to. tlje liyer; obesity, or may be secondary to pernicious anaemia POINTS ON PRACTICE. 
51 
Morbid Anatomy.-Liver enlarged, pale colored, of doughy 
consistency, lower border has a blunt feel, oil globules are 
found on the knife when it is cut. 
Treatment.-Treat the cause, exercise in the open air, al- 
bumenoid diet when caused by obesity. 
ABSCESS OF THE LIVER. 
Description.-Also called acute purulent hepatitis; is a con- 
dition usually set up by septic matter from bile passages. 
Septic emboli or may have dysentery as a cause. 
Symptomatology.-Localized pain, slight jaundice, tender- 
ness, vomiting, hiccough, irregular, intermittant fever, intestinal 
disturbances. Pus may be obtained by aspiration. 
Treatment.-Support patient, rest, aspirate if abscess can 
be located. 
HYDATID TUMOR. 
Description.-An affection due to the presence of the parasite, 
the taenia ecchinococcus, in the liver. It is diagnosed by ex- 
clusion, by the presence of cystic tumors, by the peculiar 
thrill obtained on palpation, and presence of booklets on aspi- 
ration. 
LITH^MIA. 
Description.-A condition called lithiasis or uric acid 
diathesis, in which, through failure of the liver to convert the 
uric acid of nitrogenous waste into urea, more or less of it is 
retained in the system, giving rise to toxic phenomena. 
Symptomatology. -Sleeplessness, sometimes torpidity; pain, 
tremor, spasms, heart weak, cold hands, headache, dyspepsia, 
emaciation, bowels sluggish, urine with oxalate of lime and 
urates. 
Treatment.-Diet, albumenoid at first, peptonized cod-liver 
oil; exercise in open air. 
POLYURIA. 
Description.-An excess of urinous secretion. The urine is 
passed frequently and is of light color and low specific gravity. 
Increased secretion of urine may depend upon the quantity of 52 
POINTS ON PRACTICE. 
fluid ingested, general increase of blood pressure, high tension 
of the arteries and capillaries of the kidneys, or calculi in pelvis 
of the kidney. Urine in Pyelitis contains kidney epithelium, 
blood, pus in considerable quantities, not much mucus. Urine 
in Cystitis contains bladder epithelium, blood, mucus in large 
amount. 
DIABETES MELLITIS. 
Description.-A chronic condition in which there is an ex- 
cessive discharge of urine containing glucose and a progressive 
loss of flesh and strength. The persistence of sugar in the 
urine without emaciation, loss of strength, and non-progressive 
in character, constitutes simple glycosuria, and is not a true 
diabetes. Two varieties are recognized: the first, in young, 
neurotic subjects, runs a rapid and unfavorable course; the 
second, in elderly people of disturbed digestion. 
Symptomatology. -Urine excessive in amount, emaciation, 
sub-normal temperature, great thirst, glucose in the urine, 
ravenous appetite, tendency to boils and carbuncles, sweetish 
odor to the breath, thin fawn colored coating on tongue, in- 
flammation of urethra, eczema of the genital; symptoms pro- 
gressive. 
Treatment.-Regulated diet free from sugars and starches ; 
meet indications. 
DIABETES INSIPIDUS. 
Description.-An affection usually found in neurotic and 
hysterical young people, in which there is a habitual discharge 
of large quantities of pale urine free from albumen or sugar. 
Symptomatology.-Urine secreted in great excess, great 
thirst, urine with light color and specific gravity; no glucose 
present. 
Treatment.-Valerian, zinc, arsenic, opium, ergot and 
nitro-glycerine. 
RENAL COLIC. 
Description.-A condition resulting from the passage of a 
stone from the pelvis of the kidney through the ureter to the 
bladder. POINTS ON PRACTICE. 
53 
Symptomatology.-Backache high up, usually one-sided; sud- 
den pain after straining in lumbar region; pain radiates to 
shoulder and to the testicle; testicle retracted, vesicular tenes- 
mus, vomiting, cold sweat, haemorrhage, delirium sometimes, 
and symptoms of shock. 
Treatment.-For threatened colic, liquor potassa 10 drops 
every few hours, with fluid extract hydrangea; during the 
attack, morphine, % grain, with atropine grain; liquor 
potassa and use of chloroform. 
RENAL CALCULI. 
Description.-Lithiasis is a term used to indicate a tendency 
to the formation of calculi. The varieties of calculi comprise 
uric acid, oxalate of lime, phosphates, xanthine and cystin. 
The last two are from the imperfect oxidation of albumenoids. 
The phosphatic calculi and oxalate of lime are mostcommonin 
spare, neurotic subjects, while uric acid is found in the uric acid 
diathesis. 
Description. - A catarrhal inflammation of the pelvis of 
the kidney. Where inflammation with suppuration exists it is 
termed pyelo-nephrosis, and where the pelvis of the kidney 
undergoes cystic degeneration the condition is called hydro- 
nephrosis. 
Symptomatology.-Chill, feverishness, lumbar pains, frequent 
micturition, milky urine, with acid reaction, pain exaggerated 
in stooping position, pus in the urine. 
PYELITIS. 
CHRONIC CONGESTION OF KIDNEYS. 
Description.-A chronic form of inflammation of the kidney 
with an etiology similar to that of " nutmeg liver." 
Morbid Anatomy.-Kidney enlarged, congested or cyanosed. 
Tissue of kidney contracts and becomes hard, capsule adherent, 
color dark. 
Symptomatology.-Renal incapacity, urine small in amount 
and containing albumen, general anasarca and dyspnoea some- 
times. 54 
POINTS ON PRACTICE. 
ACUTE PARENCHYMATOUS NEPHRITIS 
Description.-An acute inflammation of the parenchyma of 
the kidney from scarlet fever, toxaemias, or may be idiopathic. 
Morbid Anatomy.-Kidney large, capsule usually adherent, 
color pale, fatty degeneration in tubules, connective tissue 
little changed. 
Symptomatology.-Previous good health, indigestion, head- 
ache, dizziness, diarrhoea ; anasarca from hydraemia where dis- 
ease persists long. Urine contains albumen, epithelium and 
hyaline; fatty, granular and blood casts. The urea will be 
greatly diminished if disease is far advanced, so the quantity of 
urea is a measure of the progress of the disease. 
ACUTE INTERSTITIAL NEPHRITIS. 
Description.-Ari acute inflammation of the connective 
tissue of the kidney. 
Symptomatology.-Pain, fever, chill, indigestion, vomiting, 
headache; circulation and respiration less affected than in 
parenchymatous form, but other symptoms more acute. 
ACUTE GLOMERULAR NEPHRITIS. 
Description.-An acute inflammation of the glomeruli of 
the kidney, secondary to scarlet fever, in which urine is almost 
suppressed, loaded with albumen and containing blood and 
casts. 
Treatment of Acute Nephritis.-Complete rest, freedom 
from worry, milk diet, skin and bowels active. 
CHRONIC DIFFUSED NEPHRITIS. 
Description.-Under the above designation are classed the 
several varieties of chronic Bright's disease, including the 
parenchymatous or catarrhal form and the interstitial, cirr- 
hotic, or "gouty" form. POINTS ON PRACTICE. 
55 
CHRONIC PARENCHYMATOUS 
NEPHRITIS. 
Description.-A chronic inflammation of the parenchyma of 
the kidney, induced by alcoholism, phthisis, exposure or 
taxaemias, and characterized by slight change in vessels or 
stroma of kidneys. 
Symptomatology. - Anaemia, dyspepsia, dyspnoea, dropsy, 
disturbance of vision, heart irritable, headache, renal asthma, 
feet swollen at night, puffy eyelids, waxy, or pale look, weak, 
tired feeling. The urine is small in quantity, high colored, 
high specific gravity, sometimes urea diminished, albumen in 
large quantities, and hyaline and granular casts. 
Secondary Symptoms.-After a year kidneys may contract, 
the urine be increased, the amount of albumen less, dropsy less, 
or absent, and urea much diminished. 
CHRONIC INTERSTITIAL NEPHRITIS. 
Description.-A chronic inflammation of the stroma of the 
kidney, with an etiology of old age, gout, rheumatism or 
lithiasis usually. 
Morbid Anatomy.-Kidney small, capsule adherent, kidney 
hard and contracted, cystic degeneration from the closure of 
tubules and their distension. 
Symptomatology.-Anaemia, dyspepsia, dyspnoea, disturb- 
ance of the vision, headache, diarrhoea, vomiting and nausea, 
especially mornings; uraemia, "Bright's eye" (puffiness of con- 
junctiva), itching of the skin, nervousness and loss of memory, 
heart's rhythm disturbed, hypertrophy of left ventricle, weak, 
tired feeling; drowsiness, high arterial tension; urine is large 
in amount, light in color, low specific gravity, albumen slight 
or absent; casts, hyaline and granular, or may be absent; urea 
diminished somewhat. 
ARTERIO-CAPILLARY FIBROSIS. 
Description.-A condition involving marked changes in the 
vessels and stroma of the kidney, with persistent high arterial 56 
POINTS ON PRACTICE. 
tension, and which has trophic nerve disturbance as causative 
factor. 
Morbid Anatomy.-Changes in vessels and stroma, thicken- 
ing beginning in walls of the vessels, then changes in the vessels 
in general, changes in stroma of kidney, changes in the left 
ventricle of the heart, marked growth of fibrous connective 
tissue. 
Symptomatology.-Urine largein amount, containing albu- 
men and granular and hyaline casts, great vascular tension, 
whip-cord pulse. 
Treatment of Bright's Disease.-Rest, freedom from worry; 
keep the skin active, bowels free; Basham's mixture for 
anaemia and oxygen inhalations. 
UREMIA. 
Not necessarily of bilious tempera- 
ment. 
Persistence of attacks. 
Flatulent colic. 
Indigestion. 
Bowels loose. 
Constipation makes symptoms much 
worse. 
Headache. 
Pulse rapid. 
Heart weak. 
Urinous odor to breath. 
Cold baths detrimental. 
Rest beneficial. 
Hot baths beneficial. 
BILIOUSNESS. 
Bilious temperament naturally. 
Bilious attacks and recovery. 
Flatulent colic. 
Indigestion. 
Apt to be constipated. 
Suffer much less from effects of con- 
stipation. 
Headache. 
Liver enlarged. 
Urinous odor not present. 
Cold bath beneficial. 
Exercise beneficial. 
Hot baths not helpful.