/Manual of Differential 
/Aedical "Diagnosis WORKS BY CONDICT W. CUTLER, M.D. 
Manual of Differential Medical Diagnosis. (In 
Students' Manuals Series.) i6mo, cloth, $1.25 
Differential Diagnosis of the Diseases of the Skin. 
(In Students' Manuals Series.) x6mo, cloth, $1.25 
Essentials of Physics and Chemistry. 8vo, 
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G. P. PUTNAM'S SONS, New York and London. MANUAL 
OF 
Differential Medical Diagnosis 
BY 
CONDICT W. CUTLER, M.S., M.D. 
ID 
Physician-in-Chiefto the New York Dispensary ; Assistant Surgeon for Skin and Venereal 
Diseases at the New York Hospital, Out-Door Department; Member of the Society of 
the Alumni of Bellevue Hospital; Member of the New York Dermatological 
Society ; A uthor of " Differential Diagnosis of the Diseases of the Skin," 
etc., etc. 
FO U&F»~£D-J-TIQN 
NEW YORK AND LONDON 
G. P. PUTNAM'S SONS 
IJrsss 
1890 COPYRIGHT BY 
CONDICT W. CUTLER 
1886 
Press of 
G. P. Putnam's Sons 
New York TO MY PRECEPTORS 
Drs. CHARLES H. WILKIN and FREDRICK W. OWEN 
THIS SMALL VOLUME IS DEDICATED 
AS A TOKEN OF APPRECIATION FOR THEIR FAITHFUL AND VALUABLE INSTRUCTION 
BY 
THE AUTHOR PREFACE TO THE SECOND EDITION. 
This little work has rapidly run through its first edition, and has been favor- 
ably received by the profession and students in medicine. 
In the preface of the first edition, published less than a year ago, I then 
wrote: 
" In compiling this Manual of Medical Diagnosis I am fully aware of the 
uncertainty of the so-called characteristic symptoms of a disease. 
" I have therefore endeavored in the following pages to contrast the symp- 
toms of the diseases that are most liable to be confounded one with another, 
and have chosen for such symptoms those that will most readily call forth a 
differential diagnosis. 
* ' Although not relying upon any one symptom as diagnostic, I have limited 
myself to those that afford the most striking contrast, and thus have avoided 
any unnecessary multiplication of the pages that are intended only to serve as 
a text-book." 
In this new edition some few corrections are made, and a chapter on the 
differential diagnosis of coma added, which will, I trust, further increase the 
merits of the book and make it still more worthy of the approval of the pro- 
fession. 
150 Wbst 53D St., New York, May, 1887. PREFACE TO THE THIRD EDITION. 
The author feels grateful to the medical profession and students in medicine 
for the favorable reception this little work has had at their hands. 
In less than two years this little book has reached its third edition, and al- 
though not intended as a complete work on medical diagnosis, it has met the 
requirements of the student, by affording him an easy method of learning the 
most characteristic symptoms of diseases and their diagnosis, and the busy 
practitioner by furnishing him differential diagnosis tables of all diseases liable 
to be confounded one with another. 
150 West 53D Street, New York 
April, 1888. CONTENTS. 
PAGE 
Introduction I 
Diseases of the mouth and throat . . . • .13 
Diseases of the lungs and pleura . . . . .21 
Diseases of the heart and blood-vessels . . . • • 37 
Diseases of the digestive tract and peritoneum . . . .51 
Diseases of the liver . . . . . • .75 
Diseases of the kidneys and bladder . . . . .89 
Acute general diseases-fevers, etc. ..... 107 
Chronic general diseases-blood diseases, etc. .... 127 
Diseases of the nervous system ...... 137 
Coma T59 
Index ••••••*** I&7 INTRODUCTION. 
A careful examination of a patient is the first requisite tow- 
ard establishing a diagnosis. To conduct this properly and to 
the best advantage a systematic examination of the patient will 
lead to the quickest and surest results. 
First locate the disease, and then balance the symptoms struck, 
and the diagnosis is recast. 
The following schedule will serve as a guide toward the proper 
examination of the patient, and lead the observer quickly and in 
the right channel to the seat of the disease, and then to the estab- 
lishment of a correct diagnosis of his case. 
I.-History of the Patient. 
a. Hereditary predisposition. 
b. Previous general health. 
c. Previous diseases or injuries. 
d. Habits of life. 
e. Cause of the present sickness. 
f. Date of the present attack. 
g. Mode of invasion. 
h. Subsequent symptoms in order. 
1 2 
IN TROD UCTION. 
II.-Condition of the Patient. 
a. Position. 
b. Aspect. 
c. Skin. 
d. Pulse. 
<?. Respiration. 
f. Temperature. 
g. Tongue. 
h. Digestion. 
i. Urinary secretion. 
j. Sensations. 
k. Intellection. 
l. Examination of special organs. 
Hereditary Predisposition. 
Many diseases, among the most important of which are syphi- 
lis, cancer, tuberculosis, scrofula, etc., are hereditary. The ob- 
server, by establishing a family history of hereditary disease, is 
often aided materially in coming to a correct diagnosis of the 
case. 
Previous General Health. 
The usual general health of the patient is often of great im- 
portance for the diagnostician to know. 
If the patient's health has always been good up to the present 
attack he is able at once to exclude certain wasting and debili- 
tating diseases. 
While, on the other hand, if the patient's previous condition has 
been a poor one, we at once look for a chronic ailment as being 
in some way connected with the present sickness. IN TROD UCTION. 
3 
Previous Diseases or Injuries. 
The thorough knowledge of this important history will fre- 
quently lead to a correct diagnosis, for injury of an organ often 
results in its disease, while previous disease makes the patient 
either more or less susceptible to a similar attack. Thus if the 
patient gives a history of having had an eruptive fever, as small-pox, 
we would naturally at once exclude small-pox from our list of pos- 
sible diseases which might be the cause of his present symptoms. 
If, however, the patient had once suffered from Bright's disease 
of the kidneys, we would immediately inquire further into the 
condition of the urinary organs. 
How simple many diagnoses would appear could we but get a 
syphilitic history from our patients. 
The habits of men predispose them to certain diseases, hence 
the importance of inquiring into the regular habits of our pa- 
tients. Thus, for example, sedentary habits lead to gastric, hepa- 
tic, and intestinal disorders ; alcoholism, to cirrhosis of the liver, 
mental and nervous derangements, etc. 
The cause of the present attack, its date, its mode of inva- 
sion, and the subsequent symptoms in the order of their devel- 
opment are of the utmost importance, for by obtaining a full 
history of the same, the physician is often at once led to an im- 
mediate and correct diagnosis of his case. 
Having thus obtained the previous history of the patient, let us 
now consider his present condition. 
Habits of Life. 
Position. 
Is the patient in bed or out of bed ? If in bed, what is his po- 
sition ? If feverish and in pain, he is restless and tossing about. 4 
IN TROD UCTION. 
If suffering from acute peritonitis, there is dorsal decubitus and 
flexion of the thighs. If lying fixedly upon one side there is a 
probability that the action of the lung on this side is impaired. 
If there is orthopnoea there is probably disease of the heart or 
respiratory organs. 
If the patient is out of bed, we should notice his movements. 
In nervous disorders they are uncertain and trembling, and the 
gait often unsteady and staggering. In rheumatism, joint-dis- 
ease, etc., affecting the lower extremities, the patient limps, while 
in many diseases of the back there is rigidity of the spine and 
a bending forward. 
Aspect. 
By noting the general aspect of the patient we at once derive 
knowledge as to the occurrence of oedema, corpulency, wasting, 
cyanosis, etc. Expressions of the face denote pain, stupor, apa- 
thy, collapse, etc. The eye frequently tells us at once the condi- 
tion of the patient-whether delirious, stupid, or approaching 
death. The pupils are contracted in opium-poisoning (pin head) 
and hemorrhage into the pons (pin point) ; unequally dilated in 
apoplexy and compression of the brain, and rapidly dilate upon 
the approach of death, etc. 
Skin. 
By the state of the skin we judge of the activity of the circu- 
lation and secretions. Coldness of the surface indicates weakness 
of the capillary circulation, often due to interference of nervous 
power by some acute disease or nervous shock. A cold, clammy 
skin denotes diminished vital force. Jaundice occurs with de- 
rangements of the liver and blood-diseases. Eruptions occur 
with skin diseases and the exanthemata. INTROD UCTION. 
5 
Pulse. 
The pulse affords one of the most valuable means of informa- 
tion, and although it cannot be exclusively relied upon as a 
means of diagnosis it comes greatly to our assistance. The 
pulse enlightens us as to the action of the heart, and the condi- 
tion of the arteries. The pulse differs in frequency, rhythm, vol- 
ume, and resistance. 
The frequency of the pulse is usually greatly increased in all acute 
affections and in fevers. In shock, in pressure on the brain, and in 
inflammation of the meninges of the brain a slow pulse is the rule. 
The rhythm of the pulse is often perverted. The irregular 
action of the heart may arise from digestive disturbance, from 
the excessive use of tobacco or stimulants, from nervous exhaus- 
tion, but most frequently in cerebral or cardiac diseases. 
The volume of the pulse often varies with its strength. Usually 
a full pulse is a strong pulse, but this is not always the case. A 
full, weak pulse, or " gaseous pulse," indicates great debility and 
loss of tone in the arterial system. A " gaseous pulse " is com- 
mon in yellow fever and ether narcosis. On the other hand a 
small pulse is usually a weak pulse, but it may be tense and wiry 
as observed in peritoneal inflammations. 
The resistance of the pulse is perhaps the most important 
guide as to the real condition of the patient. A hard pulse de- 
notes a forcibly contracting heart and increased contractility of 
the arteries. A hard pulse is also associated with degenerative 
changes taking place in the arterial walls. A soft pulse is the 
pulse of low fevers and debilitated conditions. 
By means of the sphygmographic tracings, we are afforded very 
delicate means for obtaining slight variations in the pulse, and 
may thus be assisted in diagnosing valvular diseases of the heart, 
aneurisms, etc. 6 
IN TROD UC TION. 
Respiration. 
By noting the frequency and character of the respiration we 
can frequently make a correct diagnosis of thoracic diseases 
without further examination. If dyspnoea is present, we at once 
suspect disease of the heart or respiratory apparatus. If pleurisy 
is present, the respirations will be hurried, short, and catching 
in character. The breathing is " panting " in pneumonia, and 
" labored " in capillary bronchitis. 
The pulse and respiration should bear a nearly constant ratio 
to each other of about 4 to i. If this relation is increased, car- 
diac failure may be suspected, but if the ratio is diminished, and 
the respirations are much increased in frequency, an examina- 
tion of the respiratory organs will probably discover the cause. 
Opium-poisoning, compression of the brain, diseases of the 
respiratory centre, etc., will reduce the frequency of the respira- 
tions. 
Temperature. 
The temperature of the patient is of the utmost importance in 
making a diagnosis. In all acute cases the temperature is, as a 
rule, elevated. 
Usually the pulse and temperature rise synchronously ; that 
is, for every degree rise in temperature, we may expect an in- 
crease of ten beats in the pulse rate. In some diseases, as 
typhoid fever, every week presents characteristic variations in 
the temperature. 
Although we are apt to gauge the condition of our patient by 
his range of temperature, it must not be forgotten that in condi- 
tions of prostration, collapse, shock, etc., the temperature is often 
normal, or even subnormal. In cholera the temperature falls as 
low as 940, while in sunstroke the temperature is frequently ob- INTRODUCTION. 
7 
served to be at 1120. A patient seldom recovers if the tempera- 
ture remains for any length of time over xo8°. 
Tongue. 
The tongue not only indicates the condition of the digestive 
tract, but also gives us information concerning the state of the 
secretions, the blood, nervous power, etc. 
If the movements of the tongue are tremulous, one-sided, or 
crippled, we are dealing with a disease of the nervous system. 
If the tongue is dry and cracked, or covered with sordes, there is 
good reason to suspect some acute febrile affection or marked 
depression of the vital forces. 
A simply coated tongue occurs frequently with some digestive 
disturbance. The color of the tongue is red in the exanthemata, 
especially scarlet-fever (strawberry tongue), blue in asphyxia and 
obstructed circulation, etc. 
Digestion. 
The state of the digestion should always be inquired into. 
Vomiting occurs in many disorders, but frequently in diseases of 
the stomach and brain. Diarrhoea denotes a disordered state of 
the bowels. Chronic constipation is frequently the result of tor- 
pidity of the liver. Fcecal vomiting and obstinate constipation 
result from intestinal obstruction. 
Urinary Secretion. 
An examination of the urine should never be neglected. The 
kidneys are affected in so many diseases, that to establish a diag- 
nosis it is often essential to know the condition of the urine. 
In Bright's disease the urine contains albumen and casts ; in 8 
IN TROD UCTION 
cancer of the kidneys, blood and cancer cells ; in suppurative 
nephritis and pyelitis, a large number of pus cells ; in cystitis, 
ropy mucous, etc. 
Many poisons may be detected in the urine. In pneumonia 
the chlorides, and in carbolic-acid poisoning the sulphates are 
greatly diminished in the urine. 
Sensation. 
Frequently the most-marked symptom by which we can locate 
the disease is the pain. 
Most all affections are painful, and the pain is usually referred 
to the seat of the disease. Thus, diseases of the brain are asso- 
ciated with headache ; pleurisy, with pain in the side ; sciatica, 
with pain along the course of the sciatic nerve, etc. 
Not only is pain an important symptom, but disordered sensa- 
tions, as numbness, hyperaesthesia, anaesthesia, and subjective sen- 
sations, lead us at once to associate the symptoms with affections 
of the nervous system. 
Intellection. 
In affections of the brain and in many acute forms of disease 
a deranged intellect is among the first symptoms. The de- 
rangement varies from a mere confusion of the mind to its entire 
perversion and prostration. Acute diseases are associated with 
stupor, delirium, and coma, while in chronic affections loss of 
judgment, memory, etc,, are essentially noticeable. 
Examination of Special Regions or Organs. 
Having thus obtained a general history of the case, we are 
now prepared to examine some of the special organs of the body 
for the seat of the disease. INTRODUCTION. 
9 
If we have reason to believe that we are dealing with a general 
disease, it is more than likely that some local lesion or complica- 
tion may also exist. 
It is therefore well to examine the special organs, as the heart, 
lungs, etc., and thus determine if some of the symptoms present 
are not due to, or modified by, some complicating condition. 
Having thus determined the seat and character of the disease, 
let us by a differentiation of the symptoms arrive at a correct 
diagnosis. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE MOUTH AND THROAT. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE MOUTH AND THROAT. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Thrush Follicular stomatitis. 
Cancrum Oris .... 
Malignant pustule. 
Ulcerative stomatitis. 
Cancer of Tongue .... Syphilitic ulcer of tongue. 
Acute Laryngitis (croup) . 
False croup. 
Retro-pharyngeal abscess. 
CEdema of glottis. 
Diphtheria. 
Chronic Laryngitis* . 
Thoracic aneurism. 
Hysterical change of voice. 
CEdema Glottidis 
Croup. 
Thoracic aneurism. 
Asthma. 
Retro-pharyngeal abscess. 
Thrush. 
1. Removal of the white patch leaves 
an ulcer. 
2. Disease parasitic in nature. 
3. Redness around each spot. 
4. Exudation not soluble in ether. 
Follicular Stomatitis. 
1. Removal of the exudation leaves 
a red surface. 
2. Vesicular disease. 
3. No zone-inflammation about exu- 
dation. 
4. Exudation soluble in ether. 14 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Thrush. 
5. Severe gastro-intestinal symptoms. 
o. Excoriation about anus and geni- 
tals. 
7. Acid diarrhoeal movements. 
8. Oidium Albucans found under the 
microscope. 
Cancrum Oris. 
1. Begins on the cheek. 
2. Some constitutional symptoms. 
3. Rapid progress of the disease. 
4. Ulceration extends rapidly. 
5. Discoloration of the cheek. 
6. Cheek greatly swollen. 
7. Constant flow of bloody pus and 
mucus from the mouth. 
Cancrum Oris. 
1. Begins in the mucous membrane. 
2. No severe constitutional symptoms 
at first. 
3. Breath very foul. 
4. Pus and blood flow from the 
mouth. 
5. Some pain. 
6. Glands enlarged. 
Cancer of Tongue. 
1. History of hereditary cancer. 
2. Appears on the side of tongue. 
3. U sually single. 
4. Progress rapid and painful. 
DISEASES TO BE DIFFERENTIATED. 
Follicular Stomatitis. 
5. Slight intestinal disorder. 
6. No redness about anus. 
7. Diarrhoeal movements may be alka- 
line. 
8. Oil globules under microscope. 
Ulcerative Stomatitis. 
1. Begins on the gums. 
2. Local symptoms. 
3. Disease develops slowly. 
4. Slow ulceration. 
5. No discoloration of cheek. 
6. Cheeks but little swollen. 
7. Salivation. 
Malignant Pustule. 
1. Begins in the skin. 
2. Constitutional symptoms severe 
from the first. 
3. Breath not offensive. 
4. No bloody discharge from mouth. 
5. No severe pain. 
6. No enlarged glands. 
Syphilitic Ulceration of Tongue. 
1. History of syphilis. 
2. Usually appears on dorsum. 
3. Usually multiple. 
4. Progress slow and not very painful. DISEASES OF THE MOUTH AND THROAT. 
15 
NAME OF DISEASE. 
Cancer of Tongue. 
5. Ganglionic swelling. 
6. Rare before middle life. 
7. Ulcer has indurated base. 
8. Microscope shows an epithelial 
structure. 
9. Medical treatment no effect. 
True Croup. 
1. Begins with hoarseness or sore 
throat. 
2. Advent slow. 
3. Temperature high. 
4. Exudation fibrous. 
5. Bronchial symptoms. 
6. Subsides slowly. 
7. Continued cyanosis. 
8. Aphonia frequently complete. 
9. Change in voice. 
10. Well-marked constitutional symp- 
toms. 
Acute Laryngitis. 
1. History negative. 
2. Fever. 
3. Usually a disease of childhood. 
4. Difficult breathing, both inspiratory 
and expiratory. 
5. Brazen or croupous cough. 
6. Examination shows inflamed mu- 
cous membrane. 
Acute Laryngitis. 
1. Peculiar cough. 
2. No difficulty in swallowing. 
DISEASES TO BE DIFFERENTIATED. 
Syphilitic Ulceration of Tongue. 
5. No large ganglionic swelling. 
6. Appears at any age. 
7. Ulcer not especially indurated. 
8. Microscope shows a small-cell infil- 
tration. 
9. Medical treatment curative. 
False Croup. 
1. No prodromata. 
2. Advent sudden. 
3. Temperature about normal. 
4. No membranous exudation. 
5. Absence of lung complications. 
6. Disease disappears rapidly. 
7. Cyanosis of short duration. 
8. Loss of voice uncommon. 
9. Voice often natural. 
10. No severe constitutional symp- 
toms ; rarely fatal. 
(Edema Glottidis. 
1. History of general oedema-ulcers 
of larynx or acute disease, etc. 
2. Temperature often normal. 
3. Usually attacks adults. 
4. Inspiration alone affected. 
5. Cough not croupous in character. 
6. Examination at once discloses the 
cedematous condition of the larynx 
Retro-Pharyngeal Abscess. 
1. Cough not peculiar. 
2. Dysphagia. 16 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Acute Laryngitis. 
3. No stiffness of the neck. 
4. Brazen voice. 
5. Dyspnoea relieved by throwing the 
head backward or by horizontal 
position. 
6. Dyspnoea constant. 
7. Examination shows presence of in- 
flamed mucous membrane. 
DISEASES TO BE DIFFERENTIATED. 
Retro-Pharyngeal Abscess. 
3. Neck stiff and painful on motion 
or pressure along spine. 
4. Voice guttural. 
5. Dyspnoea greatly increased by 
throwing head backward or by the 
horizontal position. 
6. Dyspnoea paroxysmal and brought 
on by swallowing or by pressure 
on larynx. 
7. On examination a fluctuating pain- 
ful tumor is found at the back 
part of pharynx. 
Acute Laryngitis (Croupous). Diphtheria. 
See Diphtheria, page 20. 
Chronic Laryngitis. 
1. Symptoms appear slowly. 
2. Difficulty in breathing. 
3. Cough and expectoration. 
4. Symptoms quite constant. 
5-. Pain in larynx. 
6. Laryngeal examination positive. 
Hysterical Change of Voice. 
1. Advent sudden. 
2. Absence of dyspnoea. 
3. Cough slight and without expecto- 
ration. 
4. Sudden relief of symptoms. 
5. No pain in larynx. 
6. Laryngoscopic examination nega- 
tive. 
Chronic Laryngitis. Thoracic Aneurism. 
See Thoracic Aneurism, page 48. 
(Edema Glottidis. Acute Laryngitis. 
See Acute Laryngitis, page 15. 
(Edema Glottidis. Thoracic Aneurism. 
See Thoracic Aneurism, page 48. DISEASES OE THE MOUTH AND THROAT. 
17 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
(Edema Glottidis. Asthma. 
See Asthma, page 30. 
CEdema Glottidis. 
1. History of general oedema, ulcer of 
larynx, acute disease, etc. 
2. Dyspnoea constant. 
3. Dyspnoea inspiratory only. 
4. Usually attacks adults. 
5. Advent sudden. 
6. No chills or sweating. 
7. Dyspnoea increased by bending 
head forward. 
8. Examination shows marked cedema 
of the glottis. 
Retro-Pharyngeal Abscess. 
1. History of stiff neck, etc. 
2. Dyspnoea paroxysmal. 
3. Dyspnoea expiratory and inspira- 
tory. 
4. Disease especially of children. 
5. Advent gradual. 
6. Fever, chills, and sweating. 
7. Dyspnoea increased by throwing 
head backward. 
8. Examination shows presence of 
a post-pharyngeal fluctuating tu- 
mor. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE LUNGS AND PLEURA. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE LUNGS AND PLEURA. 
NAME OF DISEASE 
DISEASES TO BE DIFFERENTIATED. 
Acute pleurisy. 
Pleurisy with effusion. 
Broncho-pneumonia. 
Acute phthisis. 
Pneumonia 
Pneumonia. 
Capillary bronchitis. 
Acute phthisis. 
Atelactasis. 
Broncho-pneumonia 
Pneumonia. 
Broncho-pneumonia. 
Capillary bronchitis. 
Abscess of lung. 
Acute phthisis 
Chronic bronchitis. 
Pulmonary infarction. 
Cancer of lung. 
Broncho-pneumonia. 
Chronic phthisis 
Acute catarrhal bronchitis 
Broncho-pneumonia. 
Acute phthisis. 
GEdema of lungs. 
Capillary bronchitis 
21 22 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Broncho-pneumonia. 
Chronic phthisis. 
Chronic bronchitis . 
Gangrene of lung 
Abscess of lung. 
Fetid bronchitis. 
Phthisis. 
Pleurisy with effusion. 
Cancer of lung 
Emphysema . . . . 
Pneumothorax. 
Asthma. 
Asthma . . . . 
Spasmodic affections of larynx. 
Emphysema. 
Angina pectoris. 
Hemoptysis . . . . 
Hematemesis. 
Epistaxis. 
Acute pericarditis 
Pneumonia. 
Intercostal neuralgia. 
Perihepatitis. 
Acute pleurisy 
' Pneumonia. 
Cancer of lung. 
Hydatids of lung. 
Hydrothorax. 
_ Empyema. 
Pleurisy with effusion 
Pneumothorax 
Phthisical cavities. 
Emphysema. 
Pleurisy with effusion. 
Abscess of liver. 
Thoracic aneurism. 
Empyema . , , . DISEASES OF THE LUNGS AND PLEURA. 
23 
NAME OF DISEASE. 
Pneumonia. 
1. Begins with a well-marked chill. 
2. Face flushed and congested. 
3. Temperature from 104° to 106°. 
4. Expectoration rust-colored and 
viscid. 
5. Marked dulness upon percussion. 
6. Bronchial voice and breathing. 
7. Crepitant rale at end of inspira- 
tion. 
Pneumonia. 
1. Begins with a marked chill. 
2. Face flushed and mahogany color. 
3. Temperature from 104° to 106°. 
4. Expectoration rust - colored and 
characteristic. 
5. Breathing hurried and panting. 
6. Dulness on percussion. 
7. Bronchial voice and respiration. 
8. Heart in normal position. 
9. Crepitant rale at end of inspira- 
tion. 
10. Aspiration negative. 
11. Termination by crisis hbout sev- 
enth day. 
Pneumonia. 
1. Begins suddenly with a chill. 
2. Severe pains in side. 
3. Affects one lung. 
4. Attacks children or adults. 
5. Bronchial voice and breathing. 
DISEASES TO BE DIFFERENTIATED. 
Acute Pleurisy. 
1. Begins with pain in side. 
2. Face pale and anxious. 
3. Temperature from ioo° to 102°. 
4. Expectoration frothy and mucous. 
5. But slight dulness on percussion. 
6. Feeble voice and breathing. 
7. Superficial friction-sound on both 
expiration and inspiration. 
Pleurisy with Effusion. 
1. Begins with chilly sensations. 
2. Face pale and anxious. 
3. Temperature from ioo° to 102°. 
4. Expectoration scanty and mucous. 
5. Breathing less hurried and catch- 
ing. 
6. Flatnesson percussion, but changes 
with position of patient. 
7. Absence of voice and breathing. 
8. Heart displaced. 
9. Absence of rales. 
10. Aspiration positive. 
11. No critical days. 
Broncho-Pneumonia. 
1. Begins as a severe bronchitis. 
2. Stuffy feeling under sternum. 
3. Affects both lungs. 
4. Usually attacks children. 
5. Broncho-vesicular voice and breath- 
ing. 24 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Pneumonia. 
6. Dulness unilateral and well 
marked. 
7. Rales crepitant and subcrepitant. 
8. Terminates by crisis. 
Pneumonia. 
1. Begins with chill and pain in 
side. 
2. Affects one lung. 
3. Characteristic pneumonic sputum. 
4. Temperature high and somewhat 
remittent. 
5. Face flushed and mahogany color. 
6. No severe sweating until crisis. 
7. Physical signs unilateral. 
8. Breathing hurried and panting. 
9. Termination by crisis. 
DISEASES TO BE DIFFERENTIATED. 
Broncho-Pneumonia. 
6. Dulness less marked and bilateral. 
7. Rales subcrepitant and mucous. 
8. Does not terminate by crisis. 
Acute Phthisis. 
1. Begins as a bronchitis with chilly 
feeling. 
2. Affects both lungs. 
3. Sputum contains bacilli tubercu- 
losis. 
4. Temperature irregular and inter- 
mittent. 
5. Face has a hectic appearance. 
6. Profuse night sweats. 
7. Physical signs bilateral. 
8. Respiration hurried but natural. 
9. No critical days. 
Broncho-Pneumonia. Pneumonia. 
See Pneumonia, page 23. 
Broncho-Pneumonia. 
1. Often a secondary disease. 
2. Breathing panting. 
3. Temperature high. 
4. Dulness on percussion. 
5. Respiratory sounds broncho-vesicu- 
lar. 
6. Fine rales over dull areas. 
Broncho-Pneumonia. 
1. Usually a disease of children. 
Capillary Bronchitis. 
1. Disease primary. 
2. Breathing labored and hurried. 
3. Temperature not so high. 
4. Exaggerated pulmonary resonance. 
5. Respiratory sounds vesicular and 
diminished. 
6. Rales uniform all over chest. 
Acute Phthisis. 
1. Principally a disease of young 
adults. DISEASES OP THE LUNGS AND PLEURA. 
25 
DISEASES TO BE DIFFERENTIATED. 
Phthisis. 
2. Breathing quiet and hurried. 
3. Pyrexia precedes physical signs. 
4. Very rapid exhaustion and emacia- 
tion. 
5. Hemoptysis common. 
6. Sputum contains many bacilli. 
7. Physical signs most marked at 
apices. 
8. Profuse sweating. 
Atelectasis. 
1. Temperature about normal. 
2. Chest-wall retracted. 
3. Diaphragm elevated. 
4. Respiratory murmur feeble. 
5. Vocal fremitus diminished. 
6. Rales rare in collapsed lung. 
NAME OF DISEASE. 
Broncho-Pneumonia. 
2. Breathing panting and hurried. 
3. Bronchitis precedes signs of con- 
solidation. 
4. Emaciation not very rapid. 
5. No hemoptysis. 
6. No bacilli tuberculosis in sputum. 
7. Physical signs most marked in 
dependent portion of lungs, 
usually. 
8. Sweating not excessive. 
Broncho-Pneumonia. 
1. Temperature high. 
2. On inspection chest appears nor- 
mal. 
3. Diaphragm in normal position. 
4. Respiratory murmur broncho-vesic- 
ular. 
5. Vocal fremitus increased. 
6. Rales numerous and subcrepitant. 
Acute Phthisis. Pneumonia. 
See Pneumonia, page 24. 
Acute Phthisis. Broncho-Pneumonia. 
See Brone ho-Pneumonia, page 24. 
Acute Phthisis. 
1. Temperature very high and inter- 
mittent. 
2. Profuse sweats and chilly sensa- 
tions. 
Capillary Bronchitis. 
1. Temperature less high and remit- 
tent. 
2. No marked sweating or chilliness. 26 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Acute Phthisis. 
3. Emaciation very rapid. 
4. Respiration hurried without dysp- 
noea. 
5. Bacilli tuberculosis in sputum. 
6. Dulness on percussion at apex. 
7. Signs of lung consolidation. 
8. Rales marked at apices. 
Acute Phthisis. 
1. Pligh temperature, followed usually 
at night with profuse sweats and 
chilly sensations. 
2. Cough and expectoration profuse 
from the beginning. 
3. Expectoration constant. 
4. Expectoration contains tubercle 
bacilli. 
5. Signs of cavity develop gradually. 
6. No sudden improvement of patient. 
Chronic Phthisis. 
1. Sputum contains bacilli tubercu- 
losis. 
2. Profuse night sweats. 
3. Rapid emaciation. 
4. Hemoptysis common. 
5. Physical signs most marked at 
apices. 
6. Dulness on percussion. 
7. Rales subcrepitant ar 
DISEASES TO BE DIFFERENTIATED. 
Capillary Bronchitis. 
3. Emaciation less rapid. 
4. Extreme dyspnoea. 
5. No bacilli tuberculosis in sputum. 
6. Exaggerated pulmonary resonance. 
7. Lung not consolidated. 
8. Rales heard all over chest. 
Abscess of Lung. 
1. Chills, followed by fever and sweat- 
ing. 
2. Cough and expectoration profuse 
after rupture of abscess into bron- 
chii. 
3. Sudden expectoration of a large 
amount of pus. 
4. Sputum contains many pus cells. 
5. Signs of cavity develop suddenly. 
6. Patient suddenly improves after 
discharge of the abscess into bron- 
chii. 
Chronic Bronchitis. 
1. No tubercle bacilli in sputum. 
2. No profuse sweats. 
3. No rapid emaciation. 
4. Hemoptysis uncommon. 
5. Physical signs not limited to 
apices. 
6. No dulness on percussion. 
7. Rales mucous and submucous. DISEASES OF THE LUNGS AND PLEURA. 
27 
NAME OF DISEASE. 
Chronic Phthisis. 
1. Temperature more or less elevated. 
2. Hemoptysis a bright color. 
3. Heart usually normal. 
4. Sputum contains bacilli tubercu- 
losis. 
5. Symptoms come on gradually. 
6. Apices chiefly affected. 
Chronic Phthisis. 
1. Chest retracted. 
2. Pain intermittent. 
3. Patient anaemic and hectic. 
4. Disease primary. 
5. Expectoration muco-purulent. 
6. Temperature elevated. 
7. Sputum contains tubercle bacilli. 
Chronic Phthisis. 
1. Attacks any one, especially adults. 
2. Temperature elevated, especially 
3. Sputum contains tubercle bacilli. 
4. Apices principally affected. 
5. Hereditary. 
6. Hemoptysis common. 
7. Frequent signs of cavities follow- 
ing those of consolidation. 
8. Profuse night sweats. 
Capillary Bronchitis. 
1. Temperature very high. 
2. Attacks children especially. 
3. Extreme dyspnoea. 
DISEASES TO BE DIFFERENTIATED. 
Pulmonary Infarction. 
1. Temperature nearly normal. 
2. Expectorated blood dark and co- 
agulated. 
3. Advanced valvular heart disease. 
4. Sputum free from bacilli tubercu- 
losis. 
5. Symptoms appear suddenly. 
6. Lower lobes usually affected. 
Cancer of Lung. 
1. Chest bulging. 
2. Pain constant. 
3. Patient cachectic. 
4. Disease secondary. 
5. " Currant-jelly " expectoration. 
6. Temperature normal or subnor- 
mal. 
7. Sputum contains cancer cells. 
Persistent Broncho-Pneumonia. 
1. Attacks children especially. 
2. Temperature nearly normal. 
3. No tubercle bacilli in sputum. 
4. Apices not often affected. 
5. Not hereditary. 
6. No hemoptysis. 
7. No signs of cavities following 
those of consolidation. 
8. No profuse sweating. 
Acute Catarrhal Bronchitis. 
1. Temperature but moderately ele- 
vated. 
2. Attacks any one. 
3. No dyspnoea. 28 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Capillary Bronchitis. 
4.. Cyanosis common. 
Restless and feverish. 
. Rales sibilant and sonorous. 
DISEASES TO BE DIFFERENTIATED. 
Acute Catarrhal Bronchitis. 
4. No cyanosis. 
5. Patient quiet and composed. 
6. Rales mucous and submucous. 
Capillary Bronchitis. Broncho-Pneumonia. 
See Broncho-Pneumonia, page 24. 
Capillary Bronchitis. Acute Phthisis. 
See Acute Phthisis, page 26. 
Capillary Bronchitis. 
1. Temperature elevated. 
2. Expectoration tenacious. 
3. Disease primary. 
4. Exaggerated pulmonary resonance. 
CEdema of the Lungs. 
1. Temperature normal. 
2. Expectoration frothy and watery. 
3. Secondary disease. 
4. Dulness on percussion. 
Chronic Bronchitis. Chronic Phthisis. 
See Chronic Phthisis, page 26. 
Chronic Bronchitis. 
1. No dyspnoea if uncomplicated. 
2. No lung consolidation. 
3. Usually attacks adults. 
4. Vocal fremitus normal. 
5. Rales mucous and submucous. 
6. Frequent formation of bronchiec- 
tatic cavities. 
Gangrene of Lung. 
1. Sputum contains pulmonary tissue. 
2. Unilateral disease. 
3. Patient greatly prostrated. 
4. Fever, septic or hectic in character. 
5. Signs of pulmonary consolidation. 
Persistent Broncho-Pneumonia. 
1. Dyspnoea, especially upon exer- 
tion. 
2. Lung consolidated. 
3. Disease of children especially. 
4. Vocal fremitus exaggerated. 
5. Subcrepitant rales. 
6. Lung remains consolidated. 
Fetid Bronchitis. 
1. No pulmonary tissue in sputum. 
2. Disease affects both lungs. 
3. No marked prostration. 
4. Temperature normal. 
5. Bronchiectatic cavities quite com- 
mon. DISEASES OF THE LUNGS AND PLEURA. 
29 
NAME OF DISEASE. 
Gangrene of Lung. 
1. Signs of cavity follow fetid expec- 
toration. 
2. Sputum a dirty black color. 
3. Sputum contains lung tissue. 
4. Fetor has a putrefactive smell. 
Cancer of Lung. 
DISEASES TO BE DIFFERENTIATED. 
Fetid Abscess of Lung. 
1. Signs of cavity precede the fetid 
expectoration. 
2. Sputum purulent. 
3. Sputum contains numerous pus- 
cells. 
4. Fetor has a sweetish odor. 
Chronic Phthisis. 
See Chronic Phthisis, page 27. 
Cancer of Lung. 
1. Usually secondary. 
2. Cancerous cachexia. 
3. Dulness most marked above and 
in front. 
4. Dulness stationary. 
5. Areas of resonance throughout the 
dull portion of the lung. 
6. Friction sound over area of duiness. 
Emphysema. 
1. Symptoms come on gradually. 
2. Dyspnoea paroxysmal and increased 
upon exercise. 
3. Disease bilateral. 
4. Percussion sound vesiculo-tym- 
panitic. 
5. Breathing vesicular. 
6. Expiration prolonged and low- 
pitched. 
Emphysema. 
I. Vesiculo - tympanitic percussion 
note. 
Pleurisy with Effusion. 
1. Usually primary. 
2. Anaemia, but no cachexia. 
3. Dulness most marked behind and 
below. 
4. Dulness changes with position of 
patient. 
5. Uniform dulness or flatness below 
level of fluid. 
6. Absence of sound over flat area. 
Pneumothorax. 
1. Begins suddenly. 
2. Dyspnoea constant. 
3. Disease unilateral. 
4. Percussion note tympanitic. 
5. Breathing amphoric if audible. 
6. Expiratory sounds usually absent. 
Bronchial Asthma. 
1. Percussion note exaggerated. 30 
DIFFERENTIAL DIAGNOSIS OF THE 
DISEASES TO BE DIFFERENTIATED. 
Bronchial Asthma. 
2. Expiration never low-pitched. 
3. Dyspnoea only during the attack. 
4. Shape of chest normal. 
5. Heart not displaced. 
6. Attacks purely paroxysmal. 
7. Many sibilant and sonorous rales 
heard all over chest during attack. 
Spasmodic Affections of Larynx. 
1. Voice much altered. 
2. Cough and breathing stridulous. 
3. Dyspnoea inspiratory. 
4. Absence of chest rales. 
5. Ausculatory signs positive over 
larynx. 
6. Laryngoscopic examination often 
positive. 
Angina Pectoris. 
1. Lancinating pain around heart. 
2. Pulse intermittent and irregular. 
3. Patient tries not to breathe deeply. 
4. Absence of chest rales. 
NAME OF DISEASE. 
Emphysema. 
2. Prolonged low-pitched expiration. 
3. Always dyspnoea on exertion. 
4 Chest barrel-shaped. 
5. Heart displaced. 
6. Disease constant. 
7. Rales few in number, unless there 
is complicating bronchitis, and 
then mucous and submucous. 
Bronchial Asthma. 
1. No change in voice. 
2. Cough expulsive. 
3. Dyspnoea expiratory. 
4. Numerous sibilant and sonorous 
rales in chest. 
5. Ausculatory signs negative over 
larynx. 
6. Laryngoscopic examination nega- 
tive. 
Bronchial Asthma. 
1. No pain in region of heart. 
2. Pulse normal in regularity. 
3. Great difficulty in breathing. 
4. Many sibilant and sonorous rales 
in chest. 
Bronchial Asthma. Emphysema. 
See Emphysema, page 29. 
Hemoptysis. 
1. Blood liquid, bright, and frothy. 
2. Blood free from foreign matter. 
3. Sinks in water slowly. 
Hematemesis. 
I. Blood dark and coagulated. 
2 Mixed with food and bile. 
3. Sinks in water rapidly. DISEASES OF THE LUNGS AND PLEURA. 
31 
NAME OF DISEASE. 
Hemoptysis. 
4. Alkaline in reaction. 
5. Preceded by cough and other chest 
symptoms. 
6. History of lung trouble. 
7. Hemorrhage followed by great 
prostration and irritable cough. 
8. Moist rales in chest. 
Hemoptysis. 
1. Blood bright, frothy, and fluid. 
2. Attended and followed by cough. 
3. History of lung disease. 
4. Moist rales in chest. 
5. Examination of nares and pharynx 
negative. 
6. Great prostration. 
Acute Pleurisy. 
1. Temperature elevated. 
2. No tenderness over intercostal 
nerves. 
3. Pain constant and localized. 
4. No vomiting or herpetic eruption. 
5. Friction sound heard on ausculta- 
tion. 
DISEASES TO BE DIFFERENTIATED. 
Hematemesis. 
4. Acid in reaction. 
5. Preceded by vomiting and pain in 
stomach. 
6. History of gastric disturbance. 
7. Not followed by cough or great 
prostration. 
8. Absence of chest rales. 
Epistaxis. 
1. Blood coagulated and dark. 
2. No cough. 
3. No history of lung trouble. 
4. Absence of chest rales. 
5. Examination of nares and pharynx 
positive. 
6. No great prostration. 
Intercostal Neuralgia. 
1. Temperature normal. 
2. Intercostal nerves tender upon pres- 
sure. 
3. Pain shooting and intermittent. 
4. Vomiting and herpes zoster com- 
mon. 
5. No friction sound heard on auscul- 
tation. 
Acute Pleurisy. Pneumonia. 
See Pneumonia, page 23. 
Acute Pleurisy. Acute Pericarditis. 
See Acute Pericarditis, page 39. 
Acute Pleurisy. Perihepatitis. 
See Perihepatitis, page 85. 32 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. 
Pleurisy with Effusion. Pneumonia. 
See Pneumonia, page 23. 
Pleurisy with Effusion. Cancer of Lung. 
See Cancer of Lung, page 29. 
Pleurisy with Effusion. 
1. Begins acutely with pain, fever, 
etc. 
2. Quite rapid emaciation and loss of 
health. 
3. Effusion produced rapidly. 
4. Flatness on percussion changes 
with position of patient. 
5. Fluid obtained by puncture con- 
tains no booklets. 
Pleurisy with Effusion. 
1. Affects one side. 
2. Primary disease. 
3. Temperature elevated. 
4. Pain in side. 
5. No general dropsy. 
Hydatids of Lung. 
1. Begins slowly and insidiously. 
2. Health but slowly undermined. 
3. Effusion forms slowly. 
4. Flatness on percussion not much 
changed by position of patient. 
5. Fluid contains characteristic hook- 
lets. 
Hydrothorax. 
1. Affects both sides. 
2. Secondary disease. 
3. Temperature normal. 
4. No pain in side. 
5. General dropsy. 
Pleurisy with Effusion. Empyema. 
See Empyema, page 33. 
Pneumothorax. Emphysema. 
See Emphysema, page 29. 
Pneumothorax. 
1. Developed suddenly. 
2. Severe dyspnoea. 
3. Bulging of intercostal spaces. 
4. Heart displaced. 
5. Vocal fremitus diminished or ab- 
sent. 
Phthisical Cavities. 
1. Developed slowly. 
2. Dyspnoea not severe. 
3. Chest wall generally retracted. 
4. Heart in normal position. 
5. Vocal fremitus increased. DISEASES OF THE LUNGS AND PLEURA. 
33 
NAME OF DISEASE. 
Pueumothorax. 
6. Physical signs heard all over af- 
fected side. 
7. Succussion of fluid is present. 
8. Absence of rales. 
DISEASES TO BE DIFFERENTIATED. 
Phthisical Cavities. 
6. Physical signs usually limited to 
apices. 
7. No succussion. 
8 Gurgling rales at apices. 
Empyema (pulsating). Thoracic Aneurism. 
See Thoracic Aneurism, page 48. 
Empyema. Abscess of Liver. 
See Abscess of Liver, page 80. 
Empyema. 
1. Usually a history of previous dis- 
ease, as pleurisy, phthisis, general 
debility, etc. 
2. Constitutional symptoms well 
marked. 
3. Temperature often reaches 105°. 
4. Chills and profuse sweats common. 
5. Fluid remains unless it is with- 
drawn. 
6. Exploring needle withdraws pus. 
7. Whispered pectoriloquy sometimes 
heard below the level of the fluid. 
Pleurisy with Effusion. 
1. History of an acute attack follow- 
ing exposure to wet ,cold, etc. 
2. General condition remains quite 
good. 
3. Temperature seldom over 102°. 
4. No chills or sweats. 
5. Fluid disappears under appropriate 
medical treatment. 
6. Exploring needle withdraws serum. 
7. Absence of voice sounds below the 
level of the fluid. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE HEART AND BLOOD-VESSELS. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE HEART AND BLOOD-VESSELS. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Acute pericarditis 
Acute endocarditis. 
Acute pleurisy. 
Cardiac enlargement. 
Endocarditis 
Acute pericarditis. 
Functional heart murumrs. 
Typhoid fever. 
Pyaemia. 
Ulcerative endocarditis 
Cardiac dilatation. 
Displacement of heart. 
Acute pericarditis. 
Thoracic aneurism. 
Consolidation of lung tissue 
Cardiac hypertrophy 
Fatty heart 
Cardiac dilatation. 
Palpitation of heart (nervous) 
Organic heart disease. 
Bronchial asthma. 
Hysteria. 
Intercostal neuralgia. 
Thoracic aneurism. 
Angina pectoris 
Exophthalmic goitre 
37 
Cystic goitre with heart disease. 38 
DIFFERENTIAL DIAGNOSIS OF THE 
CARDIAC MURMURS. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Mitral regurgitation. 
Tricuspid regurgitation. 
Anaemic bruit. 
Thoracic aneurism. 
Aortic regurgitation. 
Aortic obstructive 
Aortic obstructive. 
Mitral obstructive. 
Pulmonary regurgitation. 
Thoracic aneurism. 
Aortic regurgitation 
Mitral obstructive 
Mitral regurgitation. 
Aortic regurgitation. 
Mitral regurgitation 
Aortic obstructive. 
Mitral obstructive. 
Tricuspid regurgitation. 
ANEURISMS. 
Pulsation of aorta. 
Abdominal tumors. 
Psoas abscess. 
Abdominal aneurisms 
Aortic obstructive. 
Aortic regurgitation. 
Cancer of pleura. 
Chronic laryngitis. 
Pulsating empyema. 
Dilated heart. 
Angina pectoris. 
Thoracic aneurism DISEASES OF THE HEART AND BLOOD-VESSELS. 
39 
NAME OF DISEASE. 
Acute Pericarditis. 
1. Superficial friction sound. 
2. Murmurs have limited areas of 
diffusion. 
3. Murmurs intensified by inclination 
of body. 
4. Murmurs intensified by taking a 
full inspiration. 
5. Murmurs not necessarily synchro- 
nous with the heart-sounds. 
6. Heart-impulse wavy and feeble. 
7. In stage of effusion, extended peri- 
cordial dulness. 
8. Murmurs disappear with the effu- 
sion, to return again with the 
absorption of the effusion. 
Acute Pericarditis. 
1. Pain not severe. 
2. Pain not affected by respiration. 
3. Pulse feeble and irritable. 
4. Friction sound constant until effu- 
sion takes place. 
Acute Pericarditis 
(with effusion). 
1. Disease developed suddenly. 
2. There is or has been a friction 
sound present. 
3. Outline of dulness, triangular. 
4. Cardiac dulness extends to the left 
of apex beat. 
5. Heart-sounds indistinct and feeble. 
DISEASES TO BE DIFFERENTIATED. 
Acute Endocarditis. 
1. Deep blowing sound. 
2. Murmurs have wide areas of 
diffusion. 
3. Position of body does not influ- 
ence the intensity of the mur- 
murs. 
4. Murmurs not increased in loud- 
ness by a full inspiration. 
5. Murmurs synchronous with the 
heart-sounds. 
6. Heart-impulse strong. 
7. No extended pericordial dul- 
ness. 
8. Murmurs constant. 
Acute Pleurisy. 
1. Pain sharp and cutting. 
2. Increased by inspiration. 
3. Pulse regular and strong. 
4. Friction sound ceases by holding 
the breath. 
Cardiac Enlargement 
(hypertrophy or dilatation). 
1. Disease developed slowly. 
2. No friction sound. 
3. Outline of dulness, quadrilateral. 
4. Dulness does not extend beyond 
apex beat. 
5. Heart-sounds distinct, however 
feeble or strong. 40 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Endocarditis. Acute Pericarditis. 
See Acute Pericarditis, page 39. 
Endocarditis. 
1. Signs of obstructed circulation. 
2. Cardiac hypertrophy or dilatation. 
3. Patient often robust. 
4. Murmurs most frequent at apex. 
5. Murmurs constant. 
6. Murmurs do not disappear under 
treatment. 
Ulcerative Endocarditis. 
1. Often rheumatic origin. 
2. Temperature fluctuating. 
3. Disease develops rapidly. 
4. Cardiac murmurs present. 
5. Frequent signs of embolus. 
6. Petechial eruption on body. 
7. No characteristic diarrhoea or nose- 
bleed. 
Ulcerative Endocarditis. 
1. Often of rheumatic origin. 
2. Cardiac murmurs present. 
3. Confusion of mind followed by de- 
lirium 
4. Petechial eruption. 
5. Sour breath 
Cardiac Hypertrophy. 
1. Pulse full and bounding. 
2. Face flushed. 
Functional Heart Murmurs. 
1. No obstructed circulation. 
2. No cardiac enlargement. 
3. Patient ansemic and feeble. 
4. Murmurs most frequent at base. 
5. Murmurs intermittent. 
6. Murmurs disappear under appro- 
priate treatment. 
Typhoid Fever. 
1. No history of rheumatism. 
2. Weekly characteristic tempera- 
tures. 
3. Disease develops slowly. 
4. No cardiac murmurs. 
5. Signs of emboli uncommon. 
6. Rose-colored lenticular spots on 
abdomen. 
7. Characteristic diarrhoea and nose- 
bleed. 
Pyaemia. 
1. History of surgical injury, or dis- 
ease. 
2. No cardiac murmurs. 
3. Mind at first clear, and then fol- 
lowed by stupor. 
4. Skin deeply jaundiced. 
5. Sweet breath. 
Cardiac Dilatation. 
1. Pulse weak and feeble. 
2. Face pale and livid. DISEASES ur rrtE HEART AND BLOOD-VESSELS. 
41 
NAME OF DISEASE. 
Cardiac Hypertrophy. 
3. Beating carotids. 
4. Apex-beat distinct and forcible. 
5. Heart-sounds intensified. 
6. First sound prolonged and intensi- 
fied. 
Cardiac Hypertrophy. 
1. Subjective symptoms, as cerebral 
hyperaemia. 
2. Heaving cardiac impulse. 
3. Increase of area of cardiac dul- 
ness. 
4. Change in character and intensity 
of heart-sounds. 
DISEASES TO BE DIFFERENTIATED. 
Cardiac Dilatation. 
3. Veins turgid. 
4. Apex-beat indistinct and feeble. 
5. Heart-sounds enfeebled. 
6. First sound indistinct, short, and 
resembles the second sound. 
Displacement of Heart. 
1. No subjective heart-symptoms. 
2. Cardiac impulse normal. 
3. No increase of heart-dulness. 
4. Normal heart-sounds. 
Cardiac Hypertrophy. Acute Pericarditis. 
See Acute Pericarditis, page 39. 
Cardiac Hypertrophy. 
1. No pain in the back. 
2. No dysphagia. 
3. Face flushed, cerebral hyperaemia. 
4. Area of heart - dulness increased 
laterally and downward. 
5. Heaving cardiac impulse. 
6. No thrill or bruit. 
Cardiac Hypertrophy 
1. Pulse full and tense. 
2. Altered first sound. 
3. Outline of cardiac dulness, quadri- 
lateral. 
4. No bronchial voice or breathing. 
5. Absence of rales, 
Thoracic Aneurism. 
1. Boring pain in dorsal spine. 
2. Dysphagia common. 
3. Face pale or livid-cerebral con- 
gestion. 
4. Heart-dulness increased upward. 
5. Impulse, dilating. 
6. Aneurismal thrill and bruit. 
Consolidation of Lung Tissue. 
1. Pulse weak. 
2. Heart's sound normal. 
3. Outline of dulness, irregular. 
4. Bronchial voice and breathing. 
5. Moist rales, 42 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Fatty Heart. 
1. Pulse irregular. 
2. Area of dulness not increased. 
3. Absence of first sound. 
4. No cardiac murmur. 
5. Cheyne-Stokes respiration. 
6. Marked cerebral symptoms. 
Organic Heart Disease. 
(Cardiac palpitation.) 
1. Comes on gradually. 
2. Causes, rheumatism, syphilis, etc. 
3. No distinct paroxysms. 
4. Increased by exercise. 
5. Patient not uneasy or worried. 
6. Often accompanied by cyanosis. 
7. Cardiac murmurs present. 
DISEASES TO BE DIFFERENTIATED. 
Dilatation of Heart. 
1. Pulse regular. 
2. Area of dulness increased. 
3. Enfeebled first sound. 
4. Cardiac murmurs common. 
5. Respiration normal, or hurried. 
6. No cerebral symptoms. 
Functional Heart Disease. 
(Cardiac palpitation.) 
1. Comes on suddenly. 
2. Causes, emotion, indigestion, to- 
bacco, etc. 
3. Distinctly paroxysmal. 
4. Increased by a sedentary life. 
5. Patient very uneasy and worried. 
6. No cyanosis. 
7. No cardiac murmurs. 
Angina Pectoris. Bronchial Asthma. 
See Bronchial Asthma, page 30. 
Angina Pectoris. 
1. Lancinating pain in side. 
2. Pulse feeble and irregular. 
3. Patient conscious and quiet. 
4. History of cardiac disease. 
5. Cardiac murmurs present. 
Angina Pectoris. 
1. History of cardiac disease. 
2. Attack quickly over. 
3. No external tenderness. 
4. Pain unilateral. 
Hysteria. 
1. Globus hysteria. 
2. Pulse strong and regular. 
3. Patient has convulsions and semi- 
coma. 
4. History of hysteria. 
5. No cardiac murmurs. 
Intercostal Neuralgia. 
1. History of neuralgic attacks. 
2. Attack lasts for some time. 
3. Marked external tenderness. 
4. Pain often bilateral. DISEASES OF THE HEART AND BLOOD-VESSELS. 
43 
NAME OF DISEASE. 
Angina Pectoris. 
5. Cardiac disturbance-feeble and 
irregular action of heart. 
6. No herpetic eruption follows the 
attack. 
Angina Pectoris. 
1. Pain referred to front of chest. 
2. Pain paroxysmal and lancinating. 
3. Pulse irregular and intermittent. 
4. Heart diseased. 
5. No thoracic pulsating tumor. 
6. Respiration shallow and catching. 
Exophthalmic Goitre. 
1. Paroxysmal enlargement of dis- 
eased thyroid gland. 
2. Thyroid very elastic. 
3. Eyes have lustrous appearance and 
marked by exophthalmus. 
4. No cardiac murmur. 
5. Cardiac palpitation paroxysmal. 
Aortic Obstruction. 
1. Pulse hard and wiry but regular. 
2. Subjective symptoms are cerebral 
in character. 
3. Murmur harsh. 
4. Loudest at base. 
5. Conveyed into vessels of neck. 
6. Pulmonic second sound feeble. 
DISEASES TO BE DIFFERENTIATED. 
Intercostal Neuralgia. 
5. Heart normal. 
6. Attack often followed by herpes 
zoster. 
Thoracic Aneurism. 
1. Pain referred to back. 
2. Pain quite constant and boring. 
3. Pulse regular, but often unlike at 
the wrists. 
4. Heart normal. 
5. Pulsating thoracic tumor. 
6. Respiration hurried and difficult. 
Cystic Goitre with Cardiac Dis- 
ease. 
1. Thyroid remains enlarged without 
fluctuating in size. 
2. Thyroid less elastic. 
3. Eyes have a dull appearance with- 
out great, exophthalmus. 
4. Cardiac murmurs present. 
6. Palpitation of the heart not strict- 
ly paroxysmal. 
Mitral Regurgitation. 
1. Pulse compressible and irregular. 
2. Subjective symptoms are pulmon- 
ary, renal, interstitial, etc. 
3. Murmur soft. 
4. Loudest at apex. 
5. Conveyed to the left and behind. 
6. Pulmonic second sound intensi- 
fied. 44 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Aortic Obstruction. 
1. No venous pulsation. 
2. Hypertrophy of left heart. 
3. Murmur heard loudest at second 
costo-sternal articulation. 
4. Conveyed upward into carotids. 
Aortic Obstruction. 
1. Pulse hard and wiry. 
2. Patient often robust. 
3. Cardiac hypertrophy. 
4. Murmurs loudest over base. 
5. Murmur harsh in character. 
6. No venous hum. 
Aortic Obstruction. 
1. No pain. 
2. Having apical impulse. 
3. No dilating impulse on palpitation. 
4. Bruit single. 
5. Pulse the same at both wrists. 
6. Sphygmographic tracings diag- 
nostic. 
7. No laryngeal or, oesophageal sub- 
jective symptoms. 
Aortic Obstruction. 
1. Hard, small wiry pulse. 
2. Systolic murmur. 
3. Conveyed upward into carotids. 
4. No capillary pulsation. 
Aortic Regurgitation. 
I. No well marked pulmonary symp- 
tons. 
DISEASES TO BE DIFFERENTIATED. 
Tricuspid Regurgitation. 
1. Pulsation of jugular. 
2. Hypertrophy of right heart. 
3. Murmur heard loudest over lower 
part of sternum. 
4. Murmur seldom heard above the 
third rib. 
Anaemic Bruit. 
1. Pulse soft and compressible. 
2. Patient always anaemic. 
3. Small heart. 
4. Murmur loudest in carotids. 
5. Murmur soft and blowing. 
6. Loud venous hum. 
Thoracic Aneurism. 
1. Boring pain in back and chest. 
2. Normal apical impulse. 
3. Dilating impulse over aneurism. 
4. Bruit double. 
5. Pulse often different at the two 
wrists. 
6. Sphygmographic tracings often 
differ at the wrists. 
7. Subjective laryngeal and oesopha- 
geal symptoms common. 
Aortic Regurgitation. 
1. " Shot " pulse. 
2. Murmur diastolic. 
3. Conveyed downward to xiphoid. 
4. Capillary pulsation. 
Mitral Obstruction. 
1. Pulmonary symptoms well marked 
upon exercise. DISEASES OF THE HEART AND BLOOD-VESSELS. 
45 
NAME OF DISEASE. 
Aortic Regurgitation. 
2. " Shot " pulse. 
3. Capillary pulsation seen at fundus, 
of eye and under nails. 
4. Murmur diastolic. 
5. Murmur soft and musical. 
6. Murmur very diffuse. 
7. No purring thrill. 
8. Left ventricle hypertrophied. 
Aortic Regurgitation. 
1. " Shot " pulse. 
2. Capillary pulsation. 
3. Left ventricle hypertrophied. 
4. Murmur heard with maximum in- 
tensity, at right second intercostal 
space, or at xiphoid cartilage. 
Aortic Regurgitation. 
1. " Shot" pulse. 
2. Capillary pulsation. 
3. Cardiac hypertrophy. 
4. Diastolic murmur. 
5. Murmur transmitted downward. 
DISEASES TO BE DIFFERENTIATED. 
Mitral Obstruction. 
2. Pulse soft and full. 
3. No capillary pulsation. 
4. Murmur presystolic. 
5. Murmur grating and blubbering. 
6. Murmur limited. 
7. Purring thrill. 
8. No ventricular hypertrophy. 
Pulmonary Regurgitation. 
1. Pulse soft. 
2. No capillary pulsation. 
3. Right ventricle hypertrophied. 
4. Murmur heard with greatest inten- 
sity at the left second intercostal 
space. 
Thoracic Aneurism. 
(Sinus of valsalva.) 
1. Pulse feeble and compressible. 
2. No capillary pulsation. 
3. Cardiac degeneration. 
4. Systolic aneurismal murmur. 
5. Murmur never transmitted toward 
apex. 
Aortic Regurgitation. Aortic Obstruction. 
See Aortic Obstruction, page 44. 
Mitral Obstruction Aortic Regurgitation. 
See Aortic Regurgitation, page 44. 
Mitral Obstruction. 
1. Murmur diastolic. 
2. Murmur of limited area. 
Mitral Regurgitation. 
1. Murmur presystolic. 
2, Conveyed around to the back. 46 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Mitral Obstruction. 
3. Murmur blubbering in character. 
4. Heard loudest above apex. 
5. Purring thrill. 
DISEASES TO BE DIFFERENTIATED. 
Mitral Regurgitation. 
3. Murmur soft and blowing. 
4. Heard loudest at apex. 
5. No thrill. 
Mitral Regurgitation. Aortic Obstruction. 
See Aortic Obstruction, page 43. 
Mitral Regurgitation. Mitral Obstruction. 
See Mitral Obstruction, page 45. 
Mitral Regurgitation. 
1. Pulmonary symptoms prominent. 
3. Murmur loudest at apex. 
2. Murmur conveyed to the left. 
4. Pulmonary second sound intensi- 
fied. 
5. No venous pulsation. 
Abdominal Aneurism. 
1. Deep boring pain in back and 
shooting down the thighs. 
2. Throbbing localized in a pulsating 
tumor. 
3. Expansive pulsation of tumor. 
4. Double murmur. 
5. Marked thrill. 
Abdominal Aneurism. 
1. Health good. 
2. Tumor has an expansive pulsation. 
3. Impulse not lessened by knee- 
chest position. 
4. Tumor not movable. 
Tricuspid Regurgitation. 
1. No pulmonary symptoms. 
2. Murmur loudest near xiphoid. 
3. Transmitted upward and to the 
right. 
4. Pulmonary second sound infeebled. 
5. Jugular pulsation. 
Pulsating Aorta. 
1. Absence of pain. 
2. Throbbing felt along whole course 
of the aorta. 
3. Pulsation sudden and jerky. 
4. No murmur. 
5. No thrill. 
Pulsating Abdominal Tumors. 
1. General health poor. 
2. Tumor has a forward pulsation. 
3. Impulse lessened by the knee- 
chest position. 
4. Tumor usually movable. DISEASES OF THE HEART AND BLOOD-VESSELS. 
47 
NAME OF DISEASE. 
Abdominal Aneurism. 
t Boring pain, and darting down the 
thighs. 
6. Marked thrill. 
7. Double murmur. 
Abdominal Aneurism. 
1. Disease of spine secondary. 
2. Expansive pulsating tumor. 
3. Well marked thrill. 
4. Double murmur. 
5. No fluctuation. 
6. No difficulty in walking. 
7. Temperature normal. 
DISEASES TO BE DIFFERENTIATED. 
Pulsating Abdominal Tumors. 
5. Pain usually dull and not neuralgic 
in character. 
6. No thrill. 
7. No murmur-if any, single. 
Psoas Abscess. 
1. Disease of spine primary. 
2. No expansive pulsating tumor. 
3. No thrill. 
4. No murmur. 
5. Deep fluctuation. 
6. Often great difficulty in walking 
due to pain and flexion of thigh. 
7. Temperature often elevated. 
Thoracic Aneurism. Aortic Obstruction. 
See Aortic Obstruction, page 44. 
Thoracic Aneurism. Aortic Regurgitation. 
See Aortic Regurgitation, page 44. 
Thoracic Aneurism. Cardiac Hypertrophy. 
See Cardiac Hypertrophy, page 41. 
Thoracic Aneurism. Angina Pectoris. 
See Angina Pectoris, page 43. 
Thoracic Aneurism. 
1. Not hereditary, or secondary. 
2. Pain wandering and not constant. 
3. Pain increased by excited heart's 
action. 
4. Pulse at two wrists often unlike. 
5. No enlarged glands in neck or ax- 
illa. 
Cancer of Pleura. 
1. Hereditary or secondary. 
2. Pain constant. 
3. Pain not increased by over-action 
of the heart. 
4. Pulse at the wrists alike. 
5. Enlarged cervical and axillary 
veins and glands. 48 
DISEASES OF THE HEART AND BLOOD-VESSELS. 
NAME OF DISEASE. 
Thoracic Aneurism. 
6. Expansive pulsation. 
7. Double murmur. 
8. Well-marked thrill. 
9. Subjective sense of throbbing. 
Thoracic Aneurism. 
1. Pain wandering. 
2. No chills, fever, or sweating. 
3. Heart in normal position. 
4. Double murmur. 
5. Well-marked thrill. 
6. Exploring needle withdraws blood. 
Thoracic Aneurism. 
1. Pain in chest. 
2. Pulsating tumor in chest. 
3. Double murmur and thrill. 
4. Cough, paroxysmal and ringing. 
5. Voice not uniformly changed in 
character. 
6. Stridulous voice and breathing 
come on suddenly and are parox- 
ysmal. 
7. Laryngoscopic examination shows 
spasm of vocal cords. 
DISEASES TO BE DIFFERENTIATED. 
Cancer of Pleura. 
6. No expansive pulsation. 
7. No double murmur. 
8. No thrill. 
9. No throbbing sensations. 
Pulsating Empyema. 
1. Pain stationary. 
2. Chills, fever, and sweating. 
3. Heart pushed to one side. 
4. No murmur. 
5. No thrill. 
6. Exploring needle withdraws pus. 
Chronic Laryngitis. 
1. Pain referred to larynx. 
2. No tumor in chest. 
3. No murmur or thrill. 
4. Cough more constant and stridu- 
lous. 
5. Voice always changed. 
6. Change in .voice and breathing less 
paroxysmal in character. 
7. Laryngeal examination shows dis- 
ease of larynx. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE DIGESTIVE TRACT AND PERITONEUM. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE DIGESTIVE TRACT AND PERITONEUM. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Cancer of the oesophagus 
Organic stricture. 
Hysterical stricture. 
Acute gastritis 
Toxic gastritis. 
Acute peritonitis. 
"Acute gastritis. 
Acute peritonitis. 
Acute enteritis. 
Cholera morbus. 
_ Cholera. 
Toxic gastritis 
Dyspepsia. 
Ulcer of stomach. 
Cancer of stomach. 
Chronic gastritis 
Chronic gastritis. 
Acid fermentation. 
Cerebral vertigo. 
Gastric dyspepsia 
Chronic gastritis. 
Ulcer of stomach. 
Abdominal aneurism. 
Cancer of liver. 
Cancer of stomach 
Ulcer of stomach 
Chronic gastritis. 
Cancer of stomach. 
Cardialgia. 
51 52 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Hematemesis Hemoptysis. 
Acute poisoning. 
Acute peritonitis. 
Cholera morbus. 
Typhoid fever. 
Acute enteritis . 
Acute enteritis. 
Asiatic cholera. 
Acute poisoning. 
Cholera morbus 
Cholera infantum 
Enteritis of children. 
Hydrocephalus. 
Diarrhoea with hemorrhoids, 
Proctitis. 
Cancer of rectum. 
Dysentery 
Typhlitis. 
Cancer of caecum. 
Distension of caecum. 
Psoas abscess. 
Intussusception. 
Perityphlitis 
Intestinal colic. 
Peritonitis. 
Hepatic colic. 
Renal colic. 
Chronic constipation. 
Intestinal obstruction 
Tubercular enteritis 
Tubercular meningitis. 
Tubercular peritonitis, 
Floating kidney. 
Proctitis. 
Perityphlitis. 
Hemorrhoids. 
Cancer of intestine 
Proctitis 
Periproctitis. 
Cancer of intestine. 
Dysentery. 
Hemorrhoids, DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
53 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Proctitis. 
Dysentery. 
Cancer of rectum. 
Intestinal hemorrhage. 
Hemorrhoids 
Acute peritonitis. 
Intestinal obstruction. 
Hepatic colic. 
Renal colic. 
Intestinal perforation. 
Muscular rheumatism. 
Uterine colic. 
Intestinal colic 
' Acute enteritis. 
Intestinal colic. 
Hysteria. 
Renal or hepatic colic. 
Acute gastritis. 
Intestinal obstruction. 
. Acute poisoning. 
Acute peritonitis 
Chronic peritonitis 
Tuberculous peritonitis. 
Cancerous peritonitis. 
Ascites. 
Cancer of peritoneum. 
Chronic peritonitis. 
Tubercular enteritis. 
Tuberculous peritonitis 
Ovarian dropsy. 
Distended bladder. 
Hydatids of liver. 
Pregnancy. 
Chronic peritonitis. 
„ Cirrhosis of the liver. 
Ascites 
Cancer of (Esophagus. 
1. History of hereditary cancer. 
2. Pain constant. 
Simple Organic Stricture. 
1. History of injury or inflammation 
of oesophagus. 
2. Pain inconstant. 54 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Cancer of CEsophagus. 
3. Pain increased by taking food. 
4. Cervical glands enlarged. 
5. Flemorrhage common. 
6. Lungs affected. 
7. Bougie brings up cancerous shreds. 
Cancer of CEsophagus. 
1. History of hereditary cancer. 
2. Comes on gradually. 
3. Greatest difficulty in swallowing 
solids. 
4. Cancerous cachexia. 
5. Lungs affected. 
6. Bougie meets with stricture. 
Acute Gastritis. 
1. Temperature elevated. 
2. Bowels usually constipated. 
3. Mouth and pharynx normal. 
4. Symptoms not very severe at first. 
5. Symptoms do not usually appear 
within an hour after eating. 
6. No blood with vomited matter. 
7. No severe prostration. 
8. No poison in vomited matter. 
DISEASES TO BE DIFFERENTIATED. 
Simple Organic Stricture. 
3. But slightly increased by swallow- 
ing. 
4. Glands not enlarged. 
5. No hemorrhage. 
6. Lungs not affected. 
7. Bougie simply meets with an ob- 
struction. 
Hysterical (Esophageal Stricture. 
1. History of hysteria. 
2. Begins suddenly. 
3. Equally as difficult to swallow 
liquids as solids. 
4. No cachexia. 
5. Lungs not affected. 
6. Bougie passes directly into stomach. 
Toxic Gastritis. 
1. Temperature often subnormal. 
2. Diarrhoea. 
3. Mouth and pharynx congested. 
4. Symptoms severe from the begin- 
ning. 
5. Symptoms make their appearance 
within an hour after eating. 
6. Bloody mucus mixed with the 
vomited matter. 
7. Great prostration and collapse. 
8. Vomited matter contains poison. 
Acute Gastritis. Acute Peritonitis. 
See Acute Peritonitis, page 69. 
Toxic Gastritis. 
(Acute poisoning.) 
Acute Gastritis. 
See Acute Gastritis, above. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
55 
NAME OF DISEASE. 
Toxic Gastritis. Acute Peritonitis. 
See Acute Peritonitis, page 69. 
Toxic Gastritis. Acute Enteritis. 
See Acute Enteritis, page 58. 
Toxic Gastritis. Cholera Morbus. 
See Cholera Morbus, page 59. 
Toxic Gastritis. Cholera. 
See Cholera, page 120. 
DISEASES TO BE DIFFERENTIATED. 
Chronic Gastritis. 
1. Disease secondary. 
2. Associated with chronic alcoholism, 
renal, hepatic, or thoracic disease. 
3. Pain and tenderness in epigastric 
region. 
4. Tongue always coated. 
5. Constant thirst. 
6. Frequent vomiting. 
7. Stimulating ingesta aggravate the 
symptoms. 
8. Many deposits in urine. 
Chronic Gastritis. 
1. Secondary disease of the heart, 
liver, or kidneys. 
2. Pain slightly increased by taking 
food. 
3. Constant thirst. 
4. Tongue greatly coated. 
5. Vomiting most frequent in early 
morning. 
6. Hematemesis rare. 
7. Common disease of adults and 
elderly people. 
8. No rapid emaciation. 
g. Deep pressure causes dull pain. 
Dyspepsia. 
1. Disease primary. 
2. Dependent upon the habits of life. 
3. Little or no epigastric pain and 
tenderness. 
4. Tongue pale and flabby. 
5. Moderate thirst. 
6. Vomiting infrequent. 
7. Spices, etc., often relieve the 
symptoms. 
8. Urine natural in appearance. 
Ulcer of Stomach. 
1. Disease primary. 
2. Pain greatly increased by taking 
food. 
3. No thirst. 
4. Tongue red and glazed. 
5. Vomiting occurs after eating. 
6. Hematemesis common. 
7. Common in young adults, especial- 
ly females. 
8. Emaciation rapid. 
9. Deep pressure causes sharp pain. 56 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Chronic Gastritis. 
1. Usually a secondary disease. 
2. Pain constant and moderate. 
3. Pain increased by taking food. 
4. Some tenderness on pressure. 
5. Vomiting occasional. 
6. Hematemesis rare. 
7. No tumor in epigastric region. 
8. No enlarged cervical glands. 
9. No cachexia. 
10. Temperature normal. 
Gastric Dyspepsia. 
1. Pain follows taking food imme- 
diately ; or, 
2. Pain occurs when the stomach is 
empty, and relieved by taking 
food. 
3. Vomiting common. 
4. Mental and constitutional symp- 
toms not marked. 
5. Flatulence uncommon. 
6. No sarcince in vomited matter. 
Gastric Dyspepsia. 
(Vertigo.) 
1. History of dyspepsia. 
2. Consciousness never lost. 
3. Special senses (except eyes) not 
affected. 
4. Patient knows that the motion of 
surrounding objects is unreal. 
DISEASES TO BE DIFFERENTIATED. 
Cancer of Stomach. 
1. Disease hereditary. 
2. Pain constant and severe, at 
times. 
3. Pain not increased by taking food. 
4. No tenderness on pressure. 
5. Vomiting frequent. 
6. Hematemesis common. 
7. Tumor felt in epigastric region. 
8. Cervical glands enlarged. 
9. Marked cachexia. 
10. Attacks of moderate fever. 
Acid Fermentation. 
1. Pain comes on sometimes after 
eating. 
2. Pain never occurs with an empty 
stomach. 
3. Vomiting uncommon. 
4. Mental and constitutional symp- 
toms well marked. 
5. Flatulence common. 
6. Sarcinae present in vomited matter. 
Cerebral Vertigo. 
1. History of mental disorder. 
2. Consciousness lost at times. 
3. Special senses affected. 
4. Movement of surrounding objects 
seems real. 
Gastric Dyspepsia. Chronic Gastritis. 
See Chronic Gastritis, page 55. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
57 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Cancer of Stomach. Chronic Gastritis. 
See Chronic Gastritis, page 56. 
Cancer of Stomach. 
1. History of hereditary cancer. 
2. Occurs in people over forty years 
of age. 
3. Pain constant and lancinating. 
4. Deep pressure not painful. 
5. Hematemesis small in amount and 
" coffee grounds " in appear- 
ance. 
6. Vomiting appears late in the dis- 
ease. 
7. Vomiting does not relieve the 
pain. 
8. Cancerous cachexia. 
9. Presence of tumor in epigastric 
region. 
Ulcer of Stomach. 
1. History of anaemia or chlorosis. 
2. Occurs usually in young adults. 
3. Pain intermittent - worse after 
eating. 
4. Deep pressure very painful. 
5. Hematemesis bright red and large 
in amount. 
6. Vomiting is one of the first symp- 
toms. 
7. Vomiting relieves the pain. 
8. Anaemia. 
9. No tumor in region of stomach. 
Cancer of Stomach. Abdominal Aneurism. 
See Abdominal Aneurism, page 46. 
Cancer of Stomach. Cancer of Liver. 
See Cancer of Liver, page 83. 
Ulcer of Stomach. Chronic Gastritis. 
See Chronic Gastritis, page 55. 
Ulcer of Stomach. Cancer of Stomach. 
See Cancer of Stomach, above. 
Ulcer of Stomach. 
1. History of anaemia. 
2. Pain increased by taking food. 
3. Pain increased by deep pressure. 
Cardialgia. 
1. History of neuralgia. 
2. Pain not increased by eating. 
3. Pain diminished by deep pressure. 58 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE 
Ulcer of Stomach. 
4. Electricity increases the pain. 
5. Hematemesis common. 
6. Gastric disturbance constantly 
present. 
DISEASES TO BE DIFFERENTIATED. 
Cardialgia. 
4. Pain relieved by electricity. 
5. No hematemesis. 
6. Gastric symptoms only present 
during the attack. 
Hematemesis. Hemoptysis. 
See Hemoptysis, page 30. 
Acute Enteritis. 
1. Onset comparatively slow. 
2. Gastric symptoms not severe. 
•3. Intestinal symptoms first to make 
their appearance. 
4. Temperature elevated. 
5. No vomiting of blood. 
6. Prostration not severe. 
7. Vomited matter free from poison. 
8. Mouth and pharynx normal. 
Acute Enteritis. 
1. Onset comparatively slow. 
2. Temperature high. 
3. Diarrhoea. 
4. Abdomen but slightly tympanitic. 
5. Pulse feeble and rapid. 
6. Vomited matter not characteristic. 
7. Abdomno-thoracic breathing. 
8. No severe prostration or collapse. 
Acute Enteritis. 
1. Onset, comparatively slow. 
2. Temperature high. 
3. Occasional attacks of diarrhoea and 
vomiting. 
Acute Poisoning. 
1. Onset sudden. 
2. Very severe gastric symptoms. 
3. Gastric symptoms first to make 
their appearance. 
4. Temperature often subnormal. 
5. Vomiting of bloody mucus. 
6. Great prostration. 
7. Vomited matter contains poison. 
8. Mouth and pharynx often congested 
and glazed. 
Acute Peritonitis. 
1. Onset sudden-usually with a chill. 
2. Temperature moderate. 
3. Obstinate constipation. 
4. Abdomen very tympanitic. 
5. Pulse tense and wiry. 
6. Vomited matter spinach green. 
7. Thoracic breathing. 
8. Great prostration and collapse. 
Cholera Morbus. 
1. Onset sudden-usually at night. 
2. Temperature normal or subnor- 
mal. 
3. Constant vomiting and purging. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
59 
NAME OF DISEASE. 
Acute Enteritis. 
4. No severe cramps in legs. 
5. No rapid prostration or collapse. 
6. Disease lasts a week or more. 
Acute Enteritis. 
1. Gastro-intestinal symptoms precede 
the febrile movement. 
2. Temperature not characteristic. 
3. No nose bleed. 
4. No eruption. 
5. Pain most severe in umbilical re- 
gion. 
6. No gurgling in iliac fossa. 
7. Recovery at the end of a week. 
Cholera Morbus. 
1. Disease sporadic. 
2. Stools have a faecal or mouse-like 
odor. 
3. Stools contain bile. 
4. Evacuations contain undigested 
food, mucus, faecal matter, etc. 
5. Pain with vomiting and purging. 
6. Urine not albuminous or sup- 
pressed. 
7. Temporary prostration. 
8. No comma bacilli. 
DISEASES TO BE DIFFERENTIATED. 
Cholera Morbus. 
4. Severe cramps in legs. 
5. Sudden prostration and collapse. 
6. Disease lasts a day or two. 
Typhoid Fever. 
1. Gastro-intestinal symptoms follow 
the febrile movement. 
2. Temperature characteristic. 
3. Frequent nose bleed. 
4. Eruption on the seventh day. 
5. Pains most severe in right iliac 
fossa. 
6. Gurgling in right iliac fossa. 
7. Disease lasts four weeks or more. 
Asiatic Cholera. 
1. Disease epidemic. 
2. Stools have no faecal odor. 
3. No bile in stools. 
4. "Rice water" evacuations often 
from the first. 
5. Painless vomiting and purging. 
6. Urine albuminous and often sup- 
pressed. 
7. Prostration greater and prolonged. 
8. Presence of comma bacilli. 
Cholera Morbus. Acute Enteritis. 
See Acute Enteritis, page 58. 
Cholera Morbus. 
1. Begins with vomiting and purging. 
2. Pain not limited to epigastric 
region. 
Acute Poisoning. 
1. Vomiting precedes the purging. 
2. Pain limited at first to the epigas- 
tric region. 60 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Cholera Morbus. 
3. No morbid appearance of mouth 
or pharynx. 
4. No blood in vomited matter. 
5. Pain colicky in character. 
6. No poison in vomited matter. 
Cholera Infantum. 
1. Temperature but slightly elevated. 
2. Abdomen retracted. 
3. Rapid emaciation and prostration. 
4. Vomiting and purging excessive. 
5. Great thirst. 
6. Diarrhoea very watery. 
7. Movements have a musty odor. 
8. Urine albuminous and often sup- 
pressed. 
g. Tendency toward coma and con- 
vulsions. 
Cholera Infantum. 
1. Diarrhoea. 
2. Pupils dilated and regular. 
3. Pulse rapid and regular. 
4. Abdomen retracted. 
5. Surface cold and perspiring. 
6. Tearless cry. 
Dysentery. 
1. Begins acutely. 
2. Temperature elevated. 
DISEASES TO BE DIFFERENTIATED. 
Acute Poisoning. 
3. Mouth and pharynx often con- 
gested and glazed. 
4. Bloody mucus mixed with vomited 
matter and stools. 
5. Pain constant with severe exacer- 
bations. 
6. Poison detected in the vomited 
matter. 
Acute Enteritis of Children. 
1. Temperature high. 
2. Abdomen tympanitic. 
3. Less rapid emaciation and prostra- 
tion. 
4. Vomiting and purging occur at 
intervals. 
5. Thirst not excessive. 
6. Diarrhoea-faeces containing undi- 
gested food. 
7. Movements have a faecal odor. 
8. Urine not suppressed or albumi- 
nous. 
g. Coma and convulsions rare. 
Acute Hydrocephalus. 
1. Constipation usually. 
2. Pupils contracted and irregular. 
3. Pulse slow and irregular. 
4. Abdomen tympanitic. 
5. Surface dry and hot. 
6. Hydrocephalic cry. 
Diarrhoea with Hemorrhoids. 
1. History of hemorroids. 
2. Temperature normal. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
61 
NAME OF DISEASE. 
Dysentery. 
3. Constitutional symptoms well 
marked. 
4. Stools scanty in amount. 
5. Stools contain mucus and blood. 
6. On examination find absence of 
hemorrhoids. 
Dysentery. 
1. Begins acutely with chill, etc. 
2. Constitutional symptoms well 
marked. 
3. Severe pain in abdomen. 
4. Temperature elevated. 
5. Diarrhoea. 
6. Abdomen tympanitic and tender. 
Chronic Dysentery. 
1. History of an acute attack. 
2. Bearing down pains in rectum. 
3. Diarrhoea common. 
4. Faeces pasty and mixed with mu- 
cus and blood. 
5. Ansemia and debility. 
6. Rectal examination shows disease 
of mucous membrane. 
Perityphlitis. 
1. Presence of tumor before intestinal 
symptoms are developed. 
2 Pain deep-seated. 
3. Pain increased upon motion of 
thigh. 
4. Presence of fluctuation. 
DISEASES TO BE DIFFERENTIATED. 
Diarrhoea with Hemorrhoids. 
3. No severe constitutional symptoms. 
4. Stools copious. 
5. Stools contain blood and fecal 
matter. 
6. Examination shows presence of en- 
larged veins. 
Acute Proctitis. 
1. Begins with uneasy feeling in 
rectum. 
2. No constitutional symptoms. 
3. Pain limited to rectum. 
4. Temperature about normal. 
5. Constipation. 
6. Abdomen not tympanitic or tender. 
Cancer of Rectum. 
1. History of hereditary cancer. 
2. Pain lancinating. 
3. Constipation. 
4. Faeces ribbon-like and covered 
with mucus and blood. 
5. Cancerous cachexia. 
6. Rectal examination shows presence 
of tumor. 
Typhlitis. 
1. Begins with colicky pains and ir- 
regular action of bowels. 
2. Pain superficial. 
3. Pain not increased by moving 
thigh. 
4. No fluctuation. 62 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Perityphlitis. 
5. Tumor irregular and deep-seated. 
6. Dulness on percussion over tumor 
has a tympanitic character. 
7. Fever, chills, and sweats. 
Perityphlitis. 
1. Usually the result of typhlitis. 
2. Tumor develops rapidly. 
3. Pain throbbing in character. 
4. Pain increased by movement of 
thigh. 
5. Tumor fluctuating. 
6. Fever, chills, and sweating. 
Perityphlitis. 
1. History of typhlitis. 
2. Fever, chills, and sweating. 
3. Tumor fluctuates. 
4. Pain increased by moving the 
right thigh. 
5. Symptoms not relieved by an ene- 
ma or cathartic. 
Perityphlitis. 
1. History of typhlitis. 
2. Intestinal symptoms well marked. 
3. No pain in spine. 
4. Fluctuating tumor appears gradu- 
ally. 
5. Constitutional symptoms are well 
marked. 
6. The pus has a faecal odor. 
DISEASES TO BE DIFFERENTIATED. 
Typhlitis. 
5. Tumor superficial and regular. 
6. No tympanitic character to the 
dulness. 
7. Absence of chills and sweating. 
Cancer of Ceecum. 
1. History of hereditary cancer. 
2. Tumor develops slowly. 
3. Pain lancinating. 
4. Pain not increased by movement 
of thigh. 
5. Tumor solid. 
6. No chills or sweating. 
Distension of Caecum. 
1. History of constipation. 
2. No fever, chills, or sweating. 
3. No fluctuation. 
4. No pain produced by movements of 
thigh. 
5. Symptoms relieved by an enema or 
cathartic. 
Psoas Abscess. 
1. History of disease of spine. 
2. No well-marked intestinal symp- 
toms. 
3. Aching pain in back. 
4. Tumor often appears suddenly. 
5. No severe constitutional symp- 
toms. 
6. No faecal odor to the pus. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
63 
NAME OF DISEASE. 
Perityphlitis. 
1. Tumor develops slowly. 
2. Simple constipation. 
3. No blood or mucus with stools. 
4. Irregular chills and sweating. 
5. No stercoraceous vomiting. 
6. Tumor irregular in shape. 
7. No severe collapse or prostration. 
Intestinal Obstruction. 
1. Obstinate constipation. 
2. Pain persistent. 
3. Pain not relieved by pressure. 
4. Stercoraceous vomiting. 
5. Symptoms of profound collapse. 
Intestinal Obstruction. 
1. Temperature normal or subnor- 
mal. 
2. Pulse feeble and rapid. 
3. Stercoraceous vomiting. 
4. Pain localized. 
5. Some tenderness upon pressure. 
6. Abdomino-thoracic breathing. 
Intestinal Obstruction. 
1. Faecal vomiting. 
2. Pain localized and constant. 
3. Obstinate constipation. 
3. Urine lessened in amount. 
5. No jaundice. 
6. Pressure increases the pain. 
DISEASES TO BE DIFFERENTIATED. 
Intussusception. 
1. Tumor develops suddenly. 
2. Complete intestinal obstruction. 
3. Small, bloody, and mucous pas- 
sages. 
4. No chills or sweating. 
5. Stercoraceous vomiting. 
6. Tumor sausage-shaped. 
7. Sudden collapse and prostration. 
Intestinal Colic. 
1. Bowels irregular. 
2. Pain intermittent. 
3. Pain relieved by pressure. 
4. No vomiting. 
5. No collapse. 
Acute Peritonitis. 
1. Temperature elevated. 
2. Pulse tense and wiry. 
3. Spinach-green vomiting. 
4. Pain general over abdomen. 
5. Great abdominal tenderness. 
6. Thoracic breathing. 
Hepatic Colic. 
1. Vomiting not stercoraceous. 
2. Pain paroxysmal and radiating 
from gall bladder to back. 
3. Stools clay-colored. 
4. Urine contains bile pigment. 
5. Jaundice common 
6. Pressure relieves the pain. 64 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Intestinal Obstruction. 
1. Fee cal vomiting. 
2. Pain localized and constant. 
3. Urine diminished in amount. 
4. Complete constipation. 
5. No pain in testicles. 
6. Pressure increases the pain. 
Intestinal Obstruction. 
1. Onset sudden. 
2. Fsecal vomiting. 
3. Tympanitic distension of abdo- 
men. 
4. Cathartics increase the severity of 
the symptoms. 
5. No scybala felt through the ab- 
dominal wall. 
6. Great prostration and collapse. 
Tubercular Enteritis. 
(Ulcer of intestine.) 
1. Abdomen distended. 
2. Diarrhoea. 
3. Pulse accelerated. 
4. Pupils normal. 
5. Vomiting rare. 
6. Inordinate hunger. 
Tubercular Enteritis. 
(Ulcer of Intestine.) 
1. Abdomen distended and flaccid. 
2. Pain moderate and not increased 
upon pressure. 
3. Rapid emaciation. 
4. Cervical glands enlarged. 
DISEASES TO BE DIFFERENTIATED. 
Renal Colic. 
1. No stercoraceous vomiting. 
2. Pain paroxysmal and extends 
along ureters to penis of testicle. 
3. Urine bloody. 
4. Bowels normal. 
5. Testicles painful and retracted. 
6. Pressure relieves the pain. 
Chronic Constipation. 
1. History of constipation. 
2. Absence of vomiting. 
3. No tympanites. 
4. Cathartics relieve the symptoms. 
5. Scybala felt through the abdom- 
inal wall. 
6. No severe constitutional symptoms. 
Tubercular Meningitis. 
1. Abdomen retracted. 
2. Constipation. 
3. Pulse retarded. 
4. Pupils contracted and irregular. 
5. Vomiting frequent and projectile. 
6. Loss of appetite. 
Tubercular Peritonitis. 
1. Abdomen distended and rigid. 
2. Pain severe and increased by pres- 
sure. 
3. Emaciation less rapid. 
4. Glands not enlarged, DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
65 
NAME OF DISEASE. 
Tubercular Enteritis. 
5. No ascites. 
6. Tympanitic percussion note. 
7. No redness around umbilicus. 
Cancer of Intestine. 
1. History of hereditary cancer. 
2. Cancerous cachexia. 
3. Pain lancinating. 
4. Tumor irregular in shape. 
5. Tumor in front of intestines. 
6. Pain not much increased by ma- 
nipulation. 
DISEASES TO BE DIFFERENTIATED. 
Tubercular Peritonitis. 
5. Ascites common. 
6. Dulness on percussion. 
7. Redness and oedema around um- 
bilicus. 
Floating Kidney. 
1. No hereditary tendencies. 
2. No cachexia. 
3. Pain dull. 
4. Tumor kidney shape. 
5. Tumor behind intestine. 
6. Sickening pain produced by 
squeezing tumor. 
Cancer of Intestine. Perityphlitis. 
See Perityphlitis, page 62. 
Cancer of Intestine. 
1. History of hereditary cancer. 
2. Cancerous cachexia. 
3. Bloody mucus with stools. 
4. Faeces ribbon like. 
5. Pain lancinating in character. 
6. By examination find a tumorous 
mass in rectum. 
Hemorrhoids. 
1. History of sedentary habits, dis- 
ease of the liver, etc. 
2. No cachexia. 
3. Occasional hemorrhage from bowel. 
4. Faeces normal in shape. 
5. Dragging pain in rectum. 
6. On examination find enlarged 
veins in rectum. 
Cancer of Intestine. Abdominal Aneurism. 
See Abdominal Aneurism, page 47. 
Proctitis. 
1. Begins with tenesmus. 
2. Stools contain gelatinous mucus 
and blood. 
Periproctitis. 
1. Begins with pain and tenderness 
in anal region. 
2. Stools do not contain blood or 
mucus. 66 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Proctitis. 
3. No chills, fever, or sweating. 
4. No external signs of inflammation. 
5. No fluctuating tumor. 
6. Examination shows diseased con- 
dition of rectal mucus membrane. 
Proctitis. 
1. Tenesmus severe. 
2. Stools contain mucus and blood. 
3. No external appearance of disease. 
4. Examination shows diseased con- 
dition of the rectal mucous mem- 
brane. 
DISEASES TO BE DIFFERENTIATED. 
Periproctitis. 
3. Chills, fever, and sweating. 
4. External signs of inflammation. 
5. Presence of fluctuating tumor. 
6. On examination an abscess is 
found in neighborhood of rectum. 
Hemorrhoids. 
1. Pain greater than the tenesmus. 
2. Stools contain pure blood. 
3. Hemorrhoids often appear exter- 
nally. 
4. Examination shows enlarged veins 
in rectum. 
Proctitis. Dysentery. 
See Dysentery, page 6l. 
Proctitis. Cancer of Intestine. 
See Cancer of Intestine, page 65. 
Hemorrhoids. Proctitis. 
See Proctitis, above. 
Hemorrhoids. Dysentery. 
See Dysentery, page 60. 
Hemorrhoids. Cancer of Intestine. 
See Cancer of Intestine, page 65. 
Hemorrhoids. 
1. Tenesmus. 
2. Bearing down pain in rectum. 
3. Constipation. 
4. Blood bright red and covers faeces. 
Intestinal Hemorrhage. 
1. No tenesmus. 
2. Abdominal pain. 
3. Usually diarrhoea. 
4. Blood tarry and mixed with faeces. DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
67 
NAME OF DISEASE. 
Hemorrhoids. 
5. No constitutional symptoms. 
6. Rectal examination shows presence 
of enlarged veins. 
Intestinal Colic. 
1. No fever. 
2. Pulse slow and full. 
3. Great restlessness. 
4. Pressure relieves the pain. 
5. Pain paroxysmal. 
6. No vomiting. 
Intestinal Colic. 
1. Pain paroxysmal. 
2. Temperature normal. 
3. Pulse slow and full. 
4. Pressure relieves the pain. 
5. No marked tympanites. 
6. No real prostration or collapse. 
7. No hemorrhage from bowels. 
DISEASES TO BE DIFFERENTIATED. 
Intestinal Hemorrhage. 
5. Well-marked constitutional symp- 
toms. 
6. Rectal examination negative. 
Acute Peritonitis. 
1. High temperature. 
2. Pulse rapid and wiry. 
3. Patient perfectly still. 
4. Pressure increases the pain. 
5. Pain constant. 
6. Spinach-green vomiting. 
Perforation of Intestine. 
1. Pain constant with paroxysmal 
aggravations. 
2. Temperature often subnormal. 
3. Pulse rapid and feeble. 
4. Pressure increases the pain. 
5. Tympanites. 
6. Great prostration and collapse. 
7. Hemorrhage from bowel common. 
Intestinal Colic. Intestinal Obstruction. 
See Intestinal Obstruction, page 63. 
Intestinal Colic. 
1. No vomiting. 
2. No jaundice. 
3. Pain most severe in the umbilical 
region. 
4. Bowels irregular. 
5. Pain colicky in character. 
6. No gall stones in fseces. 
Urine normal. 
Hepatic Colic. 
1. Vomiting. 
2. Jaundice. 
3. Pain most severe in epigastric re- 
gion, shooting toward back. 
4. Stools clay-colored. 
5. Pain tearing in character. 
6. Gall stones in faeces. 
7. Urine contains bile pigment. 68 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Intestinal Colic. 
1. Urine normal. 
2. No pain in testicles. 
3. Pain most severe in umbilical 
region. 
4. Pain colicky in character. 
5. No vomiting. 
6. No numbness of thigh. 
Intestinal Colic. 
1. Pain paroxysmal. 
2. Pain relieved by pressure. 
3. Pain of greatest intensity in um- 
bilical region. 
4. History of indigestion, exposure 
to cold, etc. 
5. No spots of extreme tenderness. 
6. Pain deep-seated. 
Intestinal Colic. 
1. Occurs at any time. 
2. Pain intermittent. 
3. Pain in umbilical region most se- 
vere. 
4. No vomiting. 
5. No bladder symptoms. 
6. Pain relieved by pressure. 
DISEASES TO BE DIFFERENTIATED. 
Renal Colic. 
1. Urine passed frequently and con- 
tains blood. 
2. Testicle retracted and painful. 
3. Pain shoots along ureters into 
testicle to penis. 
4. Pain tearing and shooting. 
5. Frequent vomiting. 
6. Marked numbness of thigh. 
Abdominal Rheumatism. 
1. Pain constant. 
2. Pain increased by pressure. 
3. Pain of greatest intensity over the 
origin and insertion of muscles. 
4. History of rheumatism. 
5. Spots of Hyperaesthesia. 
6. Pain superficial. 
Uterine Colic. 
1. At menstrual period. 
2. Pain remittent. 
3. Pain most severe in the hypogas- 
tric or pelvic region. 
4. Vomiting common. 
5. Irritability of the bladder. 
6. Pain increased by pressure. 
Acute Peritonitis. Acute Enteritis. 
See Acute Enteritis, page 58. 
Acute Peritonitis. Intestinal Colic. 
See Intestinal Colic, page 67. 
Acute Peritonitis. Intestinal Obstruction. 
See Intestinal Obstruction, page 63. DISEASES OF DIGESTIVE TRACT A HD PERU ONEUM. 
69 
NAME OF DISEASE. 
Acute Peritonitis. 
1. Temperature elevated. 
2. Harder the pressure more severe 
the pain. 
3. Pulse tense and wiry. 
4. Great prostration. 
5. Peritonitic countenance and posi- 
tion. 
6. Spinach-green vomiting. 
Acute Peritonitis. 
1. Pain increased by pressure. 
2. Patient very quiet. 
3. Temperature elevated. 
4. No change in color of faeces or 
urine. 
5. Great tympanites. 
6. Severe collapse and prostration. 
Acute Peritonitis. 
1. No vomiting at first. 
2. Vomiting inconstant and spinach- 
green in color. 
3. Pain diffuse. 
4. Great tympanites. 
5. Peritonitic countenance and posi- 
tion. 
6. Constipation. 
Acute Peritonitis. 
1. Temperature elevated. 
2. Begins with chill and pain in ab- 
domen. 
3. Spinach-green vomiting. 
DISEASES TO BE DIFFERENTIATED. 
Hysteria. 
1. Temperature normal. 
2. A light touch causes as much pain 
as deep pressure. 
3. Pulse normal. 
4. Prostration only apparent. 
5. Hysterical countenance and rest 
lessness. 
6. Globus hysterica. 
Renal or Hepatic Colic. 
1. Pain diminished by pressure. 
2. Great restlessness. 
3. Temperature normal. 
4. Faeces or urine has an abnormal 
color. 
5. Tympanites absent or slight. 
6. Prostration but temporary. 
Acute Gastritis. 
1. Begins with vomiting. 
2. Vomiting constant and bilious. 
3. Pain limited to gastric region. 
4. Tympanites moderate or absent. 
5. Countenance pale, position not 
characteristic. 
6. Bowels normal or irregular. 
Acute Poisoning. 
1. Temperature normal or subnor- 
mal. 
2. Begins with vomiting and pain in 
the stomach. 
3. Vomited matter contains blood 
and mucus. 70 
DIFFERENTIAL' DIAGNOSIS OF THE 
NAME OF DISEASE. 
Acute Peritonitis. 
4. Obstinate constipation. 
5. No cramps in legs. 
6. Mouth and pharynx normal. 
7. Abdomen tympanitic. 
8. No poison in vomited matter. 
Chronic Peritonitis. 
1. History of an acute attack. 
2. Temperature irregular-99° to 
104°. 
3. Ascitic fluid clear. 
4. Anaemia. 
5. Occasional chills. 
6. No tumefaction of the omentum. 
7. No cancer cells in ascitic fluid. 
Chronic Peritonitis. 
1. History of an acute attack. 
2. Constipation alternating with diar- 
rhoea. 
3. No redness around umbilicus. 
4. Ascitic fluid clear. 
5. No tubercle bacilli in fluid. 
6. No sign of tubercular disease in 
other organs, as the lungs. 
7. Frequent chills. 
8. Moderate ascites. 
9. Typhoid symptoms appear late. 
Chronic Peritonitis. 
1. History of an acute attack. 
2. No general oedema. 
3. Abdomen painful. 
DISEASES TO BE DIFFERENTIATED. 
Acute Poisoning. 
4. Diarrhoea. 
5. Severe cramps in legs. 
6. Mouth and pharynx red and 
glazed. 
7. Abdomen retracted. 
8. Vomited matter contains poison. 
Cancerous Peritonitis. 
1. History of hereditary cancer. 
2. Temperature usually normal. 
3. Ascitic fluid bloody. 
4. Cancerous cachexia. 
5. No chills. 
6. Tumefaction of the omentum. 
7. Ascitic fluid contains cancer cells. 
Tubercular Peritonitis. 
1. History of tuberculosis. 
2. Constant diarrhoea. 
3. Redness and oedema around um- 
bilicus. 
4. Ascitic fluid hemorrhagic. 
5. Fluid contains tubercle bacilli. 
6. Lungs and other organs frequently 
tuberculous. 
7. Frequent profuse sweating. 
8. Ascites well-marked. 
9. Typhoid symptoms appear early. 
Ascites. 
1. History of kidney, liver, and heart 
disease. 
2. General oedema. 
3. No pain in abdomen, DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
71 
NAME OF DISEASE. 
Chronic Peritonitis. 
4 Tenderness upon pressure. 
5. Temperature irregular. 
6. Abdominal veins not dilated. 
Tubercular Peritonitis. 
1. History of tuberculosis. 
2. Tubercular disease of other organs. 
3. Ascites well-marked. 
4. Profuse sweats. 
5. Temperature elevated, especially 
at night. 
6. Redness and oedema around um- 
bilicus. 
7. Abdomen has a doughy feeling. 
DISEASES TO BE DIFFERENTIATED. 
Ascites. 
4. No tenderness on pressure. 
5. Temperature normal. 
6. Dilatation of abdominal veins. 
Cancerous Peritonitis. 
1. History of hereditary cancer. 
2. Surrounding organs frequently can- 
cerous. 
3. Ascites usually not well-marked. 
4. No profuse sweats. 
5. Temperature about normal-can- 
cerous cachexia. 
6. No redness or oedema about um- 
bilicus. 
7. Abdomen feels tumorous. 
Tubercular Peritonitis. Chronic Peritonitis. 
See Chronic Peritonitis, page 70. 
Tubercular Peritonitis. Tubercular Enteritis. 
See Tubercular Enteritis, page 64. 
Ascites (Abdominal Dropsy). Chronic Peritonitis. 
See Chronic Peritonitis, page 70. 
Ascites. 
1. Uniform enlargement. 
2. Begins in dependent portion of 
abdomen. 
3. Line of dulness changes with po- 
sition of patient. 
4. Fluctuation well-marked. 
5. History of liver, kidney, or heart 
disease. 
6. Fluid serous in character. 
7. No well-defined outline of dul- 
ness. 
Ovarian Dropsy. 
1. Irregular abdominal enlargement. 
2. Begins in one iliac fossa. 
3. Line of dulness stationary. 
4. Fluctuation indistinct. 
5. No history of previous disease. 
6. Fluid albuminous and contains 
characteristic cells. 
7. Distinct outline of cyst wall, which 
limits the area of dulness. 72 
DISEASES OF DIGESTIVE TRACT AND PERITONEUM. 
NAME OF DISEASE. 
Ascites. 
1. No bladder symptoms. 
2. Line of dulness changes with po- 
sition of patient. 
3. No pain on pressure. 
4. No uniform outline of dulness. 
5. Symptoms not relieved by passing 
catheter. 
Ascites. 
1. Line of dulness changes with po- 
sition of patient. 
2. Fluctuation well-marked. 
3. No mammary changes. 
4. No well-defined outline to dul- 
ness. 
5. No foetal heart. 
6. No ballotement. 
Ascites. 
1. Flatness begins below. 
2. Line of dulness changes with po- 
sition of patient. 
3. No fremitus on percussion. 
4. Tympanites above the flat area. 
5. No hooklets in fluid. 
DISEASES TO BE DIFFERENTIATED. 
Distended Bladder. 
1. Retention or incontinence of urine. 
2. Line of dulness uniform. 
3 Pain produced by pressure. 
4. Dulness has a rounded outline. 
5. Distention relieved by passing 
catheter. 
Pregnancy. 
1. Line of dulness constant. 
2. Fluctuation indistinct. 
3. Well-marked mammary signs. 
4. Uterus has a well-defined outline. 
5. Foetal heart. 
6. Ballotement. 
Hydatids of Liver. 
1. Flatness begins above. 
2. Line of dulness constant. 
3. Hydatid fremitus on percussion. 
4. Tympanites below the flat area. 
5. Hooklets found in the fluid. 
Ascites. Cirrhosis of the Liver. 
See Cirrhosis of the Liver, page 78. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE LIVER. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE LIVER. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Acute congestion of the liver 
Abscess of the liver. 
Fatty liver. 
Catarrh of the bile ducts. 
Cirrhosis of the liver 
Fatty liver. 
Cancer of liver. 
Ascites due to other causes. 
Hydatids of the liver. 
Cancer of the liver. 
Acute congestion of the liver. 
Abscess in abdominal walls. 
Enlarged gall-bladder. 
Perihepatitis. 
Empyema. 
Pylephlebitis. 
Abscess of the liver 
Yellow fever. 
Pyaemia. 
Bilious remittent fever. 
Simple jaundice. 
Remittent fever. 
Acute yellow atrophy 
Fatty liver 
Waxy liver. 
Acute congestion of liver. 
Cancer of liver. 
75 76 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Cirrhosis of liver. 
Fatty liver. 
Abscess of liver. 
Hydatids of liver. 
Cancer of stomach. 
Cancer of kidney. 
Cancer of Liver 
Ascites. 
Cancer of liver. 
Abscess of liver. 
Enlarged gall-bladder. 
Abdominal aneurism. 
Cyst of kidney. 
Hydatids of liver 
Perihepatitis 
Abscess of liver. 
Intercostal neuralgia. 
Acute pleurisy. 
Renal colic. 
Intestinal colic. 
Acute peritonitis. 
Cardialgia. 
Hepatic colic 
Hepatogenous jaundice 
Hematogenous jaundice. 
Acute yellow atrophy. 
Acute congestion of liver. 
Acute Congestion of Liver. 
1. Uniform enlargement of liver. 
2. Rapid enlargement of liver. 
3. Pain diffuse over liver. 
4. Pain not severe. 
5. Pulse slow or normal. 
6. No chill, fever, or sweating. 
7. But slight tenderness on pressure. 
Abscess of Liver. 
1. Irregular enlargement of liver. 
2. Enlargement takes place slowly. 
3. Pain localized. 
4. Pain quite severe. 
5. Pulse rapid. 
6. Chills, fever, and profuse sweats. 
7. Well-marked tenderness on pres- 
sure. DISEASES OF THE LIVER. 
77 
NAME OF DISEASE. 
Acute Congestion of Liver. 
1. History of alcoholism, gout, syph- 
ilis, etc. 
2. Pain over liver. 
3. Dyspeptic symptoms. 
4. Skin dingy and rough. 
5. On palpation liver feels hard and 
resistant. 
6. Some tenderness on pressure. 
7. Hemorrhoids common. 
Acute Congestion of Liver. 
1. Jaundice slight. 
2. Gastro-duodenitis succeeds the 
hepatic symptoms. 
3. Hemorrhoids common. 
4. Liver considerably enlarged. 
5. Tenderness on pressure. 
6. Marked dizziness at times. 
Cirrhosis of Liver. 
1. History of alcoholism, syphilis, etc. 
2. Skin dingy and rough. 
3. Liver hard and resistant on palpa- 
tion. 
4. Some tenderness on pressure. 
5. Emaciation. 
6. Spleen enlarged. 
7. Ascites. 
8. Liver usually diminished in size. 
Cirrhosis of Liver. 
1. Liver usually small. 
2. If nodular, the nodules are not 
well marked, 
DISEASES TO BE DIFFERENTIATED. 
Fatty Liver. 
1. History of high living or phthisis. 
2. No pain over liver. 
3. Dyspeptic symptoms uncommon. 
4. Skin yellow and greasy. 
5. Liver feels soft and doughy. 
6. No tenderness on pressure. 
7. Hemorrhoids uncommon. 
Catarrh of Bile Ducts. 
1. Jaundice well-marked. 
2. Gastro-duodenitis precedes the 
hepatic symptoms. 
3. Hemorrhoids unfrequent. 
4. Liver slightly enlarged. 
5. No tenderness upon pressure. 
6. Patient stupid and drowsy. 
Fatty Liver. 
1. History of high living, phthisis. 
etc. 
2. Skin yellow and greasy. 
3. Liver soft and doughy. 
4. No tenderness on pressure. 
5. Obesity. 
6. Spleen normal. 
7. No ascites. 
8. Liver always large. 
Cancer of Liver. 
1. Liver always enlarged. 
2. Nodules well marked. 78 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Cirrhosis of Liver. 
3. Spleen enlarged. 
4. Ascites. 
5. Slight pain over liver. 
6. But slight tenderness on pressure. 
7. Skin has a dingy hue. , 
8. Gastric and intestinal hemorrhages 
common. 
9. Enlarged abdominal veins. 
Cirrhosis of Liver. 
1. Liver small. 
2. Gastric and intestinal hemorrhages 
common. 
3. Spleen enlarged. 
4. Dropsy begins as ascites. 
5. Enlarged abdominal veins. 
6. Hemorrhoids common. 
7. Absence of disease in other organs. 
Abscess of Liver. 
1. Occurs most frequently in those 
who have lived in hot climates. 
2. Rapid and acute disease. 
3. Severe pain. 
4. Chills, fever, and sweating. 
5. Well-marked gastric symptoms. 
6. No peculiar fremitus produced on 
percussion. 
7. Exploring needle withdraws pus. 
Abscess of Liver. 
1. Primary disease. 
2. Rapid enlargement of liver. 
DISEASES TO BE DIFFERENTIATED. 
Cancer of Liver. 
3. Spleen not enlarged. 
4. No ascites. 
5. Severe pain over liver. 
6. Marked tenderness on pressure. 
7. Cancerous cachexia. 
8. Hemorrhages rare unless the dis- 
ease is complicated. 
9. Adominal veins not enlarged. 
Ascites due to other Causes. 
1. Liver normal size. 
2. Hemorrhages rare. 
3. Spleen normal size. 
4. Dropsy begins in extremities or 
face. 
5. Abdominal veins not enlarged. 
6. Hemorrhoids unfrequent. 
7. Disease of heart, kidneys, peri- 
toneum, etc. 
Hydatids of Liver. 
1. Occurs most frequently in cold cli- 
mates. 
2. Slow and chronic disease. 
3. Little or no pain. 
4. No chills, fever, or sweating. 
5. No gastric disturbance. 
6. Hydatid fremitus or thrill produced 
by percussion. 
7. Fluid contains booklets. 
Cancer of Liver. 
1. Disease hereditary or secondary. 
2. Liver enlarges slowly. DISEASES OF THE LIVER. 
79 
NAME OF DISEASE. 
Abscess of Liver. 
3. Fever, chills, and sweating. 
4. No nodular feel on palpation. 
5. Patient hectic in appearance. 
6. Ascites uncommon. 
7. Exploring needle withdraws pus. 
DISEASES TO BE DIFFERENTIATED. 
Cancer of Liver. 
3. No chills or sweating. 
4. Liver distinctly nodular. 
5. Cancerous cachexia 
6. Ascites not infrequent. 
7. Exploring needle withdraws blood. 
Abscess of Liver. Acute Congestion of Liver. 
See Aczite Congestion of Liver, page 76. 
Abscess of Liver. 
1. Line of liver dulness well marked. 
2. Line of dulness corresponds to the 
hepatic area. 
3. Shiny, cedematous skin over liver 
appears late in the disease. 
4. Superficial tenderness over liver 
appears late. 
5. The tumor has an up and down 
movement, due to respiration. 
Abscess of Liver. 
1. History of injury, dysentery, etc. 
2. Abscess tumor broad and flat. 
3. Tumor not movable. 
4. Chills, fever, and sweating. 
5. Jaundice uncommon. 
6. Melancholia. 
7. Exploring needle withdraws pus. 
Abscess of Liver. 
1. Chills, fever, and sweating. 
2. Temperature, 103° to 105°. 
3. Gastric symptoms. 
4. Deep fluctuation on palpation. 
Abscess in Abdominal Wall. 
1. Line of dulness indistinct. 
2. Line of dulness does not corre- 
spond to liver dulness. 
3. Inflammation of the skin appears 
early in the disease. 
4. Superficial tenderness appears 
early. 
5. The tumor has no up and down 
movement. 
Enlarged Gall Bladder. 
1. History of jaundice or biliary colic. 
2. Tumor globular and pear-shaped. 
3. Tumor movable. 
4. No chills or sweating. 
5. Jaundice common. 
6. No depression of spirits. 
7. Exploring needle withdraws bile. 
Perihepatitis. 
1. No chills or sweating. 
2. Temperature rarely over 101°. 
3. No gastric disturbance. 
4. No fluctuating tumor. 80 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Abscess of Liver. 
5. Increased area of liver dulness on 
percussion. 
6. Patient has a hectic appearance. 
7. Melancholia. 
Abscess of Liver. 
1. Diarrhoea uncommon. 
2. Jaundice infrequent. 
3. Fluctuation on palpation. 
4. Spleen normal size. 
5. No enlargement of abdominal veins. 
6. Stools clay-colored. 
7. Exploring needle withdraws pus. 
Abscess of Liver. 
1. Gastric disturbance. 
2. Stools clay-colored. 
3. Needle thrust into liver abscess has 
an up-and-down movement. 
4. Area of dulness corresponds to 
that of enlarged liver. 
5. Dulness seldom reaches above the 
fourth rib. 
6. Disease preceded by signs of he- 
patic inflammation. 
7. Marked tenderness over liver area. 
8. No pulmonary symptoms. 
9. Exploring needle will bring away 
hepatic tissue. 
Acute Yellow Atrophy. 
1. Begins as simple jaundice. 
2. No chill with sudden rise of tem- 
perature. 
Perihepatitis. 
5. Liver not enlarged. 
6. Patient has a normal appearance. 
7. Buoyant spirits. 
Pylephlebitis. 
1. Diarrhoea. 
2. Jaundice. 
3. No fluctuating tumor. 
4. Spleen enlarged. 
5. Abdominal veins distended. 
6. Stools watery and dark. 
7. Exploring needle withdraws blood. 
Empyema. 
1. No gastric symptoms. 
2. Stools normal color. 
3. Needle thrust into plural cavity has 
no up-and-down movement. 
4. Area of dulness changes with the 
position of patient. 
5. Flatness often extends higher than 
the fourth rib. 
6. Disease preceded by pleurisy or 
pleuro-pneumonia. 
7. No tenderness on pressure. 
8. Cough, dyspnoea, and expectora- 
tion. 
9. Exploring needle withdraws pus. 
Bilious Remittent Fever. 
1. Begins with a chill. 
2. Chills followed by fever and 
sweating. DISEASES OF THE LIVER. 
81 
NAME OF DISEASE. 
Acute Yellow Atrophy. 
3. No regular remissions of symp, 
toms. 
4. No pigmentation of blood. 
5. Jaundice appears early. 
6. Liver diminishes in size. 
7. Leucin and tyrosin in urine. 
Acute Yellow Atrophy. 
1. Temperature elevated. 
2. Liver diminishes in size. 
3. Stupor, coma, and convulsions. 
4. Severe headache. 
5. Leucin and tyrosin in urine. 
6. Pulse rapid from 140 to 160. 
Acute Yellow Atrophy. 
1. Begins as simple jaundice. 
2. Spleen increased in size. 
3. Liver diminishes in size. 
4. Urine acid. 
5. Urine contains leucin and tyrosin. 
6. Pulse 140 to 160. 
7. " Black vomit " appears late. 
Acute Yellow Atrophy. 
1. Begins as simple jaundice. 
2. No chills or exhaustive sweats. 
3. Stools clay-colored and formed. 
4. Liver diminishes rapidly in size. 
5. Leucin and tyrosin in urine. 
6. No lung complications. 
Acute Yellow Atrophy. 
DISEASES TO BE DIFFERENTIATED. 
Bilious Remittent Fever. 
3. Regular remission of symptoms. 
4. Free pigment in blood. 
5. Jaundice appears late. 
6. Liver increases in size. 
7. Urine normal. 
Simple Obstructive Jaundice. 
1. Temperature normal. 
2. Liver slightly increased in size. 
3. Mind dull. 
4. Dull frontal headache. 
5. Bile pigment in urine. 
6. Pulse full and slow. 
Yellow Fever. 
1. Begins with a chill. 
2. Spleen normal in size. 
3. Liver increases in size. 
4. Urine alkaline. 
5. Urine contains many urates. 
6. Pulse gaseous and rarely over no. 
7. " Black vomit " appears early. 
Pyaemia. 
1. Begins with a chill. 
2. Irregular chills and sweating. 
3. Diarrhoea. 
4. Liver normal in size. 
5. Urine albuminous. 
6. Abscess of lungs. 
Remittent Fever. 
See .Remittent Fever, page 80. 82 
DLFFEREHTLAL DLAGNOSLS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Fatty Liver. Acute Congestion of Liver. 
See Acute Congestion of Liver, page 77. 
Fatty Liver. 
1. History of high living or phthisis. 
2. Skin shiny and greasy. 
3. Blood hydroaemic. 
4. Urine normal. 
5. Liver feels soft and flabby. 
6. Spleen normal in size. 
Fatty Liver. 
1. History of high living or phthisis. 
2. Liver uniformly enlarged. 
3. No pain over liver. 
4. Skin shiny and greasy. 
5. Slow progress of disease. 
6. No enlarged glands. 
Waxy Liver. 
1. History of suppuration or syphilis. 
2. Skin pale and dry with indigo 
odor. 
3. Blood leukaemic. 
4. Urine albuminous. 
5. Liver feels hard and well defined. 
6. Spleen increased in size. 
Cancer of Liver. 
1. History of hereditary or secondary 
cancer. 
2. Nodular enlargement of liver. 
3. Severe pain over liver. 
4. Skin dry and straw-colored. 
5. Disease rapid in progress. 
6. Abdominal and cervical glands en- 
larged. 
Cancer of Liver. Cirrhosis of Liver. 
See Cirrhosis of Liver, page 77. 
Cancer of Liver. Fatty Liver. 
See Fatty Liver, above. 
Cancer of Liver. Abscess of Liver. 
See Abscess of Liver, page 78. 
Cancer of Liver. 
1. Pain severe. 
2. Liver nodules hard. 
Hydatids of Liver. 
1. No pain. 
2. Liver tumors soft, smooth and 
elastic. DISEASES OF THE LIVER. 
83 
NAME OF DISEASE. 
Cancer of Liver. 
3. No percussion fremitus. 
4. Severe gastric symptoms. 
5. Disease rapid in development. 
6. Exploring needle withdraws blood. 
Cancer of Liver. 
1. Hepatic symptoms appear first 
2. No vomiting of blood. 
3. Gastric symptoms not increased by 
taking food. 
4. Absolute dulness over the tumor. 
5. Tumor multiple. 
6. Tumor stationary. 
Cancer of Liver. 
1 Gastric symptoms well marked. 
2. Urine normal. 
3. Outline of dulness corresponds to 
the shape of the liver. 
4. Area of dulness not bounded by a 
tympanitic resonance. 
5. Tumor lowered by a deep inspira- 
tion. 
6. Disease of adults. 
DISEASES TO BE DIFFERENTIATED. 
Hydatids of Liver. 
3. Hydatid fremitus on percussion. 
4. No gastric disturbance. 
5. Slow progress of disease. 
6. Exploring needle withdraws fluid 
containing booklets. 
Cancer of Stomach. 
1. Gastric symptoms are the first to 
appear. 
2. Hematemesis. 
3. Symptoms often increased by tak- 
ing food. 
4. Tympanitic quality to the tumor 
dulness. 
5. Tumor single. 
6. Tumor movable. 
Cancer of Kidney. 
1. No well-marked gastric disturb- 
ance. 
2. Urine contains blood. 
3. Outline of dulness corresponds to 
the shape of the kidney. 
4. Area of dulness is bounded by 
tympanitic resonance. 
5. Tumor stationary. 
6. disease of children or adults. 
Hydatids of Liver. Cancer of Liver. 
See Cancer of Liver, page 82. 
Hydatids of Liver. Abscess of Liver. 
See Abscess of Liver, page 78. 84 
differential diagnosis of the 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Hydatids of Liver. Abdominal Aneurism. 
See Abdominal Aneurism, page 46. 
Hydatids of Liver. 
1. History of eating raw meat. 
2. Tumor multiple. 
3. Tumor globular. 
4. Tumor readily manipulated. 
5. Hydatic fremitus on percussion. 
6. Exploring needle withdraws fluid 
containing booklets.. 
Hydatids of Liver. 
1. Tumor grows from above down- 
ward. 
2. Tumor rises and falls with respira- 
tion. 
3. Colon lies behind tumor. 
4. Hydatid fremitus on percussion. 
5. Hooklets found in aspirated fluid 
from tumor. 
Enlarged Gall Bladder. 
1. History of jaundice or hepatic 
colic. 
2. Tumor single. 
3. Tumor pear-shaped. 
4. Tumor not readily manipulated. 
5. No fremitus on percussion. 
6. Exploring needle withdraws bile. 
Cyst of Kidney. 
1. Tumor grows from below upward. 
2. Tumor stationary. 
3. Colon lies in front of tumor. 
4. No fremitus on percussion. 
5. Aspirating needle withdraws albu- 
minous fluid containing chlorides. 
Hydatids of Liver. Ascites. 
See Ascites, page 72. 
Perihepatitis. Abscess of Liver. 
See Abscess of Liver, page 79. 
Perihepatitis. 
1. Begins with a chill. 
2. Temperature ioo° to 1020. 
3. No distinct points of tenderness. 
4. No history of neuralgia. 
5. Pain not limited to an intercostal 
space. 
Intercostal Neuralgia. 
1. Begins with shooting pain in side. 
2. Temperature normal. 
3. Three distinct points of tenderness. 
4. History of neuralgia. 
5. Pain limited to an intercostal 
space. DISEASES OF THE LIVER. 
85 
NAME OF DISEASE. 
Perihepatitis. 
6. Pain increased by pressure upward 
under ribs. 
7. No herpetic eruptions. 
Perihepatitis. 
1. Slight dyspnoea. 
2. Pain increased by pressure upward 
under ribs. 
3. Pain most severe below fourth rib. 
4. Pulmonary physical signs normal. 
5. No cough. 
DISEASES TO BE DIFFERENTIATED. 
Intercostal Neuralgia. 
6. Pain not increased by pressure up- 
ward under ribs. 
7. Herpes zoster common. 
Acute Pleurisy. 
1. Dyspnoea well marked. 
2. Pain not increased by pressure, 
but by respiration. 
3. Pain most severe above fourth rib. 
4. Diminished vocal fremitus, dulness 
on percussion, and sticky rales. 
5. Teasing dry cough. 
Hepatic Colic. Intestinal Colic. 
See Intestinal Colic, page 67. 
Hepatic Colic. Acute Peritonitis. 
See Acute Peritonitis, page 6g. 
Hepatic Colic. 
1. Pain shoots from gall bladder to 
back. 
2. Urine contains bile pigment. 
3. Faeces clay-colored. 
4. Stools contain gall-stones. 
5. Urine voided naturally. 
6. Gall bladder remains tender on 
pressure. 
Hepatic Colic. 
1. Attack comes on at any time. 
2. Pain shoots from gall bladder to 
back. 
3. Pain ceases suddenly. 
4. U rine contains bile pigment. 
5. Faeces clay-colored. 
Renal Colic. 
1. Pain shoots along ureter to testicle 
or penis. 
2. Urine contains blood. 
3. Fasces normal color. 
4. Urine contains gravel. 
5. Urine passed every few minutes. 
6. Sharp pain followed by a dull ach 
ing in loins. 
Cardialgia. 
1. Attack comes on after eating. 
2. Pain confined to epigastric region 
3. Pain stops gradually. 
4. Urine normal. 
5. Normal color of faeces. 86 
DIFFEREN TIA L DI A GHOSTS. 
NAME OF DISEASE. 
Hepatogenous Jaundice. 
1. Occurs with gastroduodenitis, ca- 
tarrh of bile ducts, etc. 
2. Urine contains bile coloring mat- 
ter. 
3. No albumen in urine. 
4. Fzeces clay-colored. 
5. Heart slow and regular. 
6. No severe nervous symptoms. 
7. Itching of skin. 
8. Liver increased in size. 
9. Jaundice well marked. 
10. Slight loss of flesh. 
DISEASES TO BE DIFFERENTIATED. 
Hematogenous Jaundice. 
1. Occurs with fevers, blood dis. 
eases, etc. 
2. Urine contains bile acids. 
3. Urine albuminous. 
4. Fseces dark color. 
5. Heart rapid and irregular. 
6. Nervous symptoms well marked. 
7. Small hemorrhages in skin. 
8. Spleen usually enlarged. 
9. Jaundice slight. 
10. Rapid emaciation. 
Hepatogenous Jaundice. Acute Yellow Atrophy. 
See Acute Yellow Atrophy, page 81. 
Hepatogenous Jaundice. Acute Congestion of Liver. 
See Acute Congestion of Liver, page 77. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE KIDNEYS AND BLADDER. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE KIDNEYS AND BLADDER. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Epilepsy. 
Apoplexy. 
Hysteria. 
Meningitis. 
Opium poisoning. 
Alcoholic coma. 
Uraemia 
Congestion of the kidneys. 
Hematinuria. 
Suppurative nephritis. 
Acute cystitis. 
Chronic Bright's. 
Acute Bright's 
Acute Bright's. 
Cirrhotic kidney. 
Fatty or waxy kidney. 
Large White Kidney 
(Chronic Bright's) 
Acute Bright's. 
Large, white kidney. 
Fatty or waxy kidney. 
Cirrhotic kidney 
(Chronic Bright's) 
Acute Bright's. 
Cirrhotic kidney. 
Large white kidney. 
Fatty or wTaxy kidney 
(Chronic Bright's) 
Bright's disease (dropsy) . . . Dropsy due to other causes. 
89 90 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Pyelitis 
Suppurative nephritis. 
Cystitis. 
Pyonephrosis 
Perinephritic abscess. 
Hydronephrosis. 
Pyelitis. 
Pyaemia. 
Perinephritic abscess. 
Acute Bright's. 
Cystitis. 
Suppurative nephritis 
Hematuria 
Hemorrhage from bladder. 
Hemorrhage from urethra. 
Acute Bright's. 
Hematuria. 
Hematinuria 
Hydatids of kidney. 
Ovarian cyst. 
Pyonephritis. 
Cancer of kidney. 
Perinephritic abscess. 
Hydatids of liver. 
Hydronephrosis, or hydatids 
Perinephritic abscess. 
Tumor of liver. 
Tumor of spleen. 
Abdominal aneurism. 
Hydronephrosis, or Hydatids. 
Tubercle of kidney. 
Cancer of kidney 
Pyonephritis. 
Suppurative nephritis. 
Cancer of kidney. 
Hydronephrosis. 
Perinephritic abscess 
Renal calculi 
Acute peritonitis. 
Hepatic colic. 
Intestinal colic. DISEASES OF THE KIDNEYS AND BLADDER. 
91 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Acute Bright's. 
Pyelitis. 
Suppurative Nephritis. 
Spasm of the bladder. 
Cystitis 
Uraemia. 
1. History of Bright's disease. 
2. CEdema. 
3. Convulsions migratory in charac- 
ter. 
4. No change in pupils. 
5. No biting of tongue. 
6. Waxy countenance. 
7. Albumen and casts in urine. 
8. Temperature low. 
9. Deep coma follows convulsions. 
10. No initial cry or pallor. 
Uraemia. 
1. History of Bright's disease. • 
2. Coma follows convulsions. 
3. Stertor sharp and hissing. 
4. No paralysis. 
5. Urine albuminous with casts. 
6. Pupils normal. 
7. General oedema. 
8. Patient has a uriniferous smell. 
Uraemia. 
1. History of Bright's. 
2. Convulsions appear without warn- 
ing and followed by coma. 
3. Peculiar stertor. 
4. Casts and albumen in urine. 
5 Reflexes absent. 
Epilepsy. 
1. History of epilepsy. 
2. No general oedema. 
3. Convulsions general-tonic then 
clonic. 
4. Dilated pupils follow spasm. 
5. Tongue bitten. 
6. Countenance cyanotic. 
7. Urine normal. 
8. Temperature elevated. 
9. Mild coma or sleep. 
10. Initial cry and pallor. 
Apoplexy. 
1. History of disease of arteries, 
heart, or of injury. 
2. Coma precedes convulsions. 
3. Stertor labored and snoring. 
4. Paralysis and spasm of one side. 
5. Urine normal. 
6. Pupils unequal. 
7. No oedema. 
8. No smell about patient. 
Hysteria. 
1. History of hysteria. 
2. Coma alternates with convulsions 
and other hysterical symptoms. 
3. Breathing free from stertor. 
4. Urine pale and abundant. 
5. Reflexes pale or exaggerated. 92 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Uraemia. 
6. Opisthotonos rare. 
7. Cervical vessels distended. 
8. Moral treatment has no effect. 
Uraemia. 
1. History of Bright's. 
2. General oedema. 
3. Pulse rapid. 
4. Waxy countenance. 
5. Temperature highest at first. 
6. Convulsions migratory in charac- 
ter. 
7. Odor of urine about patient. 
8. Albumen and casts in urine. 
9. Delirium usually mild or absent. 
Uraemia. 
1. History of Bright's. 
2. Comaprecededby other symptoms. 
3. Respiration hurried. 
4. Pupils normal. 
5. Casts and albumen in urine. 
6. CEdema. 
7. Smell of urine about patient. 
3. Skin dry and waxy in appearance. 
Uraemia. 
1. History of Bright's. 
2. Cannot be aroused. 
3. Albumen and casts in urine. 
4. Uriniferous smell about patient. 
5. Face waxy. 
6. CEdema. 
7. Stertor hissing in character. 
DISEASES TO BE DIFFERENTIATED. 
Hysteria. 
6. Opisthotonos common. 
7. No distended veins. 
8. Moral treatment curative. 
Meningitis. 
1. History of injury or disease. 
2. No oedema. 
3. Pulse slow. 
4. Flushed face. 
5. Temperature rises from day to day, 
6. Convulsions not characteristic. 
7. No odor about patient. 
8. Urine normal. 
9. Wild delirium. 
Opium Poisoning. 
1. No previous history. 
2. Coma comes on gradually like sleep 
3. Respiration slow. 
4. Pupils contracted. 
4. Urine normal. 
6. No oedema. 
7. Often smell of opium in breath. 
8. Profuse sweating, countenance cy- 
anosed. 
Alcoholic Coma. 
1. History of alcoholism. 
2. Aroused momentarily by pain. 
3. Urine contains alcohol. 
4. Smell of alcohol in breath. 
5. Face flushed. 
6. No oedema. 
7. Stertor " puffy " in character. DISEASES OF THE KIDNEYS AND BLADDER. 
93 
NAME OF DISEASE. 
Acute Bright's Disease. 
1. History of acute disease, expos- 
ure to cold, etc. 
2. Severe constitutional symptoms as 
headache, vomiting, etc. 
3 High specific gravity of urine. 
4. Urine very albuminous. 
5. Casts in urine. 
6. Urine bloody. 
7. Temperature elevated. 
8. Dropsy well marked. 
Acute Bright's. 
1. Dropsy. 
2. Disease lasts for some time. 
3. Small amount of blood in urine. 
4. Severe constitutional symptoms. 
5. No granular pigment in urine. 
6. Much albumen and many casts in 
urine. 
Acute Bright's. 
1. Affects both kidneys. 
2. Casts abundant. 
3. Pus small in amount. 
4. Kidneys not enlarged. 
5. Continued fever. 
6. Severe backache. 
7. Dropsy. 
Acute Bright's. 
1. Pain in back. 
2. Pain not very severe. 
3. Slight pain in passing water. 
DISEASES TO BE DIFFERENTIATED. 
Congestion of Kidney. 
1. History of venous obstruction. 
2. No severe constitutional symp- 
toms. 
3. Specific gravity of urine normal. 
4. But little albumen in urine. 
5. No casts in urine. 
6. No blood in urine. 
7. Temperature normal. 
8. No general oedema. 
Hematinuria. 
1. No general oedema. 
2. Disease of short duration. 
3. Blood in large amount. 
4. No severe constitutional disturb- 
ance. 
5. Granular pigment in urine. 
6. But little albumen and few blood- 
casts in urine. 
Suppurative Nephritis. 
1. Affects one kidney. 
2. Casts few and covered with pus. 
3. Large amount of pus in urine. 
4. Affected kidney enlarged and ten- 
der. 
5. Fever remittent. 
6. Pain localized over one kidney. 
7. No general oedema. 
Acute Cystitis. 
1. Pain over bladder and in penis. 
2. Pain sharp and burning. 
3. Burning pain on urinating. 94 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Acute Bright's. 
4. Albumen large in amount. 
5. But little pus and mucus in urine. 
6. U rine bloody. 
7. Casts in urine. 
8. Dropsy. 
9. Constitutional symptoms well 
marked. 
DISEASES TO BE DIFFERENTIATED. 
Acute Cystitis. 
4. But little albumen in urine. 
5. Much ropy pus and mucus in 
urine. 
6. Bloody urine uncommon. 
7. No casts in urine. 
8. No general oedema. 
9. Less severe constitutional disturb- 
ances. 
Acute Bright's. Chronic Bright's. 
See Chronic Bright's, pages 94, 95, 96. 
Large White Kidney. 
(Chronic Bright's.) 
1. Usually the result of acute Bright's. 
2. Heart hypertrophied. 
3. Urine normal, or slightly increased 
in amount. 
4. Casts-hyaline, granular, and epi- 
thelial. 
5. Specific gravity of urine dimin- 
ished. 
6. No blood in urine. 
7. Temperature normal. 
Large White Kidney. 
1. Dropsy well marked. 
2. Most common in young adults. 
3. Amount of urine normal, or 
slightly increased. 
4. Epistaxis and retinitis uncommon. 
5. Specific gravity of urine, 1010- 
1018. 
Acute Bright's. 
1. Usually the result of exposure to 
cold or some acute disease. 
2. Heart normal. 
3. Urine diminished in amount. 
4. Blood and a few hyaline casts in 
urine. 
5. Specific gravity of urine increased. 
6. Urine bloody. 
7. Temperature elevated. 
Cirrhotic or Atrophied Kidney. 
1. Little or no general oedema. 
2. The nephritis of adults. 
3. Amount of urine greatly in- 
creased. 
4. Epistaxis and retinitis common. 
5. Urine low specific gravity, 1005- 
1010. DISEASES OF THE KIDNEYS AND BLADDER. 
95 
NAME OF DISEASE. 
Large White Kidney. 
6. Many casts in urine. 
7. Liver normal size. 
8. Much albumen in urine. 
Large White Kidney. 
1. Usually the result of acute Bright's. 
2. Dropsy comes on rapidly. 
3. Uraemic symptoms common. 
4. Liver and spleen normal size. 
5. Diarrhoea unfrequent. 
6. Casts : hyaline, granular, and epi- 
thelial. 
7. Face pale. 
Cirrhotic Kidney. 
(Chronic Bright's.) 
1. (Edema slight. 
2. Disease of slow progress. 
3. Urine increased in amount. 
4. Urine of low specific gravity. 
5. No blood in urine. 
6. Few casts-hyaline and granular. 
7. No acute symptoms at first. 
DISEASES TO BE DIFFERENTIATED. 
Cirrhotic or Atrophied Kidney. 
6. Few casts, principally hyaline. 
7. Liver small. 
8. Little or no albumen in urine. 
Fatty or Waxy Kidney. 
1. Follows wasting disease and sup- 
puration. 
2. Gradual development of oedema. 
3. Uraemic symptoms uncommon. 
4. Liver and spleen enlarged. 
5. Obstinate diarrhoea. 
6. Fatty and waxy casts in urine. 
7. Face wax-like. 
Acute Bright's. 
1. Dropsy well marked. 
2. Disease rapid in progress. 
3. Urine diminished in amount. 
4. Specific gravity of urine high. 
5. Bloody mine. 
0. Blood and hyaline casts. 
7. Symptoms acute from the begin- 
ning. 
Cirrhotic Kidney. Large White Kidney. 
See Large White Kidney, page 94. 
Cirrhotic Kidney. 
1. Flistory of previous good health. 
2. Little or no dropsy. 
3. Liver small. 
Fatty or Waxy Kidney. 
1. History of wasting disease or sup- 
puration. 
2. (Edema well marked. 
3. Liver large. 96 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Cirrhotic Kidney. 
4. Specific gravity of urine 1,005 to 
1,010. 
5. But little albumen in urine. 
6. Few hyaline and granular casts. 
7. Sallow complexion. 
DISEASES TO BE DIFFERENTIATED. 
Fatty or Waxy Kidney. 
4. Specific gravity of urine 1,010 to 
1,015. 
5. Much albumen in urine. 
6. Fatty and waxy casts. 
7. Waxy countenance. 
Fatty or Waxy Kidney. Large White Kidney. 
See Large White Kidney, page 95. 
Fatty or Waxy Kidney. Cirrhotic Kidney. 
See Cirrhotic Kidney, above. 
Fatty or Waxy Kidney. 
(Chronic Bright's.) 
1. History of wasting disease or sup- 
puration. 
2. Symptoms appear slowly. 
3. Urine increased in amount. 
4. No blood in urine. 
5. Fatty and waxy casts. 
6. Uraemic symptoms rare. 
7. Temperature normal. 
8. Specific gravity of urine low. 
Bright's Disease. 
(Dropsy.) 
1. Dropsy usually begins in the feet. 
2. Urine contains albumen and casts. 
3. Complexion pale, sallow, or waxy. 
4. Urine altered in amount or color. 
5. Urine altered in specific gravity. 
6. No pulmonary symptoms. 
7. Pain in region of kidneys. 
8. Uraemic symptoms. 
Acute Bright's. 
1. History of exposure to cold or 
some acute disease. 
2. Symptoms come on rapidly. 
3. Urine diminished 
4. Bloody urine. 
5. Blood and hyaline casts. 
6. Uraemic symptoms common. 
7. Temperature elevated. 
8. High specific gravity of urine. 
Dropsy Due to Other Causes. 
1. Dropsy begins in the face or as 
ascites. 
2. Urine normal. 
3. Complexion cyanotic or cachectic. 
4. Urine normal in color and amount. 
5. Specific gravity of urine normal. 
6. Pulmonary or liver symptoms com- 
mon. 
7. No pain over kidneys. 
8. Absence of uraemic symptoms. DISEASES OF THE KIDNEYS AND BLADDER. 
97 
NAME OF DISEASE. 
Pyelitis. 
1. Constitutional symptoms not very 
prominent. 
2. No recurring chills or fever. 
3. No diarrhoea. 
4. No typhoid symptoms. 
5. Characteristic "tailed" cells in 
urine. 
6. No tubal pus casts in urine. 
7. Much pus constantly in urine. 
8. Now and then irregular nephritic 
enlargement (pydnephritis). 
Pyelitis. 
1. Pain in lumbar region. 
2. Urine acid. 
3. Large quantities of pus in urine. 
4. " Tailed " cells in urine. 
5. No constant desire to urinate. 
6. Much foreign matter in urine. 
7. Little mucus in urine. 
8. No pain during micturition. 
Pyonephrosis. 
1. Pus, blood, and mucus in urine. 
2. Temperature nearly normal. 
3. No pain on motion. 
4. " Tailed " cells in urine. 
5. Irregular chills and sweating un- 
common. 
6. Tumor appears and disappears 
suddenly. 
7. No signs of inflammation over 
tumor. 
DISEASES TO BE DIFFERENTIATED. 
Suppurative Nephritis. 
1. Constitutional symptoms severe. 
2. Recurring chills and fever. 
3. Diarrhoea common. 
4. Typhoid symptoms. 
5. No characteristic cells in urine. 
6. Pus casts of renal tubes in urine. 
7. Pus in urine inconstant and in 
small amount. 
8. Kidney constantly enlarged and 
tender. 
Cystitis. 
1. Pain over bladder and in penis. 
2. Urine alkaline. 
3. But little pus in urine. 
4. No characteristic cells in urine. 
5. Constant desire to urinate. 
6. But little foreign matter in urine. 
7. Urine contains large quantities of 
ropy mucus. 
8. Burning pain on passing water. 
Perinephritic Abscess. 
1. Urine normal. 
2. Temperature elevated. 
3. Severe pain on motion. 
4. No characteristic cells in urine. 
5. Irregular chills and profuse sweat- 
ing at intervals. 
6. Tumor constant. 
7. Severe pain and some oedema over 
tumor. 98 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Pyonephrosis. 
1. Urine contains much pus, etc. 
2. " Tailed " cells in urine. 
3. Moderate constitutional symptoms, 
as pain, debility, etc. 
4. Indistinct fluctuation of tumor. 
5. Aspirating needle withdraws pus, 
etc. 
DISEASES TO BE DIFFERENTIATED. 
Hydronephrosis. 
1. Urine normal. 
2. No cells in urine. 
3. General health good. 
4. Distinct fluctuation of tumor. 
5. Aspirating needle withdraws wa- 
tery urine. 
Suppurative Nephritis. Pyelitis. 
See Pyelitis, page 97. 
Suppurative Nephritis. Acute Bright's. 
See Acute Bright's, page 93. 
Suppurative Nephritis. 
1. No profuse sweating. 
2. Urine purulent and bloody. 
3. Temperature moderately high. 
4. No joint affections. 
5. No pulmonary symptoms. 
6. Affected kidney enlarged and 
tender. 
7. Severe lumbar pains. 
Suppurative Nephritis. 
1. Urine bloody and purulent. 
2. No distinct renal tumor. 
3. Pus casts in urine. 
4. No superficial signs of inflamma- 
tion. 
5. Kidneys tender on pressure. 
6. No fluctuation. 
7. Temperature continues elevated. 
Pyaemia. 
1. Profuse sweats. 
2. Urine normal. 
3. Fever very high at times. 
4. Large joints affected. 
5. Pulmonary symptoms. 
6. Kidneys not enlarged or tender. 
7. Pain not referred to lumbar region. 
Perinephritic Abscess. 
1. Urine normal. 
2. A distinct tumor in lumbar region. 
3. No casts in urine. 
4. Superficial tenderness and oedema. 
5. Kidneys painful on pressure. 
6. Fluctuation. 
7. Irregular chills, fever, and sweat- 
ing. DISEASES OF THE KIDNEYS AND BLADDER. 
99 
NAME OF DISEASE. 
Suppurative Nephritis. 
1. U rine contains much pus and little 
mucus. 
2. Pain in lumbar region. 
3. Pus casts in urine. 
4. Typhoid symptoms well marked. 
5. No constant desire to urinate. 
6- Affected kidney enlarged and 
tender. 
Hematuria. 
1. History of kidney disease, blood 
disease, poisoning, etc. 
2. Blood mixed with the urine. 
3. Urine contains albumen and blood 
casts. 
4. Pain in the lumbar region. 
5. Renal epithelium in urine. 
Hematuria. 
1. History of kidney trouble, blood 
disease or poisoning. 
2. Blood is mixed with the urine. 
3. Urine contains albumen and blood 
casts. 
4. Pain in the lumbar region. 
5. Renal epithelium in urine. 
6. Blood is passed with urine. 
DISEASES TO BE DIFFERENTIATED. 
Cystitis. 
1. Urine contains much ropy mucus 
and little pus. 
2. Pain in bladder and penis. 
3. No casts in urine. 
4. No severe constitutional symptoms. 
5. Constant desire to micturate. 
6. Kidneys not enlarged or tender. 
Vesical Hemorrhage. 
1. History of disease of the bladder. 
2. Blood follows the passage of urine. 
3. Urine contains blood clots. 
4. Pain located in bladder or penis. 
5. Vesical epithelium in urine. 
Urethral Hemorrhage. 
1. History of urethritis, prostatic 
trouble, etc. 
2. Blood precedes the urinary dis- 
charge. 
3. Blood casts of urethra in the urine. 
4. Pain in penis or prostate. 
5. No renal or vesical epithelium in 
urine. 
6. Blood discharged without emptying 
the bladder. 
Hematinuria. Acute Bright's. 
See Acute Bright's, page 93. 100 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Hematinuria. 
1. Often the result of malaria. 
2. Few red blood corpuscles in urine. 
3. Abundance of blood pigment in 
urine. 
4. Often preceded by chilliness, slight 
jaundice, and gastric disorder. 
5. Coloring matter not deposited on 
standing. 
6. Urine often suddenly changes color 
on standing. 
Hydronephrosis. 
1. Urine normal. 
2. May affect both kidneys. 
3. No fremitus on percussion. 
4. Tumor single. 
5. Tumor grows rapidly. 
6. Tumor seldom of great size. 
7. Exploring needle withdraws a 
watery uriniferous fluid. 
Hydronephrosis or Hydatids of 
Kidney. 
1. Tumor grows from lumbar region. 
2. Colon lies in front of tumor. 
3. Vaginal examination negative. 
4. Absence of tympanitic percussion 
note in lumbar region. 
5. Exploring needle withdraws a 
watery fluid, either with or with- 
out booklets. 
DISEASES TO BE DIFFERENTIATED. 
Hematuria. 
1. The result of kidney disease. 
2. Many red blood corpuscles in 
urine. 
3. No free blood pigment in urine. 
4. Preceded by pain in lumbar region. 
5. Coloring matter deposited at bot- 
tom of vessel on standing. 
6. Urine does not change color on 
standing. 
Hydatids of Kidney. 
1. Urine contains hydatid vesicles. 
2. Affects one kidney. 
3. Hydatid fremitus on percussion. 
4. Tumor-multiple. 
5. Tumor grows slowly. 
6. Tumor often of large size. 
7. Exploring needle withdraws fluid 
containing booklets. 
Ovarian Cyst. 
1. Tumor starts from pelvic region. 
2. Colon behind tumor. 
3. Vaginal examination positive. 
4. Tympanitic percussion in lumbar 
region. 
5. Exploring needle withdraws albu- 
minous fluid containing character- 
istic cells. 
Hydronephrosis or Hydatids of 
Kidney. 
Pyonephritis. 
See Pyonephritis, page 98. DISEASES OF THE KIDNEYS AND BLADDER. 
101 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Hydronephrosis or Hydatids of 
Kidney. 
Hydatids of Liver. 
See Hydatids of Liver, page 84. 
Hydronephrosis or Hydatids of 
Kidney. 
1. Tumor not painful. 
2. Tumor grows forward. 
3. Superficial fluctuation. 
4. No constitutional symptoms. 
5. No signs of inflammation about the 
tumor. 
6. Exploring needle withdraws Eat- 
ery fluid, either with or without 
booklets. 
Hydronephrosis or Hydatids of 
Kidney. 
1. Tumor not painful. 
2. No constitutional symptoms. 
3. Tumor smooth and fluctuating. 
4. Urine normal. 
5. No cachexia or history of cancer. 
6. Exploring needle withdraws watery 
fluid with or without booklets. 
Perinephritic Abscess. 
1. Tumor painful. 
2. Tumor grows backward. 
3. Deep fluctuation. 
4. Chills, fever, and sweating. 
5. Tumor painful and tender, skin 
oedematous and sometimes red. 
6. Exploring needle withdraws pus. 
Cancer of Kidney. 
1. Tumor painful. 
2. Constitutional symptoms. 
3. Tumor hard and nodular. 
4. Urine contains blood and cancer 
cells. 
5. Cachexia and often history of can- 
cer. 
6. Exploring needle withdraws blood 
and cancer cells. 
Cancer of Kidney. Tumor of Liver. 
See Tumor of Liver, page 83. 
Cancer of Kidney. Abdominal Aneurism. 
See Abdominal Aneurism, page 46. 
Cancer of Kidney. 
Hydronephrosis or Hydatids of 
Kidney. 
See Hydronephrosis or Hydatids of Kidney, above. 102 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Cancer of Kidney. 
1. History of hereditary or secondary 
cancer. 
2. No fluctuation. 
3. No chills or sweating. 
4. No pain on pressure. 
5. Slow growth. 
6. Urine contains blood and cancer 
cells. 
7. Exploring needle withdraws blood 
and cancer cells. 
Cancer of Kidney. 
1. History of cancer. 
2. Tumor stationary. 
3. Outline of tumor irregular. 
4. No blood changes. 
5. Grows from lumbar region. 
6. Cancerous cachexia. 
7. Blood and cancer cells in urine. 
Cancer of Kidney. 
1. History of cancer. 
2. Blood in urine. 
3. No tenderness over the tumor. 
4. No disease of testicles or prostate. 
5. No pulmonary symptoms. 
6. Hectic appears late. 
7. Tumor grows to a large size. 
DISEASES TO BE DIFFERENTIATED. 
Perinephritic Abscess. 
1. Often a history of injury to lumbar 
region. 
2. Fluctuation about tumor. 
3. Irregular chills and profuse sweats. 
4. Marked pain and tenderness on 
pressure. 
5. Tumor of rapid growth. 
6. Urine normal. 
7. Exploring needle withdraws pus. 
« 
Tumor of Spleen. 
1. History of malaria, leucocythemia. 
2. Tumor moves up and down with 
the breathing. 
3. Outline of tumor presents the 
splenic notch. 
4. Large increase of white blood cor- 
puscles. 
5. Tumor grows from the left hypo- 
chondriac region. 
6. Patient very anaemic. 
7. Urine normal. 
Tubercular Kidney. 
1. History of tuberculosis. 
2. Cheesy debris in urine. 
3. Tumor tender on pressure. 
4. Tubercular disease of testicles or 
prostate. 
5. Lungs phthisical. 
6. Hectic appears early. 
7. Tumor rarely of large size. DISEASES OF THE KIDNEYS AND BLADDER. 
103 
NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED 
Perinephritic Abscess. Pyonephritis. 
See Pyonephritis, page 97. 
Perinephritic Abscess. Suppurative Nephritis. 
See Suppurative Nephritis, page 98. 
Perinephritic Abscess. Cancer of Kidney. 
See Cancer of Kidney, page 102. 
Perinephritic Abscess. Hydronephrosis. 
See Hydronephrosis, page 101. 
Renal Calculi. r Acute Peritonitis. 
See Acute Peritonitis, page 69. 
Renal Calculi. Hepatic Colic. 
See Hepatic Colic, page 85. 
Renal Calculi. Intestinal Colic. 
See Intestinal Colic, page 68. 
Cystitis. Acute Bright's. 
See Acute Bright's, page 94. 
Cystitis. Pyelitis. 
See Pyelitis, page 97. 
Cystitis. Suppurative Nephritis. 
See Suppurative Nephritis, page 99. 
Cystitis. 
1. Temperature elevated. 
2. Pain burning in character. 
3. Pain constant. 
4. Ropy mucus and pus in urine. 
5. No difficulty in passing water ex- 
cept the pain. 
6. Urine scalds. 
Spasm of the Bladder. 
1. Temperature normal. 
2. Pain lancinating. 
3. Pain paroxysmal. 
4. Urine normal. 
5. Great difficulty in passing any urine 
during the paroxysm. 
6. Urine does not scald. DIFFERENTIAL DIAGNOSIS OF THE ACUTE GEN- 
ERAL DISEASES. DIFFERENTIAL DIAGNOSIS OF THE ACUTE GEN- 
ERAL DISEASES. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Typhus fever. 
Typho-malarial fever. 
Acute tuberculosis. 
Septicaemia. 
Ulcerative endocarditis. 
Trichinosis. 
Acute enteritis. 
Typhoid fever 
Typhoid fever. 
Relapsing fever. 
Measles. 
Meningitis. 
Small-pox. 
Typhus fever 
Yellow fever 
Acute yellow atrophy of liver. 
Relapsing fever. 
Typho-malarial fever. 
Pernicious malarial fever. 
Yellow fever. 
Typhus fever. 
Remittent fever. 
Dengue fever. 
Relapsing fever 
Intermittent fever 
Pyaemia. 
Remittent fever. 
107 108 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Intermittent fever. 
Typhoid fever. 
Yellow fever. 
Relapsing fever. 
Remittent fever 
Pernicious malarial fever 
Meningitis. 
Cholera. 
Yellow fever. 
Scarlet fever. 
Measles. 
Epidemic cerebro-spinal meningitis. 
Varioloid. 
Chicken-pox. 
. Typhus fever. 
Small-pox 
Scarlet fever 
Measles. 
Variola. 
Erythema. 
Diphtheria. 
' Variola. 
Scarlet fever. 
Roseola. 
Typhus fever. 
Measles 
Acute poisoning. 
Cholera morbus. 
. Pernicious malarial fever. 
Cholera 
Diphtheritic sore throat. 
Membranous croup. 
Scarlet fever. 
Erysipelas of throat. 
Diphtheria 
Small-pox. 
Typhus fever. 
Tubercular meningitis. 
Pernicious fever. 
Epidemic cerebro-spinal meningitis ACUTE GENERAL DISEASES. 
109 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Suppurative nephritis. 
Septicaemia. 
Intermittent fever. 
Acute yellow atrophy of liver. 
Ulcerative endo-carditis. 
Pyaemia 
Septicaemia 
Typhoid fever. 
Pyaemia. 
Hydrophobia 
Tetanus. 
Hysteria. 
Typhoid Fever. 
1. Disease endemic. 
2. Advent slow, with general mala- 
ria, etc. 
3. Chilly sensations. 
4. Temperature characteristic for 
each week of the disease. 
5. Lenticular rose-colored eruption 
limited to abdomen. 
6. Eruption disappears on pressure. 
7. Eruption appears from seventh to 
tenth day. 
8. Eruption appears in crops. 
9. Diarrhoea. 
10. Gurgling and tenderness in right 
iliac fossa. 
11. Epistaxis and intestinal hemor- 
rhage common. 
12. Nervous symptoms appear in the 
second week. 
13. Spleen enlarged. 
14. Face flushed. 
Typhus Fever. 
1. Epidemic. 
2. Advent sudden. 
3. Severe chill. 
4. Temperature high from the first. 
and remains so until crisis. 
5. Irregular, dark, mottled eruption 
appears about shoulders and 
spreading over body. 
6. Eruption does not disappear on 
pressure. 
7. Eruption appears on fifth day. 
8. Eruption does not appear in 
crops. 
9. Constipation. 
10. No abdominal symptoms. 
11. Hemorrhages very uncommon. 
12. Nervous symptoms appear early. 
13. Spleen not much enlarged. 
14. Face mahogany color. 110 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Typhoid Fever. 
15. Lasts about four weeks. 
16. No crisis. 
17. Bed-sores. 
Typhoid Fever. 
1. Onset slow with chilly sensations. 
2. Temperature rises slowly and reg- 
ularly. 
3. Characteristic eruption. 
4. No jaundice or hepatic tender- 
ness. 
5. Spleen somewhat enlarged. 
6. Abdomen tympanitic. 
7. Tenderness and gurgling in the 
right iliac fossa. 
8. Gastric symptoms not very severe. 
9. Diarrhoea characteristic. 
10. No free pigment in blood. 
Typhoid Fever. 
1. Temperature characteristic. 
2. Eruption. 
3. Typhoid symptoms appear late. 
4. No jaundice. 
5. Gurgling, etc., in right iliac fossa. 
6. Nose bleed. 
7. History of exposure to typhoid 
poison. 
DISEASES TO BE DIFFERENTIATED. 
Typhus Fever. 
15. Lasts two weeks. 
16. Crisis about the fourteenth day. 
17. Glandular enlargements. 
Typho-malarial Fever. 
1. Onset sudden with a chill. 
2. Temperature rises suddenly and 
is periodical in character. 
3. No eruption. 
4. Jaundice and hepatic tenderness. 
5. Spleen greatly enlarged. 
6. No distension of abdomen. 
7. No tenderness or gurgling in right 
iliac fossa. 
8. Gastric symptoms especially 
marked. 
9. No characteristic diarrhoea. 
10. Free pigment in blood. 
Septicaemia. 
1. Temperature very high and irregu- 
lar from first. 
2. No eruption. 
3. Typhoid symptoms appear early. 
4. Jaundice. 
5. No iliac symptoms. 
6. No nose bleed. 
7. History of injury or infectious dis- 
ease. ACUTE GENERAL DISEASES. 
111 
NAME OF DISEASE. 
Typhoid Fever. 
1. Disease endemic. 
2. Temperature highest the end of 
second week. 
3. Spleen enlarged. 
4. Absence of dyspnoea. 
5. Bronchitis. 
6. Face flushed. 
7. Characteristic eruption. 
8. Choroid normal. 
9. Sputum not characteristic. 
Typhoid Fever. 
1. Temperature characteristic. 
2. Eruption. 
3. No oedema. 
4. No severe muscular pains. 
5. No muscular tenderness. 
6. Examination of muscle negative. 
DISEASES TO BE DIFFERENTIATED. 
Acute Tuberculosis. 
1. Disease hereditary or secondary. 
2. Temperature 106° - 107° in first 
week. 
3. Spleen not enlarged. 
4. Severe dyspnoea. 
5. Lung consolidation-subcrepitant 
rales. 
6. Face cyanosed. 
7. No eruption. 
8. Tubercular ulceration of choroid. 
9. Sputum contains tubercle bacilli. 
Trichinosis. 
1. Temperature not characteristic. 
2. No eruption. 
8. CEdema of eyelids. 
4. Severe muscular pains. 
5. Extreme muscular tenderness. 
6. Trichinae found in the muscle. 
Typhoid Fever. Ulcerative Endocarditis. 
See Ulcerative Endocarditis, page 40. 
Typhoid Fever. Acute Enteritis. 
See Acute Enteritis, page 59. 
Typhus Fever. Typhoid Fever. 
See Typhoid Fever, page 109. 
Typhus Fever. 
1. Early delirium. 
2. Mulberry rash. 
3. Great muscular weakness. 
4. Spleen normal size. 
5. Crisis on fourteenth day. 
Relapsing Fever. 
1. No delirium. 
2. No eruption. 
3. Severe muscular and arthritic pains. 
4. Spleen enlarged. 
5. Intermission end of first week. 112 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Typhus Fever. 
6. No relapse. 
7. No profuse sweats. 
8. Pulse not very rapid at first. 
9. No abdominal symptoms. 
10. Frequent glandular enlargement. 
DISEASES TO BE DIFFERENTIATED. 
Relapsing Fever. 
6. Relapse end of second week. , 
7. Severe sweats. 
8. Pulse 150 to 170 from the first. 
9. Vomiting and abdominal pain. 
10. No enlarged glands. 
Typhus Fever. Small-pox. 
See Small-pox, page 118. 
Typhus Fever. 
1. Eruption preceded by cerebral 
symptoms and great prostra- 
tion. 
2. Eruption appears on the fifth day. 
3. But little eruption about the head. 
4. Eruption not crescentic in appear- 
ance. 
5. Eruption dark-brown. 
6. Eruption does not disappear on 
pressure. 
7. Mucous membrane of throat nor- 
mal. 
Typhus Fever. 
1. Frontal headache. 
2. Headache disappears with the de- 
lirium. 
3. No muscular rigidity. 
4. Mulberry rash. 
5. No strabismus. 
6. No convulsions or paralysis. 
7. Countenance blank. 
Measles. 
1. Eruption preceded by symptoms of 
a severe cold. 
2. Eruption appears on the fourth 
day. 
3. Eruption well-marked about the 
face. 
4. Eruption crescentic. 
5. Eruption dark-red. 
6. Eruption disappears on pressure. 
7. Throat red and injected. 
Cerebro-spinal Meningitis. 
1. Occipital headache. 
2. Pain in head continues with the 
delirium. 
3. Muscular rigidity appears early. 
4. Herpetic eruption, if any. 
5. Strabismus. 
6. Convulsions and paralysis com- 
mon. 
7. Face pinched and anxious. ACUTE GENERAL DLSEASES. 
113 
NAME OF DISEASE. 
Typhus Fever. 
8. Temperature remains high from 
first. 
9. Pulse rapid and compressible. 
10. No vomiting. 
11. Crisis. 
DISEASES TO BE DIFFERENTIATED. 
Cerebro-spinal Meningitis. 
8. Temperature rises slowly seldom 
over 104°. 
9. Pulse slow. 
10. Frequent vomiting. 
11. No critical days. 
Yellow Fever. Acute Yellow Atrophy of Liver. 
See Acute Yellow Atrophy of Liver, page 81. 
Yellow Fever. 
1. Temperature rarely over 104°. 
2. Pulse comparatively slow and gas- 
eous. 
3. Jaundice well-marked. 
4. Supra-orbital pain. 
5. Remission about the fourth day. 
6. Spleen not greatly enlarged. 
7. Fiery eye. 
8. Hemorrhages common. 
Yellow Fever. 
1. Temperature constant until remis- 
sion. 
2. Constipation. 
3. Supra-orbital pain. 
4. Countenance peculiar. 
5. Jaundice well-marked. 
6. Hemorrhages common. 
7. Urine albuminous. 
8. Spleen slightly enlarged. 
9. Disease of short duration. 
Yellow Fever. 
1. Temperature rarely over 104. 
2. Pulse slow and gaseous. 
Relapsing Fever. 
1. Temperature 105° to 107°. 
2. Pulse very rapid. 
3. Jaundice slight and late in appear- 
ing. 
4. Arthritic and muscular pain. 
5. Intermission end of first week. 
6. Spleen much enlarged. 
7. No change in face. 
8. Hemorrhages uncommon. 
Typho-malarial Fever. 
1. Periodicity in daily temperature. 
2. Diarrhoea. 
3. Pain in iliac fossa. 
4. No peculiar countenance. 
5. Slight jaundice. 
6. Hemorrhages uncommon. 
7. Urine normal. 
8. Spleen greatly enlarged. 
9. Disease of long duration. 
Pernicious Malarial Fever. 
1. Temperature 104 to 106. 
2. Pulse rapid. 114 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Yellow Fever. 
3. Remission about the fourth day. 
4. Hemorrhages common. 
5. Tongue clean. 
6. Mind clear. 
7. Fiery eye. 
8. Supra-orbital pain. 
9. Urine albuminous. 
10. Vomiting projectile and severe. 
DISEASES TO BE DIFFERENTIATED. 
Pernicious Malarial Fever. 
3. Remission within twenty-four 
hours. 
4. Hemorrhages rare. 
5. Tongue coated. 
6. Delirium or stupor. 
7. Countenance not peculiar. 
8. No supra-orbital pain. 
9. No albumen in urine. 
10. Vomiting retching and moderate. 
Relapsing Fever. Typhus Fever. 
See Typhus Fever, page III. 
Relapsing Fever. Yellow Fever. 
See Yellow Fever, page 113. 
Relapsing Fever. 
1. Continued high temperature until 
remission. 
2. Pulse very rapid. 
3. Intense arthritic pains. 
4. Complete relapse. 
5. Sweating without reduction of 
temperature. 
6. Crisis. 
7. Blood contains spirilli. 
Relapsing Fever. 
1. Begins with a chill and high fever. 
2. No swelling of joints. 
3. No enlarged glands. 
4. Complete intermission toward the 
end of first week. 
Remittent Fever. 
1. Daily remissions. 
2. Pulse not very rapid. 
3. No severe pain in muscles or 
joints. 
4. No relapses. 
5. Sweating with reduction of tem- 
perature. 
6. No crisis. 
7. Blood contains free pigment. 
Dengue Fever. 
1. Begins as a rheumatism. 
2. Joints swollen and tender. 
3. Glands enlarged and tender. 
4. Remission on third or fourth day. ACUTE GENERAL DISEASES. 
115 
NAME OF DISEASE. 
Relapsing Fever. 
5. Vomiting. 
6. Profuse sweats. 
7. No eruption. 
Intermittent Fever. 
1. History of exposure to malarial 
poisoning. 
2. Paroxysms regular. 
3. Temperature very high. 
4. Jaundice uncommon. 
5. No severe prostration. 
6. Breath normal odor. 
7. No pulmonary or joint symptoms. 
8. No points of local infection. 
Intermittent Fever. 
1. Many chills. 
2. Complete intermissions. 
3. Periods of no fever. 
4. Regular development of parox- 
ysms. 
5. Patient feels well during the inter- 
missions. 
DISEASES TO BE DIFFERENTIATED. 
Dengue Fever. 
5. Vomiting uncommon. 
6. No profuse sweats. 
7. Accompanying the relapse an 
eruption appears first on the 
hands. 
Pyaemia. 
1. History of injury or infectious dis- 
ease. 
2. Irregular paroxysms. 
3. Temperature lower. 
4. Jaundice. 
5. Patient greatly prostrated. 
6. Breath sweet and nauseous. 
7. Abscess of lungs and joints. 
8. Points of local infection. 
Remittent Fever. 
1. One Chill. 
2. Remissions. 
3. Always fever. 
4. Symptoms irregularly developed. 
5. Patient feels sick all of the time. 
Remittent Fever. Typhoid Fever. 
See Typhoid Fever, page no. 
Remittent Fever. Yellow Fever. 
See Yellow Fever, page 113. 
Remittent Fever. Relapsing Fever. 
See Relapsing Fever, page 114. 116 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Remittent Fever. Intermittent Fever. 
See Intermittent Fever, page 115. 
Pernicious Malarial Fever. 
(Cerebral form.) 
1. Coma appears early. 
2. History of malaria. 
3. Temperature very high. 
4. Pulse rapid and full. 
5. Distinctly paroxysmal. 
6. Attack ends in a few hours with 
sweating, fall in temperature, 
and sleep. 
7. Free pigment in blood. 
Pernicious Malarial Fever. 
(Gastro-enteric form.) 
1. History of malarial infection. 
2. Temperature elevated. 
3. Discharges bloody from first. 
4. No albumen in urine. 
5. Vomiting painful and retching. 
6. Free pigment in blood. 
Cerebro-Spinal Meningitis. 
1. Coma preceded by headache, de- 
lirium, etc. 
2. History of injury and infectious 
disease. 
3. Temperature rarely over 104°. 
4. Pulse slow and irregular. 
5. No intermissions or remissions. 
6. Attacks usually end in coma and 
death. 
7. No pigment in blood. 
Cholera. 
1. History of epidemic cholera. 
2. Temperature subnormal. 
3. Rice-water evacuations. 
4. Urine albuminous. 
5. Vomiting regurgitative. 
6. Comma bacilli in discharges. 
Pernicious Malarial Fever. 
(Bilious remittent fever.) 
Yellow Fever. 
See Yellow Fever, page 113. 
Small-Pox. 
1. Begins with a chill and severe pain 
in head and back. 
2. Eruption appears on third day 
around the edges of the hair. 
Scarlet Fever. 
1. Begins with headache, vomiting, 
sore throat, and chilliness. 
2. Eruption appears beginning of 
second day about the neck and 
chest. ACUTE GENERAL DISEASES. 
117 
NAME OF DISEASE. 
Small-Pox. 
3. Eruption changes from day to day 
-macular, papular, vesicular, 
and lastly, pustular. 
4. Eruption spreads slowly. 
5. Remission on occurrence of erup- 
tion. 
6. Relapse or secondary fever about 
the eighth day. 
7. Scabbing and pitting ' 
Small-Pox. 
1. Begins with a chill and a severe 
pain in head and back. 
2. Eruption appears about the hair 
on third day. 
3. Eruption macular, then papular, 
vesicular, and lastly pustular. 
4. Remission on occurrence of erup- 
tion. 
5. Secondary fever and relapse during 
suppuration. 
6. Scabbing and pitting. 
Small-Pox. 
1. Pustules maturate on eighth day. 
2. Secondary fever. 
3. Deep suppuration. 
4. Many pustules. 
5. Pustules burst, then dry, forming 
scabs. 
6. Cicatrices well marked. 
Small-Pox. 
1. Begins with high temperature, etc. 
2. Vesicles terminate in pustules. 
DISEASES TO BE DIFFERENTIATED. 
Scarlet Fever. 
3. Eruption erythematous with inter- 
spersed, minute, elevated, dark 
red points. 
4. Eruption spreads rapidly. 
5. No remission in symptoms. 
6. No secondary fever. 
7. Well-marked scaly desquamation. 
Measles. 
1. Begins with the symptoms of a 
severe cold. 
2. Eruption appears on the face on 
the fourth day. 
3. Eruption papular, and appears in 
crescentic patches. 
4. Temperature rises on appearance 
of eruption. 
5. No secondary fever. 
6. Bran-like desquamation. 
Varioloid. 
1. Pustules maturate from fourth to 
sixth day. 
2. No secondary fever. 
3. Superficial suppuration. 
4. Few pustules. 
5. Pustules dry up without bursting. 
6. Cicatrices not well marked. 
Chicken-Pox. 
1. Fever, etc., follow the eruption. 
2. Vesicles dry up without pustulating. 118 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Small-Pox. 
3. Eruption complete on eighth day. 
4. Eruption begins about the hair. 
5. Vesicles umbilicated. 
6. Remission on occurrence of erup- 
tion. 
7. Secondary fever. 
Small-Pox. 
1. Frontal headache. 
2. Face flushed. 
3. Temperature high. 
4. Pulse rapid. 
5. Sore throat. 
6. Vomiting retching. 
7. Temperature falls with the appear- 
ance of the eruption. 
Etc., etc., etc. 
Small-Pox. 
1. No great muscular prostration. 
2. Sore throat. 
3. Eruption appears on third day. 
4. Eruption appears first about hair. 
5. Characteristic eruption of small- 
pox. 
Etc., etc., etc. 
Scarlet Fever. 
1. Begins with chilliness, vomiting, 
headache, and sore throat. 
2. Eruption appears on the second 
day. 
3. Eruption erythematous with 
minute, interspersed, elevated 
dark red spots. 
DISEASES TO BE DIFFERENTIATED. 
Chicken-Pox. 
3. Eruption complete on fourth day. 
4. Eruption begins on the trunk. 
5. Vesicles globular. 
6. No remissions. 
7. No secondary fever. 
Cerebro-Spinal Meningitis. 
1. Occipital headache. 
2. Face pale and anxious. 
3. Temperature rarely over 104*. 
4. Pulse not very rapid. 
5. No sore throat. 
6. Vomiting projectile. 
7. No fall in temperature on appear- 
ance of eruption. 
Etc., etc., etc. 
Typhus Fever. 
1. Severe muscular prostration. 
2. No sore throat. 
3. Eruption appears on fifth day. 
4. Eruption appears first on trunk. 
5. Characteristic typhus eruption. 
Etc., etc., etc. 
Measles. 
1. Begins as a severe cold in the 
head. 
2. Eruption appears on the fourth 
day. 
3. Eruption papular, and is arranged 
in crescentic patches. ACUTE GENERAL DISEASES. 
119 
NAME OF DISEASE. 
Scarlet Fever. 
4. Strawberry tongue. 
5. Severe sore throat. 
6. Albumen in urine. 
7. Eruption appears first on neck 
and chest. 
8. Eruption spreads rapidly. 
9. Desquamation scale-like. 
10. Sequelae Bright's disease. 
Scarlet Fever. 
1. Diffuse redness of tonsils and 
pharynx. 
2. Exudation mucous and easily re- 
moved. 
3. Strawberry tongue. 
4. Temperature very high* 
5. Erythematous eruption followed 
by desquamation. 
6. Sequelae, Bright's disease. 
DISEASES TO BE DIFFERENTIATED. 
Measles. 
4. Tongue coated. 
5. Bronchitis. 
6. Urine normal. 
7. Eruption appears first on face. 
8. Eruption spreads slowly. 
g. Desquamation bran-like. 
10. Sequelae broncho-pneumonia. 
Diphtheria. 
1. Dark local redness of throat. 
2. Exudation membranous and ad- 
herent. 
3. Tongue dry and cracked. 
4. Temperature rarely over 104.° 
5. No eruption, if any, roseola not 
followed by desquamation. 
6. Sequelae, paralysis. 
Scarlet Fever. Small-Pox. 
See Small-Pox, page 116. 
Scarlet Fever. 
1. High temperature. 
2. Eruption covers the body. 
3. Sore throat. 
4. Enlarged cervical glands. 
5. Urine albuminous. 
6. Strawberry tongue. 
7. Eruption interspersed with minute 
dark red, elevated spots. 
8. Desquamation. 
Erythema (Simple). 
1. Temperature slightly elevated. 
2. Eruption irregularly distributed. 
3. No sore throat. 
4. Glands not enlarged. 
5. No albumen in urine. 
6. Tongue normal. 
7. Eruption uniform. 
8. No desquamation. 
Measles. Typhus Fever. 
See Typhus Fever, page Ii2. 120 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Measles. 
1. Eruption confluent. 
2. Coryza and bronchitis well marked. 
3. Temperature high. 
4. Eruption dark, elevated and cres- 
centic. 
5. Eruption appears first on the face. 
6. No sore throat. 
7. Desquamation. 
DISEASES TO BE DIFFERENTIATED. 
Roseola. 
1. Non-confluent eruption. 
2. Slight coryza and bronchitis. 
3. Temperature slightly elevated. 
4. Eruption bright, smooth, and not 
crescentic. 
5. Eruption appears first on trunk. 
6. Some sore throat. 
7. No desquamation. 
Measles. • Scarlet Fever. 
See Scarlet Fever, page 118. 
Measles. Small-Pox. 
See Small-Pox, page 117. 
Cholera. 
1. Mouth and pharynx normal. 
2. Vomiting painless and regurgita- 
tive. 
3. No burning pain in oesophagus or 
stomach. 
4. Rice-water discharges. 
5. Comma bacilli in discharges. 
Acute Poisoning. 
1. Mouth and pharynx glazed and 
congested. 
2. Vomiting painful and retching. 
3. Intense burning sensation in stom- 
ach and oesophagus. 
4. Discharge bloody and mucous. 
5. Poison found in discharges. 
Cholera. Cholera Morbus. 
See Cholera Morbus, page 59. 
Cholera. Pernicious Malarial Fever. 
See Pernicious Malarial Fever, page 116. 
Diphtheria. 
1. Preceded by sore throat. 
2. Attacks any one. 
3. Cervical glands greatly enlarged. 
Membranous Croup. 
1. Preceded by cough and hoarseness. 
2. Attacks children. 
3. Glands but slightly enlarged. ACUTE GENERAL DISEASES. 
121 
name of disease. 
Diphtheria. 
4. Great prostration from the first. 
5. Exudation deep-cannot be readi- 
ly detached. 
6. Exudation if detached leaves an 
ulcer. 
7. Temperature rarely over 104°. 
8. Exudation of a gray-color, and 
contains characteristic bacteria. 
9. Death due to blood-poison. 
10. Sequelae, paralysis. 
DISEASES TO BE DIFFERENTIATED. 
Membranous Croup. 
4. Prostration follows the throat-ob- 
struction. 
5. Exudation superficial-can be 
readily detached. 
6. No ulcer produced by detaching 
the exudation. 
7. Temperature often 104° to 1060. 
8. Exudation of a white color, and 
does not contain characteristic 
bacteria. 
9. Death usually due to suffocation. 
10. No paralysis. 
Diphtheria. Scarlet Fever. 
See Scarlet Fever, page 119. 
Diphtheria. 
1. Begins with sore throat and slight 
fever. 
2. Constitutional symptoms well- 
marked. 
3. Inflammation localized at first. 
4. Pulse feeble and rapid. 
5. Cervical glands greatly enlarged. 
6. Exudation cannot be easily re- 
moved. 
7. Laryngeal symptoms common. 
Diphtheria. 
1. Tongue coated. 
2. Throat not greatly swollen. 
3. Cervical glands greatly enlarged. 
4. Exudation membranous. 
5. Throat has a grayish appearance. 
Diphtheritic Sore Throat. 
1. Begins with a chill and high range 
of temperature. 
2. No severe depression or prostra- 
tion. 
3. General inflammation of throat. 
4. Pulse rapid and strong. 
5. Glands slightly enlarged. 
6. Exudation easily removed or 
picked off. 
7. Usually no complicating laryn- 
gitis. 
Erysipelas of Throat. 
1. Tongue brown and fissured. 
2. Throat greatly swollen. 
3. Cervical glands slightly enlarged. 
4. Exudation serous in character. 
5. Mucous membrane of throat vivid 
or dusky in color. 122 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Epidemic Cerebro-Spinal Menin- 
gitis. 
1. History of epidemic. 
2. Muscular rigidity appears early. 
3. Pain and tenderness along spine. 
4. No peculiar cry. 
5. Delirium often wild. 
6. Disease begins suddenly. 
7. Herpetic eruption common. 
8. Pulse moderately slow. 
9. Incoordinate movements. 
DISEASES TO BE DIFFERENTIATED, 
Tubercular Meningitis. 
1. History of tuberculosis. 
2. Muscular rigidity appears late. 
3. No marked spinal symptoms. 
4. Hydrocephalic cry. 
5. Mild delirium. 
6. Disease develops slowly. 
7. No herpetic eruption. 
8. Pulse very slow at first. 
9. Automatic movements. 
Epidemic Cerebro-Spinal Menin- 
gitis. 
Small-Pox. 
See Small-Pox, page 118. 
Epidemic Cerebro-Spinal Menin- 
gitis. 
Typhus Fever. 
See Typhus Fever, page 112. 
Epidemic Cerebro-Spinal Menin- 
gitis. 
Pernicious Fever. 
See Pernicious Fever, page 116. 
Pyaemia. 
1. Begins with a chill. 
2. Recurrent chills, fever, and sweat- 
ing. 
3. Jaundice well marked. 
4. Sweetish odor to breath. 
5. Temperature irregular-ioo° to 
105°. 
6. Diarrhoea moderate if present. 
7. Formation of metastatic abscesses 
in lungs, joints, etc. 
Septicaemia. 
1. Begins with chilly sensations. 
2. No recurrent chills and sweating. 
3. Slight jaundice. 
4. Odor to breath not peculiar. 
5. Temperature less fluctuating. 
6. Obstinate diarrhoea. 
7. No metastatic abscesses. ACUTE GENERAL DISEASES. 
123 
NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. 
Pyaemia. Intermittent Fever. 
See Intermittent Fever, page 115. 
Pyaemia. Acute Yellow Atrophy. 
See Acute Yellow Atrophy, page 81. 
Pyaemia. Ulcerative Endocarditis. 
See Ulerative Endocarditis, page 40. 
Pyaemia. Suppurative Nephritis. 
See Suppurative Nephritis, page 98. 
Hydrophobia. 
1. History of dog or cat bite. 
2. Delirium. 
3. Fear of liquids. 
4. Clonic convulsions. 
5. Marked hypersesthesia. 
6. Special senses involved. 
7. Much frothy mucus about mouth. 
8. Spasms occur at intervals. 
Hydrophobia. 
1. History of dog or cat bite. 
2. Spasms clonic. 
5. Delirium. 
4. Special senses affected. 
5. Fear of liquids, caused by the ina- 
bility to swallow without produc- 
ing convulsions. 
6. Occurs usually in men. 
7. Moral treatment has no effect. 
Tetanus. 
1. History of injury. 
2. Mind clear. 
3. No fear of liquids. 
4. Convulsions tonic. 
5. Slight hypersesthesia. 
6. Special senses normal. 
7. Risus sardonicus. 
8. Severe tonic spasms all the time. 
Hysteria. 
1. Hysterical history. 
2. Spasms hysterical. 
3. Mind clear. 
4. Special senses normal. 
5. Fear of liquids imaginary, as pa- 
tient can swallow without caus- 
ing spasms. 
6. Occurs usually in hysterical young 
women. 
7. Moral treatment curative. DIFFERENTIAL DIAGNOSIS OF THE CHRONIC GEN- 
ERAL DISEASES. DIFFERENTIAL DIAGNOSIS OF THE CHRONIC GEN- 
ERAL DISEASES. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Acute articular rheumatism 
Acute gout. 
Gonorrhoeal rheumatism. 
Arthritis deformans . 
Chronic articular rheumatism. 
Chronic gout. 
Diabetes . . . . . 
Glycosuria. 
Simple anaemia. 
Chlorosis. 
Leucocythaemia. 
Pernicious anaemia . 
Chlorosis. 
Pernicious anaemia. 
Anaemia . . . . . 
Leucocythaemia 
Pseudo-leukaemia. 
Pernicious anaemia. 
Scurvy . . . . 
Purpura. 
Trichinosis 
Myalgia. 
Typhoid fever. 
Apoplexy. 
U raemia. 
Meningitis. 
Opium poisoning. 
Sunstroke. 
Alcoholism 
127 128 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
N euralgia. 
Intestinal colic. 
Trichinosis. 
Spinal meningitis. 
Myalgia 
Syphilis (chancre) .... Chancroid. 
Acute Articular Rheumatism. 
1. History of exposure to wet or cold. 
2. Begins with a chill and fever. 
3. Large joints first attacked. 
4. Pain constant. 
5. Temperature high. 
6. Profuse sweats. 
7. Attacks young people usually. 
8. Joint swollen, but not greatly in- 
flamed. 
9. No pruritis or desquamation. 
10. Urine abundant. 
11. Frequent cardiac complications. 
12. Tophi never formed. 
Acute Articular Rheumatism. 
1. History of exposure to cold, etc. 
2. Begins usually with a chill. 
3. Many joints attacked. 
4. Eyes rarely inflamed, 
5. Copious sweating. 
6. Temperature high. 
7. Disappears rapidly under treat- 
ment. 
Acute Gout. 
1. History of high living or heredi- 
tary tendency. 
2. Begins at night with severe pain 
in some small joint-as the great 
toe 
3. Small joints first attacked. 
4. Pain paroxysmal. 
5. Temperature rarely over 103°. 
6. No profuse sweats. 
7. Attacks adults. 
8. Joints greatly inflamed with sur- 
rounding veins enlarged. 
9. Desquamation and itching of skin 
about joint attacked. 
10. Urine scanty and highly colored. 
11. No cardiac complications. 
12. Frequent formation of tophi. 
Gonorrhoeal Rheumatism. 
1. History of gonorrhoea. 
2. Begins with pain and lameness in 
one joint, usually the knee. 
3. Usually but one or two joints at- 
tacked. 
4. Eyes frequently inflamed. 
5. No profuse sweats. 
6. Temperature rarely over 102°. 
7. Treatment has but little effect. CHRONIC GENERAL DISEASES. 
129 
NAME OF DISEASE. 
Acute Articular Rheumatism. 
8. Frequent cardiac complications. 
9. Pain very severe and acute. 
Arthritis Deformans. 
1. Not hereditary. 
2. Disease progressive. 
3. Usually attacks females. 
4. No kidney complications. 
5. No chalky deposits. 
6. Marked deformity and ankylosis. 
7. No excess of uric acid. 
Arthritis Deformans. 
1. No history of acute rheumatism. 
2. Disease progressive. 
3. Marked deformity. 
4. Small joints first involved. 
5. Weather has no effect upon the 
disease. 
Diabetes. 
1. Occurs at all ages. 
2. Causes unknown. 
3. Amount of sugar varies but little 
from day to day. 
4. Polyuria and polyphagia well- 
marked. 
5. Well-marked nervous and skin 
symptoms. 
6. Fehling's method of analysis easy. 
7. Complications, as phthisis, etc., 
common. 
DISEASES TO BE DIFFERENTIATED. 
Gonorrhoeal Rheumatism. 
8. Heart rarely attacked. 
9. Subacute inflammation of joint. 
Chronic Gout. 
1. Hereditary. 
2. Disease periodic. 
3. Usually attacks males. 
4. Frequent kidney complications. 
5. Chalky deposits in joints, etc. 
6. Marked deformity and ankylosis 
uncommon. 
7. Excess of uric acid. 
Chronic Rheumatism. 
1. History of acute rheumatism. 
2. Disease periodical. 
3. Deformity not well-marked. 
4. Large joints first attacked. 
5. Disease worse in damp, cold 
weather. 
Simple Glycosuria. 
1. Common in aged people. 
2. Caused by insanity, injuries, medi- 
cine, etc. 
3. Amount of sugar varies greatly 
from time to time. 
4. Polyuria and polyphagia less 
severe. 
5. Obscure nervous and skin symp- 
toms. 
6. Method of analysis obscure from 
presence of keratinine. 
7. Complications rare. 130 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Pernicious Anaemia. 
1. Disease of adults. 
2. Dropsy. 
3. Hemorrhages common. 
4. Purpura. 
5. Fever. 
6. Face has a straw color. 
Pernicious Anaemia. 
1. No severe emaciation. 
2. Fever. 
3. Flemorrhages common. 
4. Purpuric spots. 
5. Persistent dropsy and cardiac mur- 
murs. 
6. Severe dyspnoea. 
7. Does not yield to treatment. 
Pernicious Anaemia. 
1. Spleen normal. 
2. Glands not enlarged. 
3. Bones not painful or tender. 
4. No pain in sternum. 
5. Plemorrhages occur early. 
6. Fever. 
7. No actual increase in the number 
of white blood corpuscles. 
Simple Anaemia. 
1. Emaciation. 
2. Skin pale. 
3. Attacks any one 
4. No mental disturbance. 
5. No uterine complications. 
6. No cough or severe dyspnoea. 
DISEASES TO BE DIFFERENTIATED. 
Chlorosis. 
1. Disease of girls at puberty. 
2. No dropsy. 
3. Hemorrhages uncommon- 
4. No purpuric eruption. 
5. No fever. 
6. Face has a greenish hue. 
Anaemia. 
1. Quite rapid emaciation. 
2. No fever. 
3. Occasional hemorrhages. 
4. No purpuric eruptions. 
5. Occasional slight dropsy and blow- 
ing murmurs. 
6. Slight dyspnoea. 
7. Yields readily to treatment. 
Leucocythaemia. 
1. Spleen greatly enlarged. 
2. Lymphatic glands enlarged. 
3. Bones painful and tender. 
4. Pain in sternum. 
5. Hemorrhages occur late. 
6. No fever. 
7. White blood corpuscles greatly in- 
creased, often one in twenty. 
Chlorosis. 
1. No emaciation. 
2. Skin has a greenish hue. 
3. Disease of girls at puberty. 
4. Mental disturbance. 
5. Frequent uterine complications. 
6. Severe cough and dyspnoea. CHRONIC GENERAL DISEASES. 
131 
NAME OF DISEASE. 
Leucocythaemia. 
1. Spleen greatly enlarged. 
2. Lymphatic glands somewhat en- 
larged. 
3. Pain in bones, especially sternum, 
well marked. 
4. White blood corpuscles greatly in- 
creased (1 to 20). 
5. Progressive anaemia and rapid loss 
of health. 
DISEASES TO BE DIFFERENTIATED. 
Pseudo-Leukaemia. 
1. Spleen somewhat enlarged. 
2. Lymphatic glands greatly enlarged. 
3. Pain in bones less marked. 
4. Number of white blood corpuscles 
not actually increased. 
5. Anaemia and loss of health less 
marked. 
Leucocythaemia. Pernicious Anaemia. 
See Pernicions Ancemia, page 130. 
Scurvy. 
1. Hemorrhages not confined to free 
surfaces. 
2. Disease of long duration. 
3. History of faulty nutrition. 
4. CEdema well marked. 
5. Muscles swollen. 
6. Great depression and despondency. 
7. Gums spongy. 
8. Attacks numbers of people. 
9. Treatment dietetic. 
Trichinosis. 
1. Abdominal pain. 
2. Fever. 
3. Diarrhoea. 
4. History of eating raw meat. 
5. Trichinae found in muscle. 
6. CEdema of eyelids, feet, etc. 
Purpura. 
1. Hemorrhages confined to free sur- 
faces. 
2. Disease of short duration. 
3. No faulty dietetic history. > 
4. No oedema. 
5. No swelling of muscles. 
6. No mental prostration. 
7. Gums normal. 
8. Seen in isolated cases. 
9. Dietetic treatment of no effect. 
Myalgia. 
1. No deep abdominal pain. 
2. No fever. 
3. No diarrhoea. 
4. History of exposure to wet or 
strain. 
5. Examination of muscle negative. 
6. No oedema. 132 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Trichinosis. Typhoid Fever. 
See Typhoid Fever, page III. 
Alcoholism (Coma). 
1. Patient can be aroused. 
2. Pupils equal. 
3. Pupils dilate by slapping face. 
4. Reflexes normal. 
5. Odor of alcohol about patient. 
6. Steamboat respiration. 
7. No paralysis or convulsions. 
8. Pulse rapid. 
9. Temperature equal on both sides. 
Alcoholism (Delirium). 
1. Delirium wild but coherent. 
2. Temperature normal. 
3. Surface cool and sweaty. 
4. Pupils normal. 
5. Patient sees animals and objects. 
6. Does not complain of pain. 
7. Pulse rapid. 
8. Marked tremor. 
9. Eyes wild but otherwise no pecul- 
iar appearance of body. 
Alcoholism (Coma). 
1. Pupils about normal. 
2. Pupils dilate by slapping face. 
3. Surface hot and often congested. 
4. Respiration hurried and deep. 
5. Respirations regular and blowing 
in character. 
Apoplexy. 
1. Cannot arouse patient. 
2. Pupils unequal. 
3. Pupils do not respond. 
4. Reflexes often absent on one side. 
5. No peculiar odor about patient. 
6. Stertorous respiration. 
7. Paralysis and convulsions common. 
8. Pulse slow. 
9. Temperature elevated on paralyzed 
side. 
Acute Meningitis. 
1. Delirium incoherent and not very 
wild. 
2. Temperature elevated. 
3. Surface hot and dry. 
4. Pupils contracted. 
5. Patient continually trying to get 
out of bed. 
6. Patient complains of headache. 
7. Pulse slow. 
8. No tremor. 
9. "Boat-belly" and strabismus, or 
photophobia common. 
Opium Poisoning. 
1. Pupils " pin-head." 
2. Pupils do not respond. 
3. Surface cool and perspiring. 
4. Respiration very slow. 
5. Respirations irregular and shallow 
in character. CHRONIC GENERAL DISEASES. 
133 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Alcoholism (Coma). 
6. Smell of alcohol about patient. 
7. Pulse rapid. 
8. Face flushed. 
Alcoholism. 
1. Temperature normal. 
2. No diarrhoea. 
3. Odor of alcohol about patient. 
4. Reflexes normal. 
5. Steamboat respiration. 
6. Patient can swallow. 
Opium Poisoning. 
6. Odor df opium about patient. 
7. Slow pulse. 
8. Face pale and cyanotic. 
Sun-Stroke. 
1. Temperature very high. 
2. Profuse diarrhoea. 
3. No peculiar smell about patient. 
4. Reflexes absent. 
5. Quiet or stertorous breathing. 
6. Patient cannot swallow. 
Alcoholism (Coma). Uraemia. 
See Uramia, page 92. 
Syphilis (Chancre). 
1. Incubation about twenty days. 
2. Begins as a papule. 
3. Single. 
4. Ulceration superficial. 
5. Edges of ulcer sloping. 
6. Floor of ulcer copper-colored. 
7. Scanty secretion. 
8. No pain. 
9. Indolent induration of glands. 
10. Constitutional symptoms. 
Myalgia. 
1. Skin normal. 
2. Skin not sensitive to pressure. 
3. Pain greatly increased by contrac- 
tion of muscle. 
Chancroid. 
1. Incubation from one to five days. 
2. Begins as a pustule or ulcer. 
3. Multiple. 
4. Deep ulceration. 
5. Edges of ulcer abrupt. 
6. Floor of ulcer worm-eaten in ap- 
pearance. 
7. Secretion purulent and abundant. 
8. Ulcer painful. 
9. Acute suppurative inflammation 
of glands. 
10. Disease purely local. 
Neuralgia. 
1. Skin frequently inflamed. 
2. Skin anaesthesia or hyperaesthesia. 
3. Pain greatly increased by pressure. 134 
DIFFERENTIAL DIAGNOSIS. 
NAME OF DISEASE. 
Myalgia. 
4. Pain constant and tearing in char- 
acter. 
5. Pain most severe at points of at- 
tachment of muscle. 
6. No eruptions. 
DISEASES TO BE DIFFERENTIATED. 
Neuralgia. 
4. Pain paroxysmal and shooting. 
5. Pain most severe over course of 
nerve. 
6. Frequent herpetic eruptions. 
Myalgia. Trichinosis. 
See Trichinosis, page 131. 
Myalgia. Intestinal Colic. 
See Intestinal Colic, page 67. 
Myalgia. Spinal Meningitis. 
See Spinal Meningitis, page 146. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE NERVOUS SYSTEM. DIFFERENTIAL DIAGNOSIS OF THE DISEASES OF 
THE NERVOUS SYSTEM. 
DISEASES OF THE BRAIN. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Uraemia. 
Typhus fever. 
Small-pox. 
Delirium tremens. 
Tubercular meningitis. 
Pachymeningitis interna. 
Acute meningitis 
Cerebral tumor. 
Cerebral softening. 
Chronic meningitis 
Acute meningitis. 
Spurious hydrocephalus. 
Infantile remittent fever. 
Tubercular enteritis. 
Cerebro-spinal meningitis, 
T ubercular meningitis 
Cerebral softening 
Chronic meningitis. 
Cerebral tumor. 
Abscess of brain. 
Cerebral embolus. 
U raemia. 
Alcoholism.- 
Opium poisoning. 
Hysteria. 
Asphyxia. 
Epilepsy. 
Cerebral-apoplexy, or embolus 
137 138 
DIFFERENTIAL DIAGNOSIS OF THE 
Cerebral tumor. 
Cerebral softening. 
Abscess of the brain . 
Cerebral tumor 
Abscess of the brain. 
Chronic meningitis. 
Cerebral softening. 
Cerebral concussion 
Cerebral compression. 
DISEASES OF THE CORD. 
Tetanus. 
Myelitis. 
Muscular rheumatism. 
Spinal meningitis 
Spinal meningitis. 
Hysterical paralysis. 
Spinal apoplexy. 
Polio-myelitis anterior. 
Congestion of the cord. 
Myelitis 
Bulbar embolus or hemorrhage. 
Tumor of medulla. 
Progressive muscular atrophy. 
Bulbar paralysis 
Myelitis. 
Progressive muscular atrophy. 
Amyotrophic lateral sclerosis. 
Locomotor ataxia. 
Polio-myelitis anterior 
Progressive muscular atrophy 
Polio-myelitis anterior. 
Amyotrophic lateral sclerosis. 
Paralysis agitans. 
Amyotrophic lateral sclerosis. 
Chorea. 
Cerebro-spinal sclerosis 
Locomotor ataxia 
Polio-myelitis anterior. 
Cerebellar disease. 
Progressive muscular atrophy. 
Polio-myelitis anterior. 
Cerebro-spinal sclerosis, 
Amyotrophic lateral sclerosis DISEASES OF THE NERVOUS SYSTEM. 
139 
FUNCTIONAL NERVOUS DISEASES. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Apoplexy. 
Hysteria. 
Opium poisoning. 
Uraemia. 
Syncope. 
- Organic brain diseases. 
Epilepsy . . . . . 
Angina pectoris. 
Cancer of oesophagus. 
Epilepsy. 
Uraemia. 
Acute peritonitis. 
Hydrophobia. 
Myelitis. 
Chronic laryngitis. 
Hysteria » , 
Cerebro-spinal sclerosis. 
Paralysis agitans. 
Chorea . . . . . 
Tetanus . . . . . 
Strychnia poisoning. 
Spinal meningitis. 
Hydrophobia. 
Paralysis agitans . . , 
Cerebro-spinal sclerosis. 
Chorea. 
General paralysis of insane. 
Acute Meningitis. Uraemia. 
See Uramia, page g2. 
Acute Meningitis. Typhus Fever. 
See Typhus Fever, page 112. 
Acute Meningitis. Small-Pox. 
See Small-Pox, page 118. 
DISEASES OF THE BRAIN. 140 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Acute Meningitis. Delirium Tremens. 
See Delirium Tremens, page 132. 
Acute Meningitis. 
1. History of injury or acute disease. 
2. Begins suddenly. 
3. Temperature high and constant. 
4. No peculiar cry. 
5. Usually a disease of adults. 
6. Convulsions appear early. 
7. Active delirium. 
8. Incoordinate movements. 
Acute Meningitis. 
1. Begins acutely. 
2. Temperature high. 
3. General headache. 
4. Active delirium. 
5. No apoplectic seizures. 
6. Marked paralysis uncommon. 
7. T&che cMbrale. 
Chronic Meningitis. 
1. History of head injury or blood 
disease. 
2. Headache dull and constant. 
3. Paralysis not limited to certain 
nerves. 
4. Marked general decline in mental 
and physical powers. 
5. Symptoms of a general nature. 
6. Speech usually unimpaired. 
7. Great irritability of temper. 
8. Choked discs appear late if at all. 
Tubercular Meningitis. 
1. History of phthisis or tuberculosis. 
2. Prodromata. 
3. Temperature lower and very irreg- 
ular. 
4. Hydrocephalic cry. 
5. Disease especially of children. 
6. Late convulsions. 
7. Mild or passive delirium. 
8. Automatic movements. 
Pachymeningitis Interna. 
1. Prodromata. 
2. Temperature slightly elevated. 
3. Localized and vertical headache. 
4. Passive delirium or simply im- 
paired intellection. 
5. Periods of sudden loss of con- 
sciousness. 
6. Paralysis comes on gradually. 
7. No "cerebral trace." 
Cerebral Tumor. 
1. Negative history. 
2. Headache severe and paroxysmal. 
3. Paralysis of certain nerves or set 
of nerves. 
4. No rapid decline in mental or phys- 
ical powers. 
3. Local symptoms. 
6. Speech often impaired. 
7. Temper not especially excitable. 
8. Choked discs appear early. DISEASES OF THE NERVOUS SYSTEM. 
141 
NAME OF DISEASE. 
Chronic Meningitis. 
1. History of head injury or blood 
disease. 
2. No contraction of muscles. 
3. Mental excitement. 
4. Great irritability of temper. 
5. Speech usually unimpaired. 
6. No disease of heart or arteries. 
7. Constant headache. 
8. No well-marked paralysis. 
Tubercular Meningitis. 
1. History of tuberculosis. 
2. Vomiting projectile. 
3. Constipation. 
4. Abdomen retracted. 
5. No special thirst. 
6. Flushing of one cheek. 
7. Pulse slow at first. 
8. Pupils contracted. 
9. Fever irregularly remittent. 
DISEASES TO BE DIFFERENTIATED. 
Cerebral Softening. 
1. Often a history of apoplexy. 
2. Muscular contraction. 
3. Mental apathy. 
4. Temper not excitable. 
5. Speech frequently affected. 
6. Heart or arterial disease common. 
7. Inconstant headache. 
8. Paralysis usually well marked. 
Infantile Remittent Fever. 
1. History of gastro-enteritis. 
2. Vomiting retching. 
3. Diarrhoea. 
4. Abdomen distended. 
5. Great thirst. 
6. Flushing of both cheeks. 
7. Pulse rapid. 
8. Pupils normal. 
9. Fever regularly remittent. 
Tubercular Meningitis. Acute Meningitis. 
See Acute Meningitis, page 140. 
Tubercular Meningitis. Spurious Hydrocephalus. 
See Spurious Hydrocephalus, page 64. 
Tubercular Meningitis. Tubercular Enteritis. 
See Tubercular Enteritis, page 64. 
Tubercular Meningitis. 
Epidemic Cerebro-Spinal Menin- 
gitis. 
See Epidemic Cerebro-Spinal Meningitis, page 122. 
Cerebral Softening. 
Chronic Meningitis. 
See Chronic Meningitis, above. 142 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Cerebral Softening. 
1. History of apoplexy or heart dis- 
ease common. 
2. Headache dull and diffuse. 
3. Speech and intellect usually af- 
fected. 
4. No facial paralysis. 
5. Epileptiform convulsions uncom- 
mon. 
6. Symptoms steadily progressing. 
7. Limbs chiefly affected. 
Cerebral Softening. 
1. History of apoplexy or heart dis- 
ease common. 
2. Disease of months' duration. 
3. No chills or fever. 
4. Headache dull and diffuse. 
5. Hemiplegia and muscular contrac- 
tions common. 
6. Speech and intellect affected early. 
Cerebral Apoplexy. 
1. Disease of old people. 
2. Arteries usually diseased. 
3. Aphasia uncommon. 
4. Complete hemiplegia. 
5. Frequent loss of consciousness. 
6. No sudden improvement in the 
paralysis. 
7. Pulse slow and full. 
DISEASES TO BE DIFFERENTIATED. 
Cerebral Tumor. 
1. Negative history. 
2. Local pain in head. 
3. Speech and intellect not greatly 
implicated. 
4. Facial paralysis common. 
5. Frequent epileptiform convulsions. 
6. Symptoms irregular and of long 
duration. 
7. Cranial nerves affected ; choked 
discs. 
Cerebral Abscess. 
1. History of head injury or disease 
of ear. 
2. Disease of weeks' duration. 
3. Chills, fever, and sweating. 
4. Headache local and acute. 
5. Hemiplegia and contractions rare. 
6. Speech, intellect, etc., not early 
affected. 
Cerebral Embolus. 
1. Disease of young people. 
2. History frequently of heart dis- 
ease. 
3. Aphasia common. 
4. Partial hemiplegia. 
5. Loss of consciousness uncommon. 
6. Improvement in symptoms often 
followed by a sudden relapse. 
7. Pulse rapid and feeble. 
paralysis. DISEASES OF THE NERVOUS SYSTEM. 
143 
NAME OF DISEASE. 
Cerebral Apoplexy. 
8. Pupils unequal. 
9. Vomiting common. 
10. Breathing stertorous. 
DISEASES TO BE DIFFERENTIATED. 
Cerebral Embolus. 
8. Pupils normal. 
9. Rarely vomiting. 
10. Breathing normal. 
Apoplexy or Embolus. Ursemia. 
See Urcemia, page 91. 
Apoplexy or Embolus. Alcoholism. 
See Alcoholism, page 132. 
Apoplexy or Embolus. 
1. Pupils irregular. 
2. Convulsions common. 
3. Coma appears suddenly. 
4. Pulse irregular and full. 
5. Hemiplegia. 
6. Stertor. 
7. Face flushed. 
8. No odor to breath. 
9. Respirations hurried. 
10. Skin hot. 
Apoplexy or Embolus. 
1. History of heart or arterial dis- 
ease. 
2. Pupils irregular, pulse slow. 
3. Breathing stertorous and hurried. 
4. Frequent loss of sensation. 
5. Administration of ether gives a 
negative result. 
6. Moral treatment has no effect. 
Apoplexy or Embolus. 
1. History of heart or other arterial 
disease. 
2. Tongue never bitten. 
Opium Poisoning. 
1. Pupils " pin-head. " 
2. No convulsive movements. 
3. Coma deepens gradually. 
4. Pulse slow and regular. 
5. No paralysis. 
6. Shallow, irregular breathing. 
7. Face pale and cyanotic. 
8. Odor of opium about patient. 
9. Respirations slow. 
10. Skin cool and perspiring. 
Hysteria. 
1. History of hysteria. 
2. Pupils regular, pulse rapid, 
3. Breathing catching and sobbing. 
4. Hyperesthesia common. 
5. Paralyzed limbs moved during 
ether administration. 
6. Moral treatment curative. 
Epilepsy. 
1. History of epilepsy. 
2. Tongue frequently bitten. 144 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Apoplexy or Embolus. 
3. No permanent rapid improvement. 
4. No bloody froth about mouth. 
5. Pulse full and slow. 
6. Paralysis follows the coma. 
7. Coma deepening. 
8. Paralyzed side hot and red. 
Apoplexy or Embolus. 
1. Face pale or congested. 
2. Breathing stertorous. 
3. Hemiplegia common. 
4. Pupils irregular. 
5. Pulse full and strong. 
6. Reflexes absent and temperature 
higher on paralyzed side. 
7. Blood red. 
Cerebral Abscess. 
1. History of injury to the head or 
disease of the ear. 
2. Emaciation. 
3. Chills and sweatings. 
4. No local paralysis. 
5. No choked discs. 
6. Headache sudden in development. 
7. Epileptiform convulsions, and suc- 
ceeded by paralysis. 
8. Rapid disease. 
DISEASES TO BE DIFFERENTIATED. 
Epilepsy. 
3. Rapid improvement. 
4. Bloody froth about mouth. 
5. Rapid, irregular, and feeble pulse. 
6. Sleep follows the coma. 
7. Coma alternating with hysterical 
symptoms. 
8. Both sides the same. 
Asphyxia. 
1. Face turgid and cyanotic. 
2. Distressed and embarrassed breath- 
ing. 
3. No paralysis. 
4. Pupils regular. 
5. Pulse small and rapid. 
6. Reflex and temperature the same 
on both sides. 
7. Blood blue. 
Cerebral Tumor. 
1. Negative history. 
2. No rapid emaciation. 
3. No chills or sweats. 
4. Local paralysis of long standing. 
5. Choked discs. 
6. Headache gradually increasing. 
7. Spasm of single muscles or group 
of muscles, and not followed by 
paralysis. 
8. Slow disease. 
Cerebral Abscess. Cerebral Softening. 
See Cerebral Softening, page 144. 
Cerebral Tumor. Chronic Meningitis. 
See Chronic Meningitis, page 140. DISEASES OF THE NERVOUS SYSTEM. 
145 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Cerebral Tumor. Cerebral Softening. 
See Cerebral Softening, page 142. 
Cerebral Tumor. Cerebral Abscess. 
See Cerebral Abscess, page 144. 
Cerebral Concussion. 
1. Symptoms appear immediately. 
2. Power of speech retained. 
3. Special senses retained. 
4. Noiseless respiration. 
5. Feeble and frequent pulse. 
6. Sphincters relaxed. 
7. Nausea and vomiting. 
8. No paralysis. 
9. Pupils contracted and regular. 
10. Lids open and movable. 
11. Skin cool and pale. 
12. Mental faculties not abolished. 
Cerebral Compression. 
1. Symptoms appear gradually. 
2. Power of speech lost. 
3. Special senses blunted. 
4. Stertorous breathing. 
5. Slow and full pulse. 
6. Sphincters contracted. 
7. No vomiting. 
8. Hemiplegia common. 
9. Pupils dilated and irregular. 
10. Eyelids shut. 
11. Skin hot and red. 
12. Mental faculties abolished. 
DISEASES OF THE CORD. 
Spinal Meningitis. 
1. No traumatic history. 
2. Face not peculiar. 
3. No jaw symptoms. 
4. Great pain on motion. 
5. Spasm produced by attempts to 
move. 
6. Paralysis follows spasms. 
7. Temperature elevated. 
Spinal Meningitis. 
1. Fever. 
2. Marked rigidity of spine. 
3. Cutaneous hyperaesthesia. 
Tetanus. 
1. History of traumatism. 
2. Risus sardonicus. 
3. Lockjaw. 
4. Intense hyperaesthesia. 
5. Spasm caused by external irrita 
tion. 
6. No paralysis. 
7. Temperature nearly normal. 
Lumbago. 
1. Temperature normal. 
2. Apparent rigidity of spine. 
3. No cutaneous hyperaesthesia. 146 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Spinal Meningitis. 
4. Spasms. 
5. Paralysis. 
6. No tenderness on pressure. 
7. Shooting pains along the course of 
the spinal nerves. 
Spinal Meningitis. 
1. Pain increased by moving. 
2. Pain shoots in direction of spinal 
nerves. 
3. Tonic spasm of back and other 
muscles. 
4. Increased reflex irritation. 
5. Urine normal until paralysis is 
well marked. 
6. No constricting bands. 
7. Sphincters not affected. 
8. No bed-sores. 
9. Moderate paralysis. 
10. Short duration. 
11. Temperature elevated. 
12. Electro-contractility of muscle 
preserved. 
13. Hyperaesthesia of skin. 
Myelitis. 
1. Paralysis well-marked. 
2. Urine alkaline. 
3. Pain on pressure along cord. 
4. Constricting band about waist. 
5. Bed-sores. 
6. Anaesthesia well marked. 
7. Wasting of muscles affected. 
DISEASES TO BE DIFFERENTIATED. 
Lumbago. 
4. No convulsions. 
5. No paralysis. 
6. Tenderness on pressure over origin 
and insertion of muscles. 
7. No shooting pain along spinal 
nerves. 
Myelitis. 
1. Pain increased by pressure. 
2. No darting pains along nerves. 
3. No tonic convulsions. 
4. Diminished reflex action. 
5. Urine alkaline. 
6. Constriction about waist. 
7. Constipation and incontinence or 
retention of urine. 
8. Bed-sores form early. 
9. Paraplegia. 
10. Disease of long duration. 
11. Temperature normal usually. 
12. Diminished electro-contractility 
of paralyzed muscles. 
13. Anaesthesia of affected parts. 
Spinal Congestion. 
1. Paralysis usually slight. 
2. No urinary symptoms. 
3. No pain in cord on pressure. 
4. No constricting bands. 
5. No bed-sores. 
6. Usually hyperaesthesia. 
7. No wasting of muscles. DISEASES OF THE NERVOUS SYSTEM. 
147 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Myelitis. 
8. Paralysis progressive. 
g. Paralysis of sphincters. 
10. Electro-contractility of muscles 
diminished. 
Myelitis. 
1. Fever. 
2. Paralysis usually appears gradually 
after exposure to cold, etc. 
3. Bladder symptoms appear gradu- 
ally. 
4. Subjective sensation in feet, etc. 
5. No convulsions. 
6. Pain in spine increased on pressure. 
Spinal Congestion. 
8. Diminishing paralysis. 
9. Sphincters normal. 
10. Electro-contractility of muscles 
preserved and sometimes in- 
creased. 
Spinal Apoplexy. 
1. Temperature normal. 
2. Paralysis comes on suddenly- 
often the result of injury. 
3. Bladder symptoms appear sud- 
denly. 
4. No subjective sensations. 
5. Twitching of affected muscles com- 
mon. 
6. No pain in cord on pressure. 
Myelitis. Spinal Meningitis. 
See Spinal Meningitis, page 146. 
Myelitis. 
1. Paralysis of sphincters. 
2. Bed-sores. 
3. Anaesthesia. 
4. Constriction about waist. 
5. Urine alkaline. 
6. Paralysis progressive. 
7. No rapid wasting of muscles. 
8. Temperature of affected limbs low- 
er than normal. 
Myelitis. 
1. History of exposure to cold, syph- 
ilis, etc. 
2. Urine scanty and alkaline. 
Polio-myelitis Anterior. 
1. Sphincters normal. 
2. No bed-sores. 
3. Anaesthesia absent or slight. 
4. No constricting bands. 
5. Urine normal. 
6. Symptoms improve under treat- 
ment. 
7. Rapid wasting of affected muscles. 
8. Temperature of affected limbs 
higher than normal. 
Hysterical Paralysis. 
1. History of hysteria. 
2. Urine acid and abundant. 148 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Myelitis. 
3. Urine cloudy. 
4. Constriction about waist. 
5. Reflexes diminished. 
6. Diminished electro-contractility of 
muscles. 
7. Pain on pressure along spine. 
8. Disease of long duration. 
9. Moral treatment of no effect. 
Bulbar Paralysis. 
1. Bilateral disease. 
2. Progressive paralysis of facial and 
lingual muscles. 
3. Vomiting inconstant. 
4. No severe neuralgic pains. 
5. No epileptiform attacks. 
6. Special senses not especially af- 
fected. 
Bulbar Paralysis. 
1. Bilateral disease. 
2. Symptoms appear gradually. 
3. Vomiting infrequent. 
4. No convulsions. 
5. No loss of consciousness. 
6. Paralysis confined to cranial nerves 
usually. 
Bulbar Paralysis. 
x. Paralysis precedes atrophy. 
2. Thenar and hypothenar eminences 
involved late if at all. 
3. Atrophy confined to the muscles 
supplied by the cranial nerves. 
4. Articulation affected early 
DISEASES TO BE DIFFERENTIATED, 
Hysterical Paralysis. 
3. Urine clear and limpid. 
4. Globus hystericus. 
5. Reflexes normal or increased. 
6. Increased electro-contractility of 
muscles. 
7. Pain on pressure over ovaries. 
8. Disease of short duration. 
9. Moral treatment curative. 
Tumor of Medulla. 
1. Disease unilateral. 
2. Convulsions usually precede the 
paralysis of muscles. 
3. Frequent vomiting. 
4. Facial neuralgia. 
5. Epileptiform attacks common. 
6. Special senses affected; choked 
discs. 
Bulbar Embolus or Apoplexy. 
1. Unilateral symptoms predominate. 
2. Disease develops suddenly. 
3. Frequent vomiting. 
4. Epileptiform convulsions. 
5. Frequent loss of consciousness. 
6. Often hemiplegia or paraplegia. 
Progressive Muscular Atrophy. 
1. Paralysis follows atrophy. 
2. Thenar centres involved early. 
3. Atrophy not confined to muscles 
supplied by the cranial nerves. 
4. Articulation affected late if at all. DISEASES OF THE NERVOUS SYSTEM. 
149 
Polio-myelitis Anterior. 
1. Pain not severe. 
2. Paralysis. 
3. Normal balancing power. 
4. Coordinate movements. 
5. Loss of electro-contractility of 
muscles. 
6. Muscular atrophy well marked. 
7. No joint or eye symptoms. 
Locomotor Ataxia. 
1. Lightning-like pains. 
2. No true paralysis. 
3. Loss of balancing power. 
4. Incoordinate movements especially 
marked when the eyes are closed. 
5. Electro-contractility of the muscles 
preserved. 
6. No muscular atrophy. 
7. Joints swollen, impaired eyesight, 
etc. 
Polio-myelitis Anterior. Myelitis. 
See Myelitis page 146. 
Polio-myelitis Anterior. 
1. Paroxysmal increase of paralysis. 
2. Paralysis precedes atrophy. 
3. Reflexes impaired early. 
4. Early loss of muscular electro 
contractility. 
5. Temperature highest in -affected 
limbs. 
6. General atrophy of affected parts. 
7. No fibrillary contractions. 
8. Pain not severe. 
g. Rapid disease. 
10. Begins in muscles of lower ex- 
tremity. 
Polio-myelitis Anterior. 
1. Large muscles early affected. 
2. Begins in lower extremity. 
3. No rigidity of affected limbs. 
Progressive Muscular Atrophy. 
1. Steadily progressive paralysis. 
2. Paralysis follows atrophy. 
3. Reflexes not impaired until late. 
4. Electro-contractility of muscles 
preserved. 
5. Low temperature in affected 
parts. 
6. Atrophy of one muscle follows 
another. 
7. Fibrillary contractions of muscles. 
8. Fulminating pains. 
9. Very slow disease. 
10. Usually begins in small muscles 
of thumb. 
Amyotrophic Lateral Sclerosis. 
1. Small muscles first affected. 
2. Often attacks upper extremities 
first. 
3. Well-marked rigidity of affected 
parts. 150 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Polio-myelitis Anterior. 
4. No well-marked contractions of 
fingers or toes. 
5. Reaction of degeneration. 
6. Diminished tendon reflex. 
Progressive Muscular Atrophy. 
1. Atrophy precedes the paralysis. 
2. No marked rigidity of affected 
parts. 
3. Very slow disease. 
4. Normal tendon reflex. 
5. Loss of electro-contractility of the 
affected muscles. 
6. Usually begins in the muscles of 
ball of thumb. 
7. Does not affect all the limbs. 
8. No bulbar paralysis as a rule. 
9. No fibrillary contractions of the 
muscles. 
DISEASES TO BE DIFFERENTIATED. 
Amyotrophic Lateral Sclerosis. 
4. "Bird-claw" contractions of fin- 
gers and toes. 
5. No reaction of degeneration. 
6. Increased tendon reflex. 
Amyotrophic Lateral Sclerosis. 
1. Atrophy follows the paralysis. 
2. Rigidity of paralyzed parts. 
4. Disease progresses quite rapidly. 
4. Increased tendon reflex. 
5. Electro-contractility of muscles 
preserved. 
6. Usually begins in muscles of lower 
extremities. 
7. Affects both extremities. 
8. Usually bulbar paralysis toward 
the last. 
9. Fibrillary contractions of the affec- 
ted muscles. 
Progressive Muscular Atrophy. Polio-myelitis Anterior. 
See Polio-myelitis Anterior, page 149 
Cerebro-spinal Sclerosis. 
(Multiple Sclerosis.) 
1. No tremor when patient is at rest. 
2. Disease of young adults. 
3. Shaking of the head. 
4. Change in voice and speech. 
5. Tendon reflex greatly increased. 
6. Patient has no tendency to run 
forward. 
7. Disease usually begins in the 
lower extremities. 
Paralysis Agitans. 
1. Continued muscular tremor. 
2. Disease of the aged. 
3. No violent shaking of the head. 
4. Speech slow. 
5. Normal tendon reflex. 
6. Patient has a tendency to run for- 
ward when starting to walk. 
7. Usually first noticed in the hands. DISEASES OF THE NERVOUS SYSTEM. 
151 
NAME OF DISEASE. 
Cerebro-spinal Sclerosis. 
8. No rigidity of the limbs. 
9. No peculiar physiognomy. 
10. Voluntary motion beyond control. 
11. Patient peevish and childish. 
12. Periods of marked improvement. 
Cerebro-spinal Sclerosis. 
1. Tendon reflex greatly increased. 
2. Muscular atrophy not marked. 
3. Voluntary motion beyond control. 
4. No fibrillary contractions. 
5. No claw-like appearance of fin- 
gers, etc. 
6. Mental disturbance. 
7. No rigidity of affected parts. 
8. Periods of marked improvement. 
Cerebro-spinal Sclerosis. 
1. Disease of young adults. 
2. Voluntary motion beyond control. 
3. Increased tendon reflex. 
4. No tremor when quiet. 
5. Patient can keep quiet if he tries. 
6. Both sides affected alike. 
7. Movements the same in character. 
DISEASES TO BE DIFFERENTIATED. 
Paralysis Agitans. 
8. Limbs become rigid. 
9. Features present a peculiar physi- 
ognomy. 
10. Voluntary motion can be accom- 
plished, but with trembling. 
11. Intellect remains good. 
12. Disease steadily progressive. 
Amyotrophic Lateral Sclerosis. 
1. Tendon reflex slightly increased. 
2. Well-marked muscular atrophy. 
3. Coordinate voluntary motion. 
4. Fibrillary contractions of muscles. 
5. Claw-like contractions of fingers 
and toes. 
6. Intelligence good. 
7. Rigidity of affected parts. 
8. Disease steadily progressive. 
Chorea. 
1. Disease of childhood. 
2. Voluntary motion under control, 
but incoordinate. 
3. Normal tendon reflex. 
4. Jactitations when quiet and often 
during sleep. 
5. Choreic movements more marked 
when patient tries to appear 
quiet. 
6. No symmetrical distribution of 
symptoms ; often confined to 
one side. 
7. Movements irregular and rapidly 
changing. 152 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Locomotor Ataxia. 
1. No headache or vertigo. 
2. No vomiting. 
3. Paraplegic symptoms. 
4. Gait abrupt and jerky. 
5. Cutaneous sensibility greatly im- 
paired. 
6. Walking much more difficult with 
eyes closed. 
7. Absence of knee-jerk. 
8. Lightning-like pains. 
DISEASES TO BE DIFFERENTIATED. 
Cerebellar Disease. 
1. Headache and vertigo common. 
2. Frequent vomiting. 
3. Hemiplegia. 
4. Drunken gait. 
5. Normal cutaneous sensibility. 
6. Patient walks much better with 
the eyes closed. 
7. Normal reflexes. 
8. No severe neuralgic pains. 
Locomotor Ataxia. Polio-myelitis Anterior. 
See Polio-myelitis Anterior, page 149. 
Amyotrophic Lateral Sclerosis. Progressive Muscular Atrophy. 
See Progressive Muscular Atrophy, page 150. 
Amyotrophic Lateral Sclerosis. Polio-myelitis Anterior. 
See Polio-myelitis Anterior, page 149. 
Amyotrophic Lateral Sclerosis. Cerebro-spinal Sclerosis. 
See Cerebral-spinal Sclerosis, page 150. 
Epilepsy. Apoplexy. 
See Apoplexy, page 91. 
Epilepsy. Uraemia. 
See Urcemia, page 91. 
FUNCTIONAL NERVOUS DISEASES. 
Epilepsy (Coma). 
1. History of epilepsy. 
2. Coma preceded by convulsions. 
3. Pupils dilated. 
4. Temperature elevated. 
5. Tongue bitten. 
Opium Poisoning. 
1. History usually negative. • 
2. No convulsive seizures. 
3. Pupils contracted. 
4. Temperature normal or sub- 
normal. 
5. No injury to tongue. DISEASES OF THE NERVOUS SYSTEM. 
153 
NAME OF DISEASE. 
Epilepsy (Coma). 
6. Respiration normal or rapid. 
7. No odor to breath. 
8. Skin hot and dry. 
9. Pulse rapid. 
IO. Bloody froth about mouth. 
Epilepsy. 
1. History of epilepsy. 
2. Temperature elevated. 
3. General muscular rigidity. 
4. Aura epileptica. 
5. Anaesthesia. 
6. Attacks both sexes. 
7. No apparent cause. 
8. Highly-colored urine. 
9. No ovarian tenderness. 
10. Face cyanosed. 
11. Complete loss of consciousness. 
12. Biting of tongue. 
13. Pupils insensible to light. 
14. Countenance distorted. 
15. Convulsions tonic, then clonic. 
16. Paroxysms of short duration. 
17. Paroxysms followed by sleep. 
18. Eyelids half-open. 
Epilepsy. 
1. Loss of consciousness sudden. 
2. Coma preceded by convulsions. 
DISEASES TO BE DIFFERENTIATED. 
Opium Poisoning. 
6. Slow, shallow respiration. 
7. Odor of opium about patient. 
8. Skin cool and moist. 
9. Pulse slow. 
10. No frothy mucus about mouth. 
Hysteria. 
1. History of hysteria. 
2. Temperature normal. 
3. No general muscular rigidity. 
4. Globus hystericus. 
5. Hypersesthesia. 
6. Attacks females. 
7. Caused by menstrual disorders. 
8. Urine abundant, clear, and lim- 
pid. 
9. Ovarian tenderness. 
10. Face flushed. 
11. Loss of consciousness incomplete, 
and accompanied with sobbing, 
grinding of teeth, etc. 
12. Tongue not bitten. 
13. Pupils sensitive. 
14. No distortion of countenance. 
15. Clonic convulsions. 
16. Paroxysms often of some length. 
17. Paroxysms followed by wakeful- 
ness. 
18. Eyelids closed. 
Syncope. 
1. Loss of consciousness comes on 
slowly. 
2. Coma preceded by a weak, faint 
feeling. 154 
DIFFERENTIAL DIAGNOSIS OF THE 
NAME OF DISEASE. 
Epilepsy. 
3. Rapid recovery. 
4. Loss of consciousness of short 
duration. 
5. No recollection of the attack. 
6. Pulse not greatly affected. 
7. Hands warm. 
Epilepsy. 
1. History of epilepsy. 
2. Advent sudden. 
3. Attack followed by sleep. 
4. Apparently a complete recovery 
from the attack. 
5. Attack preceded by a well-marked 
aura. 
DISEASES TO BE DIFFERENTIATED. 
Syncope. 
3. Slow recovery. 
4. Patient remains unconscious for 
some time. 
5. Patient can recall the facts con- 
nected with the attack. 
6. Pulse very weak, hardly felt at the 
wrist. 
7. Hands and feet very cold. 
Convulsions Due to Organic Brain 
Disease. 
1. History of a brain disorder. 
2. Advent slow. 
3. Attack often followed by impaired 
intellect. 
4. Symptoms of brain disorder usually 
more marked after an epilepti- 
form attack. 
5. No aura epileptica. 
Hysteria. Myelitis. 
See Myelitis, page 147. 
Hysteria. Epilepsy. 
See Epilepsy, page 153. 
Hysteria. Uraemia. 
See Urcemia, page 91. 
Hysteria. Acute Peritonitis. 
See Acute Peritonitis, page 69. 
Hysteria. Hydrophobia. 
See Hydrophobia, page 123. DISEASES OE THE NERVOUS SYSTEM. 
155 
NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. 
Hysteria. Chronic Laryngitis. 
See Chronic Laryngitis, page 16. 
Hysteria. Angina Pectoris. 
See Angina Pectoris, page 42. 
Hysteria. Cancer of the (Esophagus. 
See Cancer of the (Esophagus, page 54. 
Chorea. Cerebro-Spinal Sclerosis. 
See Cerebro-Spinal Sclerosis, page 151. 
Chorea. 
1. Disease usually of young people. 
2. Spasmodic contraction of muscles. 
3. Loss of muscular control. 
4. No general disturbance. 
5. Symptoms usually more marked 
upon one side. 
6. No muscular rigidity. 
7. No peculiar physiognomy. 
8. No tendency to run forward. 
Paralysis Agitans. 
1. Disease of adults. 
2. Great muscular weakness. 
3. Muscular tremor. 
4. Signs of general decay. 
5. Both sides of body alike affected. 
6. Muscular rigidity well marked. 
7. Physiognomy peculiar. 
8. Patient loses balance when about 
to walk and runs forward. 
Tetanus. Spinal Meningitis. 
See Spinal Meningitis, page 145. 
Tetanus. Hydrophobia. 
See Hydrophobia, page 123. 
Tetanus. 
1. History of traumatism. 
2. Arms and legs last affected. 
3. No epigastric pain. 
4. Slow development of disease. 
5. Spasms affect the jaws first. 
Strychnine Poisoning. 
1. No traumatic history. 
2. Extremities first affected. 
3. Severe epigastric pain. 
4. Advent sudden. 
5. Jaws secondarily affected. 156 
DISEASES OF THE NERVOUS SYSTEM. 
NAME OF DISEASE. 
Tetanus. 
6, Some spasmodic rigidity constant- 
ly present. 
7. Disease lasts usually for several 
days. 
DISEASES TO BE DIFFERENTIATED. 
Strychnine Poisoning. 
6. Complete muscular relaxation in 
interval between spasms. 
7. Attack of short duration. 
Paralysis Agitans. Cerebro-Spinal Sclerosis. 
See Cerebro-Spinal Sclerosis, page 150. 
Paralysis Agitans. Chorea. 
See Chorea, page 155. 
Paralysis Agitans. 
1. Voice slow. 
2. Intelligence remains good until 
late in the disease. 
3. Physiognomy peculiar. 
4. Peculiar gait. 
5. No trembling of the head. 
6. Tremor constantly present. 
7. Disease of long duration. 
8. Unaltered cutaneous sensibility. 
General Paralysis of the Insane. 
1. Voice tremulous. 
2. Intelligence early affected. 
3. Dull expression to face. 
4. No peculiar gait. 
5. Head unsteady. 
6. Inconstant tremor. 
7. Rapid progressive disease. 
8. Altered cutaneous sensibility. DIFFERENTIAL DIAGNOSIS OF COMA. DIFFERENTIAL DIAGNOSIS OF COMA. 
FORMS OF COMA TO BE DIFFERENTIATED. 
Uraemic. 
Apoplectic. 
Narcotic (opium.) 
Alcoholic. 
Diabetic. 
Epileptic. 
Hysterical. 
Congestive (sunstroke.) 
Asphyxial. 
Anaemic (syncope.) 
Cerebral, due to injury to brain. 
NAME OF DISEASE. DISEASES TO BE DIFFERENTIATED. 
Uraemic Coma. Apoplectic Coma. 
See Urcemia, page 91. 
Uraemic Coma. Narcotic Coma. 
See Urczmia, page 92. 
Uraemic Coma. Alcoholic Coma. 
See Urczmia, page 92. 
Uraemic Coma. Hysterical Coma. 
See Urcemia, page 91. 
Uraemic Coma. Epileptic Coma. 
See Urcemia, page 91. 
Uraemic Coma. 
1. History of Bright's disease. 
2. Albumen and casts in urine. 
3. Begins with delirium or convul- 
sions. 
Diabetic Coma. 
1. History of diabetes. 
2. Sugar in urine. 
3. Begins with somnolency and great 
oppression. 
159 160 
DIFFERENTIAL DIAGNOSIS OF COMA. 
NAME OF DISEASE. 
Uraemic Coma. 
4. Urine scanty and retained. 
5. General oedema. 
6. Uriniferous odor about patient. 
7. Pulse strong and full. 
Uraemic Coma. 
I History of Bright's disease. 
2. General oedema. 
3. Urine albuminous. 
4. Face waxy. 
5. Breathing stertorous. 
6. Uriniferous smell about patient. 
7. Heart's action usually good. 
Uraemic Coma. 
1. History of Bright's disease. 
2. Temperature low. 
3. Coma and repeated convulsions. 
4. Breathing stertorous. 
5. Urine scanty and albuminous. 
6. General oedema. 
7 Urine retained. 
8. No diarrhoea. 
g. Coma complete. 
10. Pulse not very rapid. 
DISEASES TO BE DIFFERENTIATED. 
Apoplectic Coma. 
4. Urine abundant and passed in- 
voluntarily. 
5. Emaciation. 
6. Sweet odor to breath and urine. 
7. Pulse weak and small. 
Asphyxia. 
1. Of exposure to foul air. 
2. (Edema of lungs. 
3. Urine negative. 
4. T ongue and lips livid and blue. 
5. Breathing embarrassed. 
6. Breath contains large amount of 
carbonic acid. 
7. Heart action greatly embarrassed. 
Congestive Coma. 
(Sunstroke.) 
1. Of exposure to heat. 
2. Temperature high. 
3. Coma without or with slight con- 
vulsions. 
4. Breathing usually quiet. 
5. Urine negative. 
6. No oedema. 
7. Urine passed involuntarily. 
8. Involuntary diarrhoeal discharges. 
9. Coma yields readily to treatment, 
io. Pulse rapid. 
Apoplectic Coma. Alcoholic Coma. 
See Alcoholism, page 132. 
Apoplectic Coma. Narcotic Coma. 
See Apoplexy, page 143. DIFFERENTIAL DIAGNOSIS OF COMA. 
161 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Apoplectic Coma. Hysterical Coma. 
See Apoplexy, page 143. 
Apoplectic Coma. Epileptic Coma. 
See Apoplexy, page 143. 
Apoplectic Coma. 
(Cerebral hemorrhage.) 
1. Apoplectic history. 
2. No signs of injury. 
3. No oozing from nose or ears. 
4. Stupor intense from first. 
5. Flemiplegia. 
6. Remissions infrequent. 
7. No headache. 
8. Vaso-motor disturbance on affected 
side. 
9. Convulsions and paralysis limited 
to one side. 
Apoplectic Coma. 
1. Hemiplegia. 
2. Begins suddenly. 
3. Slow, full pulse. 
4. Respiration slow and stertorous. 
5. Urine negative. 
6. Urine often retained. 
7. Temperature elevated, especially 
on paralyzed side. 
8. Pupils irregular. 
g. Deviation of head and eyes. 
Coma, Result of Injury. 
(Meningeal hemorrhage.) 
1. History of injury. 
2. Signs of head injury. 
3. Blood or serous discharge common. 
4. Gradually increasing stupor. 
5. Hemiplegia comes on late, if at 
all. 
6. Frequent remissions. 
7. Headache. 
8. Vaso-motor disturbance uncom- 
mon. 
9. Both sides may be affected. 
Diabetic Coma. 
1. No true paralysis. 
2. Slowly, with somnolency. 
3. Rapid, weak pulse. 
4. Rapid respiration. 
5. Sugar in urine. 
6. Passed involuntarily in large 
quantities. 
7. Temperature normal. 
8. Pupils regular. 
g. No deviation. 
Apoplectic Coma. Asphyxia. 
See Apoplexy, page 144. 162 
DIFFERENTIAL DIAGNOSIS OF COM Al 
NAME OF DISEASE. 
Apoplectic Coma. 
1. Apoplectic history. 
2. Appears suddenly. 
3. T emperature higher on paralyzed 
side. 
4. Hemiplegia. 
5. Pupils irregular. 
6. Breathing loudly stertorous. 
7. Deviation of head and eyes. 
8. Retention of faeces. 
9. Increasing coma. 
10. Pulse slow and full. 
DISEASES TO BE DIFFERENTIATED. 
Congestive Coma. 
(Sunstroke.) 
1. Exposure to heat. 
2. Usually comes on gradually. 
3. Temperature very high on both 
sides. 
4. No true paralysis. 
5. Pupils contracted. 
6. Stertor absent or low. 
7. No deviation. 
8. Involuntary diarrhoeal discharges. 
9. Coma diminishes on appropriate 
treatment. 
10. Pulse rapid and often feeble. 
Alcoholic Coma. Narcotic Coma. 
See Alcoholism, page 133. 
Alcoholic Coma. 
1. History of alcoholism. 
2. Breath smells of alcohol. 
3. Alcohol in urine. 
4. Temperature low. 
5. Tongue negative. 
6. Face flushed and swollen. 
7. No loss of semen. 
8. "Steamboat" respiration. 
9. Can be aroused by inhalation of 
ammonia. 
10. Coma lasts for hours. 
11. Not preceded by convulsions. 
Epileptic Coma/ 
1. History of epilepsy. 
2. No odor to breath. 
3. Urine negative. 
4. Temperature high. 
5. Tongue bitten. 
6. Face cyanotic with froth about 
mouth. 
7. Frequently is. 
8. No stertorous breathing. 
9. Cannot be aroused. 
10. Coma of short duration. 
11. Coma follows convulsions. 
Alcoholic Coma. 
Congestive Coma. 
(Sunstroke.) 
See Alcoholism, page 133. DIFFERENTIAL DIAGNOSIS OF COMA. 
163 
NAME OF DISEASE. 
Alcoholic Coma. 
1. History of alcoholism. 
2. Can be aroused. 
3. Pulse full and strong. 
4. Pupils dilated. 
5. Alcohol in urine. 
6. Face flushed and red. 
7. Steamboat respiration. 
8. Breath smells of alcohol. 
Alcoholic Coma. 
1. Breath smells of alcohol. 
2. Pulse full and strong. 
3. Alcohol in urine. 
4. Urine retained. 
5. Can be aroused. 
6. Begins with delirium. 
7. Respiration slow and steamboat 
quality. 
8. Coma gradually lessens. 
Alcoholic Coma. 
1. History of alcoholism. 
2. Usually seen in males. 
3. Stertorous breathing. 
4. Vomiting common. 
5. Coma continuous. 
6. Urine retained. 
7. Urine high-colored and contains 
alcohol. 
8. Breath smells of alcohol. 
DISEASES TO BE DIFFERENTIATED. 
Asphyxia. 
1. Of breathing impure air. 
2. Cannot be aroused. 
3. Pulse small and weak. 
4. Pupils contracted. 
5. Urine negative. 
6. Face and lips blue. 
7. Shallow and embarrassed breath- 
ing. 
8. Frequently of gas. 
Diabetic Coma. 
1. Sweet odor to breath. 
2. Pulse rapid and weak. 
3. Sugar in urine. 
4. Urine passed involuntarily and in 
large amounts. 
5. Cannot be aroused. 
6. Begins with somnolency. 
7. Respiration shallow and rapid. 
8. Coma deepens. 
Hysterical Coma. 
1. History of hysteria. 
2. Occurs in females. 
3. No stertor. 
4. No vomiting. 
5. Coma alternates with hysterical 
delirium. 
6. Incontinence of urine. 
7. Urine abundant and clear. 
8. No odor to breath. 
Epileptic Coma. Hysterical Coma. 
See Epilepsy, page 153. 164 
DIFFERENTIAL DIAGNOSIS OF COMA. 
NAME OF DISEASE. 
DISEASES TO BE DIFFERENTIATED. 
Epileptic Coma. Narcotic Coma. 
See Epilepsy, page 152. 
Epileptic Coma. Syncope. 
See Epilepsy, page 153. 
Epileptic Coma. 
1. History of epilepsy. 
2. Preceded by convulsions. 
3. Coma of short duration. 
4. Temperature elevated. 
5. Pulse not greatly affected. 
6. Face covered with foam. 
7. Breathing not restrained. 
8. Face pale. 
Epileptic Coma. 
1. Begins with convulsions. 
2. Face cyanotic. 
3. Pulse not affected. 
4. Temperature elevated. 
5. Breathing normal. 
6. Urine negative. 
7. Coma of short duration. 
8. Seminal emissions. 
Opium Coma. 
1. Comes on gradually. 
2. Pupils contracted. 
3. Pupils insensible. 
4. Coma deepens gradually. 
5. Breathing very slow and irregular. 
6. Surface cool and perspiring. 
7. Opium in breath and urine. 
Asphyxia. 
1. Of breathing impure air. 
2. May end in convulsions. 
3. Profound coma. 
4. Temperature low. 
5. Pulse weak, rapid, and small. 
6. No saliva about the mouth. 
7. Breathing embarrassed. 
8. Face and lips very blue. 
Diabetic Coma. 
1. Begins with somnolency. 
2. Face pale. 
3. Pulse weak and rapid. 
4. Not affected. 
5. Breathing very rapid. 
6. Urine contains sugar. 
7. Coma ends in death. 
8. Incontinence of urine. 
Hysterical Coma. 
1. Appears suddenly. 
2. Pupils normal. 
3. Pupils sensitive to light. 
4. Coma alternates with hysterical 
delirium. 
5. Breathing sighing and rapid. 
6. Surface flushed and hot. 
7. Incontinence of limpid urine. DIFFERENTIAL DIAGNOSIS OF COMA. 
165 
NAME OF DISEASE. 
Opium Coma. 
1. Pupils contracted. 
2. Face pale. 
3. Breathing very slow and irregular. 
4. Opium in breath and urine. 
5. Surface cool and perspiring. 
6. Heart negative. 
Opium Coma. 
1. Breath smells of opium. 
2. Opium in urine. 
3. Pulse slow. 
4. Breathing slow and irregular. 
5. Urine retained. 
6. Pupils contracted. 
7. Surface cool and perspiring. 
Diabetic Coma. 
1. History of diabetes. 
2. Respiration rapid. 
3. Urine contains sugar. 
4. Urine passed involuntarily. 
5. Face pale. 
6. Sweet smell to breath. 
7. Convulsions uncommon. 
8. Coma deepens. 
Diabetic Coma. 
1. History of diabetes. 
2. Temperature normal. 
3. Urine contains sugar. 
4. Incontinence of urine. 
DISEASES TO BE DIFFERENTIATED. 
Asphyxia. 
1. Pupils dilated or normal. 
2. Face cyanosed. 
3. Breathing rapid and embarrassed. 
4. Urine and breath negative or 
smell of coal gas. 
5. Surface dry and hot. 
6. Heart's action greatly interfered 
with. 
Diabetic Coma. 
1. Sweet breath. 
2. Sugar in urine. 
3. Rapid, weak pulse. 
4. Rapid breathing. 
5. Incontinence of urine. 
6. Pupils negative. 
7. Surface dry and hot. 
Asphyxia. 
1. Breathing impure air. 
2. Greatly embarrassed breathing. 
3. Urine negative or suppressed. 
4. Retention of urine. 
5. Face and lips blue. 
6. Smells of gas frequently. 
7. Occasional convulsions. 
8. Coma diminished by treatment. 
Congestive Coma. 
(Sunstroke.) 
1. Of exposure to heat. 
2. Temperature elevated. 
3. Urine negative. 
4. Incontinence of faeces,-diarrhoea. 166 
DIFFERENTIAL DIAGNOSIS OF COMA. 
NAME OF DISEASE. 
Diabetic Coma. 
5. Pupils normal. 
6. Breathing rapid. 
7. Coma deepens. 
Congestive Coma. 
(Sunstroke.) 
1. History of exposure to heat. 
2. Coma well-marked. 
3. Temperature slightly elevated. 
4. Pupils contracted 
5. Cannot be aroused. 
6. Incontinence of faeces. 
7. Diarrhoea. 
Syncope. 
1. Advent sudden 
2. Face pale. 
3. Coma of short duration. 
4. Breathing weak but not restricted. 
5. Surface cold and perspiring. 
6. Heart principally affected. 
7. Pulse not felt at wrist. 
DISEASES TO BE DIFFERENTIATED. 
Congestive Coma. 
5. Pupils contracted. 
6. Respiration normal. 
7. Coma lessens by proper treatment. 
Hysterical Coma. 
1. Hysterical history. 
2. Coma alternates with hysterica] 
symptoms. 
3. Temperature very high. 
4. Pupils negative or dilated. 
5. Can be aroused. 
6. Incontinence of urine. 
7. No diarrhoea. 
Asphyxia. 
1. Advent slow. 
2. Face and lips blue. 
3. Coma lasts for hours. 
4. Breathing greatly embarrassed. 
5. Surface hot and dry. 
6. Lungs. 
7. Pulse weak and rapid. INDEX. 
A 
Abscess of the brain, 144 
" perinephritic, 103 
" in abdominal wall, 79 
" psoas, 62 
" of the lung, 26 
" of the liver, 78 
" retro-pharyngeal, 15, 17 
Acid fermentation in stomach, 56 
Acute general diseases, 107 
Alcoholism, 132 
Anaemia, 130 
" pernicious, 130 
Anaemic bruit, 44 
Aneurism, abdominal, 46 
" thoracic, 47 
Angina pectoris, 42 
Aorta, pulsations of, 46 
Aortic obstruction, 43 
" regurgitation, 44 
Amyotrophic lateral sclerosis, 152 
Apoplexy, cerebral, 142 
" bulbar, 148 
" spinal, 147 
Arteries, diseases of, 38, 46 
Arthritis deformans, 129 
Ascites, 71 
Asphyxia, 144 
Asthenia, 30 
Atelectasis, 25 
B 
Bladder, spasms of, 103 
" distended, 72 
Bilious remittent fever, 116 
Brain, diseases of, 137 
Bright's disease, acute, 93 
" " chronic, 94 
Bronchitis, acute, 27 
capillary, 27 
" chronic, 28 
" fetid, 28 
Broncho-pneumonia, 24 
C 
Caecum, cancer of, 62 
" distension of, 62 
Calculi, renal, 103 
Cancer of caecum, 62 
" kidney, IOI 
" liver, 82 
" the intestines, 65 
" lung, 29 
" the pleura, 47 
" peritoneum, 70, 71 
" the oesophagus, 53 
" stomach, 57 
" rectum, 61 
" the tongue, 14 
Cancrum oris, 14 
Cardiac dilatation, 40, 42 
" enlargement, 39 
" hypertrophy, 40 
* ' murmurs, 43 
Cardialgia, 57 
Catarrh of the bile ducts, 77 
Cerebellar disease, 152 
Cerebro-spinal sclerosis, 150 
Chancre, 133 
Chancroid, 133 
167 168 
INDEX. 
Chicken-pox, 117 
Chlorosis, 130 
Cholera, 120 
" infantum, 60 
" morbus, 59 
Chorea, 155 
Chronic general diseases, 127 
Cirrhosis of the liver, 77 
Cirrhotic kidney, 95 
Colic, hepatic, 85 
" intestinal, 67 
" renal, 103 
" uterine, 68 
Coma, 159 
Compression of the brain, 145 
Concussion of the brain, 145 
Congestion of the liver, 76 
" spinal cord, 146 
Consolidation of lung tissue, 41 
Constipation, chronic, 64 
Croup, false, 15 
" true or membranous, 15 
Cyst of kidney, 84 
Cystitis, acute, 103 
D 
Delirium tremens, 132 
Dengue fever, 114 
Diabetes, 129 
Diarrhoea with hemorrhoids, 60 
Digestive tract, diseases of, 51 
Dilated heart, 40 
Diphtheria, 120 
Diphtheritic sore throat, 121 
Diseases, acute general, 107 
" chronic general, 127 
" functional nervous, 139 
" of the arteries, 38, 46 
" " brain, 137 
" digestive tract, 51 
" " liver, 75 
" " lungs, 21 
" " heart, 37 
" " kidneys, 89 
" " mouth, 13 
" " nervous system, 137 
" peritoneum, 53, 68 
Diseases of the spinal cord, 138 
" throat, 13 
Displacement of the heart, 41 
Dropsy, general, 96 
" ovarian, 71 
Dysentery, 60 
Dyspepsia, 55 
E 
Embolism, cerebral, 142 
bulbar, 148 
Emphysema, 29 
Empyema, 33 
" pulsating, 33 
Endocarditis, 40 
ulcerative, 40 
Enlarged gall-bladder, 79, 84 
Enteritis, acute, 58 
" of children, 60 
" tubercular, 64 
Epilepsy, 152 
Epistaxis, 31 
Erysipelas of throat, 121 
Erythema, 119 
F 
Fatty heart, 42 
" kidney, 96 
" liver, 82 
Fevers, 107 
Floating kidney, 65 
Functional heart murmurs, 40 
G 
Gall-bladder, enlarged, 79, 84 
Gangrene of the lung, 28 
Gastritis, acute, 54 
" chronic, 55 
" toxic, 54 
General diseases, acute, 107 
" " chronic, 127 
" paralysis of insane, 156 
Glycosuria, 129 
Goitre, cystic, 43 
" exophthalmic, 43 
Gout, acute, 128 
" chronic, 129 INDEX. 
169 
H 
Heart, diseases of, 37 
Hematemesis, 30 
Hematinuria, 99 
Hematuria, 99 
Hemoptysis, 30 
Hemorrhage, intestinal, 66 
from bladder, 99 
from urethra, 99 
Hemorrhoids, 66 
Hydatids of liver, 83 
" lung, 32 
kidney, 100 
Hydrocephalus, 141 
spurious, 64 
Hydronephrosis, 100 
Hydrophobia, 123 
Hydrothorax, 32 
Hysteria, 154 
Hysterical change of voice, 16 
" stricture of oesophagus, 54 
I 
Infantile remittent fever, 60 
Insane, paralysis of, 156 
Intercostal neuralgia, 31 
Intermittent fever, 115 
Intestinal hemorrhage, 66 
" obstruction, 63 
" perforation, 67 
Intestine, diseases of, 51 
Intussusception, 63 
J 
Jaundice, hematogenous, 86 
" hepatogenous, 86 
' ' simple, 81 
K 
Kidney, diseases of, 89 
L 
Large white kidney, 94 
Laryngitis, acute, 15 
" chronic, 16 
Larynx, oedema of, 16 
" spasmodic affections of, 30 
Leucocythemia, 131 
Liver, diseases of, 75 
Locomotor ataxia, 152 
Lungs, diseases of, 21 
M 
Malignant pustule, 14 
Measles, 1x9 
Meningitis, acute, 139 
" chronic, 140 
" epidemic cerebro-spinal. 
122 
Meningitis, spinal, 145 
tubercular, 141 
Mitral obstruction, 45 
" regurgitation, 46 
Mouth, diseases of, 13 
Murmurs, cardiac, 38, 43 
Myalgia, 133 
Myelitis, 146 
N 
Nephritis, 89 
Nervous system, diseases of, 137 
Neuralgia, 134 
intercostal, 31 
O 
CEdema of glottis, 16 
" lungs, 28 
(Esophagus, cancer of, 53 
stricture of, 53 
Organic brain disease, 154 
" heart disease, 42 
Ovarian cyst, 100 
" dropsy, 71 
P 
Pachymeningitis interna, 140 
Palpitation of the heart, 42 
Paralysis agitans, 156 
" bulbar, 148 
" of insane, 156 170 
INDEX. 
Perforation, intestinal, 67 
Pericarditis, 39 
Perihepatitis, 84 
Perinephritis, 103 
Periproctitis, 65 
Peritoneum, diseases of, 53, 68 
Peritonitis, acute, 68 
" chronic, 70 
" cancerous, 70, 71 
tubercular, 71 
Perityphlitis, 61 
Pernicious anaemia, 130 
" remittent fever, 116 
Phthisical cavities, 32 
Phthisis, acute, 25 
" chronic, 26 
Pleurae, cancer of, 47 
Pleurisy, acute, 31 
" with effusion, 32 
Pneumonia, acute lobar, 23 
broncho-, 24 
Pneumothorax, 32 
Poisoning, acute, 54 
" opium, 92 
" strychnine, 155 
Polio-myelitis anterior, 149 
Pregnancy, 72 
Proctitis, 65 
Progressive muscular atrophy, 150 
Pseudo leukaemia, 131 
Psoas abscess, 62 
Pulmonary mfarction, 27 
regurgitation, 45 
consolidation, 41 
Pulsation, abdominal, 46 
Purpura, 131 
Pyaemia, 122 
Pyelitis, 97 
Pylephlebitis, 80 
Pyonephritis, 97 
R 
Relapsing fever, 114 
Remittent fever, 115 
" infantile, 60 
" pernicious, 116 
Retro-pharyngeal abscess, 15, 17 
Rheumatism, acute, 128 
" chronic, 129 
" gonorrhoeal, 128 
muscular, 133 
Roseola, 120 
S 
Scarlet-fever, 118 
Scurvy, 131 
Septicaemia, 122 
Small-pox, 116 
Softening of the brain, 141 
Sore throat, diphtheritic, 121 
Spasmodic affections of larynx 30 
Spasm of bladder, 103 
Spinal cord, diseases of, 138 
Stomach, diseases of, 51, 54 
" cancer of, 57 
" ulcer of, 57 
Stomatitis, follicular, 13 
ulcerative, 14 
Sun-stroke, 133 
Suppurative nephritis, 98 
Syncope, 153 
Syphilis, 133 
Syphilitic ulcer of tongue, 14 
T 
Tetanus, 155 
Throat, diseases of, 13 
Thrush, 13 
Tubercle of kidney, 102 
Tuberculosis, acute, m 
Trichinosis, 131 
Tricuspid regurgitation, 46 
Tumor of spleen, 102 
" liver, 101 
" brain-cerebral, 145 
" medulla, 148 
Tumors of abdomen, 46 
Typhilitis, 61 
Typhoid fever, 109 
Typho-malarial fever, no 
Typhus fever, in INDEX. 
171 
U 
Ulcer of stomach, 57 
" tongue, 14 
Uraemia, 91 
V 
Vertigo, cerebral, 56 
w 
Waxy kidney, 96 
" liver, 82 
Y 
Yellow atrophy of liver, acute, 8c 
Yellow fever, 113