PHYSICIANS AND SURGEONS
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TREATMENT OF DISEASE
BY THE SAME AUTHOR.
Manxial of Fever Nursing.
" In this little book the author has presented the medical profession
with a hand-book of the highest value to nurses and one which will
prove most useful to physicians as well. The subject is treated thor-
oughly and exhaustively and the guide followed by the author has been
his lectures to the nurses of St. Mark's Hospital of New York City.
The book is divided into nine chapters, which are respectively
devoted to fever, its definition and diagnosis, and its general treatment.
Then the nurse, the sick-room and its furniture, the patient, etc., are
considered. Infections of continued type, and the same with local
manifestations, are noted. Infections of intermittent type are next
taken up, and following this, the exanthemata. The concluding chap-
ter deals with thermic fever. The book is a well written one and
practical in every detail. The author is a well-known writer, who has
made many valuable contributions to medical literature. We feel cer-
tain that his little work will be eagerly taken up by trained nurses and
we unhesitatingly recommend it to them as well as to their teacher. It
is a timely work and full of good suggestions, useful to patients,
nurses, and to physicians alike." — St. Louis Medical and Surgical
i2mo. 236 pages. Cloth, $1.00 net.
P. BLAKISTON'S SON & CO., - - Philadelphia.
TREATMENT OF DISEASE
A MANUAL OF
REYNOLD WEBB WILCOX, M.A., M.D., LL.D.
PROFESSOR OF MEDICINE AT THE NEW YORK POST GRADUATE MEDICAL SCHOOL AND^HOSPITAL;
CONSULTING PHYSICIAN TO THE NASSAU HOSPITAL; VISITING PHYSICIAN TO ST. MARK's
HOSPITAL; FELLOW OF THE AMERICAN ACADEMY OF MEDICINE; MEMBER OF THE
AMERICAN THERAPEUTIC SOCIETY AND OF THE AMERICAN MEDICAL ASSOCIATION;
PERMANENT MEMBER OF THE MEDICAL SOCIETY OF THE STATE OF NEW
YORK; HONORARY MEMBER OF THE CONNECTICUT STATE MEDICAL
SOCIETY; VICE-CHAIRMAN OF THE REVISION COMMITTEE OF THE
UNITED STATES PHARMACOPCEIA, ETC.
BLAKISTON'S SON & CO.
1012 WALNUT STREET
Copyright, 1907, By P. Blakiston's Son & Co.
The Maple Press,
THE MEMORY OF
REYNOLD WEBB, M. D.,
AND MY UNCLE,
DANIEL MEIGS WEBB, A. M., M. D.,
THIS VOLUME IS DEDICATED.
Twenty-three years' experience in teaching more than ten thousand
medical graduates has impressed upon the author that the practitioner
desires especially the latest views upon questions of diagnosis and methods
of treatment. Under the influence of Post Graduate Schools the medical
student is more thoroughly grounded in diagnosis, and particularly in physical
diagnosis, than formerly. There still remains an anxious endeavor on the
part of the physician to increase his knowledge of therapeutics, whether
physical, medicinal or dietetic, which goes to make up what may be termed the
management of a patient suffering from disease. While aetiology is important,
pathology is interesting and a sound basis, and diagnosis is essential, it is
from a thorough and broad knowledge of therapeutics in its larger sense that
the practitioner will achieve his greatest success and win his most endiiring
reputation among his patients and the public at large. The therapeutic
awakening which is now being experienced, shows that more to-day, than ever
before, is expected of the clinician. With the practical needs of the physician
always in view, this book has been written. To Dr. Henry Hubbard Pelton,
Instructor in Medicine at the New York Post Graduate Medical School and
Hospital, and Chief of Medical Clinic, Presbyterian Hospital Dispensary,
who has diligently collected his lectures during the sessions of 1904-6, who
has filled the lacuncB inseparable to clinical teaching and who has borne the
labor of proof-reading and index-making, the author would tender his heart-
felt acknowledgment of his varied and valuable services.
TABLE OF CONTENTS.
THE INFECTIOUS DISEASES.
Enteric Fever i
Paratyphoid Fever 22
Mountain Fever 23
Typhus Fever 24
Malta Fever 28
Relapsing Fever 30
Yellow Fever 33
Malaria] Fevers 45
Nasha Fever 54
Catarrhal Dysentery 62
Tropical Dysentery 63
Amoebic Dysentery 64
Diphtheritic Dysentery 67
Epidemic Gangrenous Proctitis 71
Hill Diarrhoea 72
The Plague 75
Climatic Bubo 77
Whooping Cough go
Cerebrospinal Fever 95
Acute Articular Rheumatism 105
X TABLE OF CONTENTS.
Septicaemia; Pygemia iii
Actinomycosis ' 127
Epidemic Stomatitis 128
Milk Sickness 129
Gonorrhoeal Infections 130
Acute Miliary Tuberculosis 147
Acute General Miliary Tuberculosis 148
Acute General Tuberculosis of Pulmonary Form . . . . ; 149
Acute General Tuberculosis of Meningeal Form 150
Pulmonary Tuberculosis 150
Acute Pneumonic Pulmonary Tuberculosis 150
Chronic Pulmonary Tuberculosis 151
Fibroid Phthisis 158
Tuberculosis of the Lymphatic Glands 173
Tuberculosis of the Pleura 175
Tuberculosis of the Peritonseum 175
Tuberculosis of the Pericardium 176
Tuberculosis of the Kidney 177
Tuberculosis of the Pelvis of Kidney, Ureter and Bladder 177
Tuberculosis of the Testicles, Prostate Gland and Seminal Vesicles. 178
Tuberculosis of the Ovaries, Uterus and Fallopian Tubes 178
Tuberculosis of the Mammary Gland 179
Tuberculosis of the Heart and Blood-vessels 179
Acute Infectious Pneumonia 179
Chronic Interstitial Pneumonia 192
Embolic Pneumonia 194
Hsemorrhagic Infarct of the Lung 194
Septic Embolic Pneumonia 195
Protracted Idiopathic Continued Fever 200
Weil's Disease 201
Glandular Fever 201
Miliary Fever 202
TABLE OF CONTENTS. XI
Japanese River Fever 203
Tick Fever 204
Scarlatina ■ 220
Fourth Disease 228
Diabetes Mellitus 254
Diabetes Insipidus 262
Chronic Rheumatism 265
Muscular Rheumatism ■ 267
Arthritis Deformans 269
Infantile Scurvy 279
THE INTOXICATIONS, INCLUDING THE EFFECTS OF
EXPOSURE TO HIGH TEMPERATURES.
Lead Poisoning 286
Arsenical Poisoning 290
Mercurial Poisoning 292
Antimonial Poisoning 294
Xll TABLE or CONTENTS.
Acute Alcoholism 297
Chronic Alcoholism 299
Delirium Tremens 302
Sulphonmethane (Sulphonal) Poisoning 305
Sulphonethylmethane (Trional) Poisoning 305
Veronal Poisoning 306
Haschisch Poisoning - 09
Tobacco Poisoning 310
Carbon Bisulphide Poisoning 311
Lacquer Poisoning 311
Food Poisoning 312
Grain Poisoning 313
Pellagra •. 314
The Effects of Exposure to High Temperatures 316
Heat Exhaustion 316
DISEASES OF THE DIGESTIVE SYSTEM AND PERITONEUM.
DISEASES OF THE MOUTH AND TONGUE.
Mycotic Stomatitis 320
Gangrenous Stomatitis 321
The Geographical Tongue 322
Leucoplakia Buccalis 323
DISEASES OF THE SALIVARY GLANDS.
Dry Mouth 324
Acute Parotitis 324
Ludwig's Angina 325
DISEASES OF THE TONSILS AND PHARYNX.
Acute Catarrhal Pharyngitis 325
Acute Follicular TonsiUitis 327
Quinsy Sore Throat 329
TABLE OF CONTENTS. Xlll
DISEASES OF THE (ESOPHAGUS.
Acute CEsophagitis 330
Chronic Catarrhal CEsophagitis 331
CEsophageal Spasm 331
Cancer of the (Esophagus 331
Benign Stricture of the CEsophagus 332
Dilatations of the (Esophagus 333
DISEASES OF THE STOMACH.
A-c ':^^^ : Catarrhal Gastritis 334
Chronic Catarrhal Gastritis 337
Phlegmonous Gastritis .• 343
Traumatic and Toxic Gastritis 343
Diphtheritic Gastritis 344
Mycotic Gastritis 344
Gastric Ulcer ' 345
Cancer of the Stomach 356
Hypertrophic Stenosis of the Pylorus 360
Gastric Dilatation 361
Acute Gastric Dilatation 364
Hour-glass Stomach 365
Visceroptosis .*" 366
Neuroses of the Stomach 369
Gastric Hyperperistalsis 375
Nervous Eructation of Gas 376
Gastric Hyperaesthesia . . . . 376
Anorexia Nervosa 379
Cyclic Vomiting 379
DISEASES OF THE INTESTINE.
Simple Acute Catarrhal Enteritis 381
Chronic Catarrhal Enteritis 383
Cholera Morbus 387
XIV TABLE OF CONTEXTS.
Diarrhoeas of Children 389
Acute Gastro-enteritis 389
Cholera Infantum 391
Acute Entero-colitis 393
Pseudo-membranous Entero-colitis 395
Phlegmonoius Enteritis 396
Haemorrhagic Infarct of the Bowel 396
Ulceration of the Bowel 397
Ulcer of the Duodenum ■ 397
Primar}' Tuberculous Ulceration of the Intestine 398
EmboHc Ulcer of the Intestine 399
S}^hilitic Ulcer of the Intestine 399
Intestinal Obstruction 404
Dilatation of the Colon 416
Ner\'ous Affections of the Intestine 416
Malignant Gro'n1;hs of the Intestine 419
DISEASES OF THE LIVER.
Abnormalities in Shape and Position of the Liver 422
Abscess of the Liver 425
Cirrhosis of the Liver 429
The Fatty Liver 437
The Amyloid Liver 438
Syphilis of the Liver 439
Acute YeUow Atrophy of the Liver 441
Neoplasms of the Liver 443
Cancer of the Liver 443
Parasites of the Liver 447
Echinococcus Disease of the Liver 447
Other Parasites of the Liver 450
DISEASES OF THE HEPATIC BLOOD-VESSELS.
Anaemia and Hyperaemia of the Liver 45°
Thrombosis and Embolism of the Portal Vein 452
TABLE OF CONTENTS. XV
DISEASES OF THE BILIARY TRACT.
Acute Catarrhal Jaundice 453
Toxic Jaundice 457
Icterus Neonatorum 458
Acute Cholecystitis 458
Neoplasms of the Gall-bladder 468
Neoplasms of the Gall Ducts 469
Stenosis of the Gall Ducts 469
Parasites of the Gall Ducts 470
DISEASES OF THE PANCREAS.
Acute Pancreatitis 470
Acute Haemorrhagic Pancreatitis 471
Acute Suppurative Pancreatitis 471
Acute Gangrenous Pancreatitis 472
Chronic Pancreatitis 473
Tumors of the Pancreas 474
Cancer of the Pancreas 474
Cysts of the Pancreas 475
Pancreatic Calculi 476
DISEASES OF THE PERITONEUM.
Acute Peritonitis 476
Chronic Peritonitis 481
Neoplasms of the Peritonaeum 483
DISEASES OF THE BLOOD.
The Anaemias 487
Secondary Anaemia 487
Primary or Essential Anaemias 490
Progressive Pernicious Anaemia 494
Chronic Cyanosis 504
Anaemia Infantum 504
XVI TABLE OF CONTENTS.
Arthritic Purpura 506
Purpura Haemorrhagica 507
Hasmorrhagic Diseases of the New-born 508
DISEASES OF THE DUCTLESS GLANDS.
DISEASES OF THE SPLEEN.
The Wandering Spleen 512
Abscess of the Spleen 513
Rupture of the Spleen 514
The Amyloid Spleen 514
Neoplasms of the Spleen 514
Echinococcus Cysts of the Spleen 515
Splenic Anaemia 515
Banti's Disease 516
Status Lymphaticus 519
DISEASES OF THE THYROID GLAND.
Simple Goitre 521
Congestion of the Thyroid Gland 523
Acute Thyroiditis 523
Exophthalmic Goitre 523
Neoplasms of the Thyroid Gland 532
DISEASES OF THE THYMUS GLAND.
Hypertrophy of the Thymus Gland 533
Thymus Death 533
Atrophy of the Thymus Gland 533
Haemorrhage into the Thymus Gland 533
Abscess of the Thymus Gland 533
Neoplasms of the Thymus Gland 533
Tuberculous Inflammation of the Thymus Gland 533
DISEASES OF THE SUPRARENAL GLAND.
Addison's Disease 534
TABLE OF CONTENTS. XVll
DISEASES OF THE HEART AND BLOOD-VESSELS.
DISEASES OF THE PERICARDIUM.
Acute Pericarditis 537
Chronic Adhesive Pericarditis 542
Calcification of the Pericardium 543
DISEASES OF THE MYOCARDIUM.
Cardiac Hypertrophy 543
Cardiac Dilatation 546
Cardiac Atrophy 551
Parenchymatous Myocarditis 551
Fatty Myocarditis 552
Fatty Infiltration of Heart 552
Fibrous Myocarditis 553
Acute Suppurative Myocarditis 555
Aneurysm of the Heart 555
Rupture of the Heart 555
DISEASES OF THE ENDOCARDIUM.
Acute Endocarditis 556
Simple Acute Endocarditis 556
Malignant Endocarditis 556
Chronic Endocarditis 561
Mitral Insufficiency 562
Mitral Obstruction 564
Aortic Insufficiency 566
Aortic Obstruction 569
Tricuspid Insufficiency 570
Tricuspid Obstruction 571
Pulmonic Insufficiency 572
Pulmonic Obstruction 572
Combined Valvular Lesions 573
Congenital Cardiac Defects 573
The Neuroses of the Heart 585
XVm TABLE OF CONTENTS.
Angina Pectoris 590
DISEASES OF THE BLOOD-VESSELS.
Aneurysm . 597
Aneurysm of the Thoracic Aorta 598
Aneurysm of the Abdominal Aorta 602
Aneurysm of the Branches of the Abdominal Aorta 603
DISEASES OF THE RESPIRATORY SYSTEM.
DISEASES OF THE NOSE.
Acute Rhinitis 607
Hay Fever 608
DISEASES OF THE LARYNX.
Acute Catarrhal Laryngitis 610
Simple Chronic Catarrhal Laryngitis 611
Spasmodic Laryngitis 613
Tuberculous Laryngitis 614
OEdema of the Glottis 616
DISEASES OF THE TRACHEA AND BRONCHI.
Acute Bronchitis 617
Chronic Bronchitis 621
Fibrinous Bronchitis . 623
Spasmodic Bronchitis 625
DISEASES OF THE LUNGS.
Pulmonary Emphysema 631
Syphilis of the Lung 637
Neoplasms of the Lung 638
Hydatid Disease of the Lung 639
Abscess of the Lung 639
Gangrene of the Lung 641
DISEASES OF THE PLEURA.
Acute Fibrinous Pleurisy 643
Acute Serous Pleurisy 645
Chronic Adhesive Pleurisy 653
TABLE OF CONTENTS. XIX
Hydropneumothorax and Pyopneumothorax 654
Neoplasms of the Pleura 656
DISEASES OF THE MEDIASTINUM.
Carcinoma and Sarcoma of the Mediastinum 657
Non-malignant Neoplasms of the Mediastinum 659
Abscess of the Mediastinum 659
Simple Lymphadenitis of the Mediastinum 659
Indurative Mediastino-pericarditis 659
Mediastinal Emphysema 660
DISEASES OF THE URINARY SYSTEM.
Anomalies of the Kidney 661
The Movable Kidney 662
Functional Albuminuria 665
•Acute Congestion of the Kidney 666
Chronic Congestion of the Kidney 666
Acute Nephritis 671
Chronic Parenchymatous Nephritis 678
Chronic Arterial Nephritis 683
The Amyloid Kidney 689
Suppurative Nephritis, Pyelonephrosis and Pyelitis 691
Neoplasms of the Kidney 703
The Cystic Kidney 705
Idiopathic Haematuria 706
Toxic Haemoglobinuria 708
Paroxysmal Haemoglobinuria 708
DISEASES OF THE NERVOUS SYSTEM.
DISEASES INVOLVING CHIEFLY THE BRAIN AND ITS MEMBRANES.
Acute Encephalitis 710
Cerebral Meningitis 711
XX TABLE OF CONTENTS.
External Pachymeningitis 711
Internal Pachymeningitis 711
Tuberculous Meningitis 714
Chronic Hydrocephalus 715
Cerebral Heemorrhage 716
Embolism and Thrombosis of the Cerebral Arteries 720
Thrombosis of the Venous Sinuses of the Brain 722
General Paralysis 723
Disseminated Sclerosis 725
Abscess of the Brain 727
Tumors of the Brain and its Membranes 729
Cerebellar Disease 734
DISEASES INVOLVING CHIEFLY THE SPINAL CORD AND ITS
Acute Myelitis 735
Chronic Myelitis 735
Acute Anterior Poliomyelitis 739
Chronic Anterior Poliomyelitis 742
Lateral Sclerosis 742
Amyotrophic Lateral Sclerosis 744
Locomotor Ataxia 745
Friedreich's Ataxia 751
Hereditary Cerebellar Ataxia 752
Bulbar Paralysis 752
Acute Ascending Paralysis 753
Morvan's Disease 756
Haemorrhage into the Spinal Cord 757
Caisson Disease 758
Compression of the Spinal Cord 759
Tumors of the Spinal Cord and its Meninges 761
Spinal Meningitis 763
Spinal Pachymeningitis 763
Acute Spinal Leptomeningitis 764
Haemorrhage into the Spinal Membranes 766
TABLE or CONTENTS. XXI
DISEASES INVOLVING CHIEFLY THE PERIPHERAL NERVES.
Multiple Peripheral Neuritis 770
Diseases of the Cranial Nerves 775
Diseases of the First Pair — The Olfactory Nerves 775
Diseases of the Second Pair — The Optic Nerves 776
Diseases of the Third, Fourth and Sixth Pairs — The Oculo-motor
Nerves, the Trochlear Nerves and the Abducentes 779
Diseases of the Fifth Pair — The Trigeminal Nerves 781
Diseases of the Seventh Pair — The Facial Nerves 782
Diseases of the Eighth Pair — The Auditory Nerves 785
Diseases of the Ninth Pair — The Glosso-pharyngeal Nerves 787
Diseases of the Tenth Pair — The Pneumogastric Nerves 788
Diseases of the Eleventh Pair — The Spinal Accessory Nerves 791
Diseases of the Twelfth Pair — The Hypoglossal Nerves 794
FUNCTIONAL DISEASES OF THE NERVOUS SYSTEM.
Acute Chorea 795
Choreiform Affections 799
Convulsive Tic 800
Impulsive Tic 800
Saltatory Spasm 801
Chronic Chorea 801
Myotonia Congenita 808
Paramyoclonus Multiplex 809
Paralysis Agitans 810
Infantile Eclampsia 812
Puerperal Eclampsia 813
The Neurasthenia of the Menopause 825
Traumatic Neuroses 828
Occupation Neuroses 829
VASO-MOTOR AND TROPHIC DISORDERS.
Raynaud's Disease 832
Ery thro melalgia 833
XXll TABLE OF CONTENTS.
Angioneurotic (Edema 834
Facial Hemiatrophy 837
Myasthenia Gravis 838
Periodical Paralysis 839
Adiposis Dolorosa 840
Leontiasis Ossea 842
Osteitis Deformans 842
Hypertrophic Pulmonary Osteoarthropathy 842
DISEASES OF THE MUSCULAR SYSTEM.
Myositis - 846
Infectious Myositis 846
Ossifying Myositis 847
Muscular Dystrophies 847
Pseudo-hypertrophic Paralysis 847
Juvenile Muscular Dystrophy 848
Muscular Atrophy of the Landouzy-Dejerine Type 849
Muscular Atrophy of the Peroneal Type 849
Echinococcus Disease 868
Intestinal Cestodes 868
Parasitic Insects 874
Arachnidse and Ticks 874
Parasitic Flies > 875
Other Parasitic Insects 876
In a treatise upon Practical Medicine the classification of the various
diseases is to be undertaken with circumspection, for the progress which is
daily taking place in the study of pathologic states is continually rendering
it necessary for us to change our opinions of the nature of morbid condi-
tions. Theories which have been credited as facts are frequently being
controverted or are becoming hypotheses while apparently established facts
may be overthrown to give place to their successors. As an instance, pneu-
monia and acute articular rheumatism are now regarded as infections while
previously the former was classed with diseases of the lungs and the latter
with morbid conditions of the joints. It is not at all improbable that soon
we shall be considering certain affections, now classed as splenic, as diseases
of the blood and vice versa, and other changes in classification are quite as
possible. Hence the difificuky of arranging a given list of diseases in a
manner which shall not be subject to criticism.
On the other hand it matters httle under what heading a disease is con-
sidered, for the various organs and bodily systems are so intimately related
that an affection of one of these can hardly exist as a distinct entity. In
almost every instance associated morbid processes are taking place in other
structures which have a definite bearing upon the primary state.
For this reason the present-day tendency toward speciaUsm in internal
medicine is to be decried and a reversion to the type of physician commonly
designated as the "General Practitioner" advocated. It is such a medical
man who, when confronted by a difficult problem, will grasp the moment
when the aid of the surgeon or that of another worker in special fields is
necessary; and this consultant will take in hand the work properly begun by
the practitioner and carry it to a successful conclusion which shall be quite
as much a result of the skill of the one as that of the other.
The tendency of the speciahst is to attribute all the symptoms of which he
complains to some lesion of the organ or system in which he is interested, for-
getting, perhaps, that other organs exist; thus the gastrologist loses sight of the
possibility that the stomach symptoms of a patient, to ascertain the reasons
for which the resources of chemistry are exhausted, may be an evidence of a
beginning tuberculous process at a pulmonary apex and are not due to some dis-
order of the gastric motility or to a secretory abnormaHty of the glands of the
stomach. Likewise the specialist upon thoracic diseases must not neglect
nor be unable to treat intelligently the renal condition associated with a given
instance of pulmonary emphysema or aortic obstruction, and the clinician
who devotes himself exclusively to the subject of acute diseases should recol-
lect the extreme probability of the occurrence of cardiac involvement when
treating a patient affiicted with acute polyarthritis. Numerous instances
might be cited showing the intimate relation of the diseases of one system to
those of others but these will sufl&ce.
In ehciting a patient's history the importance of the consideration of
heredity hes less in the possibihty of the direct transmission of disease than
in that of the inheritance of a constitution predisposed to morbid affections
by reason gf its inherited vitiated powers of resistance. Not only may
such a diminished resistance to disease be handed down from father to child
but there is a definite possibility that the offspring of physically strong for-
bears may possess an increased resistance to disease which may account for
some of the instances of apparent natural immunity which are observed.
In considering the ailments from which an individual has previously suf-
fered we must not lose sight of the fact that these may have a material bear-
ing upon the disease which now brings him to the physician, in obtaining the
history of which we must revert to the first noticed symptom, and its char-
acter. The associated manifestations must then be ascertained until we
are able to learn which organ is chiefly affected and the others which are
probably involved in consequence.
Having elicited the patient's history, we should proceed to the physical
examination, and this being accomplished we are finally ready to make the
Here it is a weU-recognized fact that, in every instance, we must proceed by
a process of exclusion, all the possibilities being ruled out one by one until we
have sifted the matter to its bottom and the true diagnosis is established.
After diagnosis, treatment is to be considered and, while not underrating the
value of pathological knowledge nor decrying the importance of aetiology or
history and without ignoring the advantage of expert physical diagnosis, or
minimizing the weight of trained and logical reasoning or deprecating the
assumption of conclusions based on long-continued experience — all of which
are necessary for a correct diagnosis— we must insist that learning and experi-
ence are in greatest demand in deciding upon the treatment to be prescribed.
This is, to the mind of the patient, the most important consideration, for to
him history and diagnosis are merely subsidiaries, his object in consulting the