Willis Webster Grube.

A compendium of practical medicine for the use of students and practitioners of medicine online

. (page 38 of 57)
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peral state. It is a matter of ordinary experience that the reten-
tion of a small bit of the membranes within the uterus will pro-
duce fetid lochia, and as the result of infection, a febrile condi-


tiou which as a rule, subsides with the expulsion of the offend-
ing body and the use of disinfectant washes (Lusk).

Prevention. — The physician should insist upon the value of
plenty of light and fresh air as a means of contributing to the
speedy recovery of child-bed women, otherwise they may become
poisoned with their own exhalations. Complete antisepsis be-
fore confinement will prevent the introduction of germs and after
confinement will paralyze their action. Employ means to pro-
mote uterine contraction. Refrain from attending a case of labor
when fresh from the presence of contagious diseases or septic
material. In every case of labor the hands and forearms should
be freely bathed in a carbolic solution before making a vaginal
examination. All instruments employed during confinement
should be disinfected. The warm carbolized douche after deliv-
ery stimulates uterine retraction and promotes the rapid healing
of wounds in the vaginal canal. The fountain syringe should be
used (Lusk).

Symptoms. — The first febrile symptoms usually occur within
three days of the birth of the child. The third clay is the one
upon which, ordinarily, the beginning of the fever is to be antici-
pated. After the fifth day an attack is rare. In most cases the
fever is ushered in by chilly sensations, or by a well-defined chill.
A frequent pulse is always a suspicious symptom in childbed,
even where the other symptoms are apparently normal. There
may be headache, sleeplessness, pain, vomiting, anorexia, and
coated tongue (Lusk).

Treatment. — It is to be recommended that in every case of
puerperal fever, the vagina be cleansed with a two to three per
cent, solution of carbolic acid, or corrosive sublimate (1:3,000)
every four to six hours. The douche in itself is absolutely harm-
less. No portion of the injected fiuid should be retained in the
vagina. All necrotic patches of the vagina or cervix should be
touched with hydrochloric acid, or with a ten per cent, solution
of carbolic acid, or with iodoform. Intra -uterine injections
should be resorted to with extreme circumspection. Rarely are
they indicated. Opium must be given for the pain. Purgatives
(castor-oil in two or three tablespoonful doses) should be ad-
ministered with caution. For the fever quinia may be adminis-


tered in five grain doses at intervals of four to six hours. Stimu-
lants in the form of whiskey, rum, or brandy may be given in
doses of one or two teaspoonfuls hourly. Ice-cold drinks should
be freely allowed (Lusk).


Is a general disease, characterized by circumscribed extra-
vasations of blood into the skin (Loomis). Purpura may be
simple, rheumatic, hemorrhagic, or symptomatic. In simple pur-
pura there are only minute extravasations into the skin (petechias);
in rheumatic purpura there is a combination of purpura and
rheumatic pains in the joints; in hemorrhagic purpura there is
great constitutional disturbance, petechias not only appear in
the skin, but ecchymoses, and there may be hemorrhage from all
the mucous tracts; in symptomatic purpura, the purpuric spots
accompany the exanthems and contagious fevers, and are purely
symptomatic (Bartholow, Loomis and Flint).

Morbid Anatomy. — There are changes in the walls of the
vessels, or in the blood, or in both (Loomis).

Causes. — Purpura occurs more frequently in women than in
men. It may appear in the healthy and robust. The leading
causes are bites of insects, passive congestion, various drugs, such
as iodide of potassium, phosphorus, cojDaiba, ergot, chloral, and
mercury; snake-bites, embolism and thrombosis of cutaneous
vessels, cachexias, as tuberculosis, cancer, Bright's disease, cirrhosis
of the liver, anaemia, leucocythasmia; diseases of the nervous
system, small -pox, typhus and typhoid fevers, measels, scarlet
fever, malaria, cholera, yellow fever, cerebro- spinal meningitis,
icterus, scorbutus, etc. Purpura may be accidentally present in
the course of any disease (Flint).

Symptoms, — In many cases for days before the eruption
appears, there is a feeling of malaise with digestive derangement.
Purpuric spots are bright-red, livid, or dark purplish -red in color,
they do not disappear on pressure, and are unattended by itching
or other signs of local irritation. As a rule the sj>ots are not
elevated. They vary in size from a pin's head to a large pea, or
a spot may measure an inch in circumference, and change in color


successively from bluish -red to greenish, brown, and yellow. It
is more common from fifteen to twenty than at any other age.
In ordinary cases a crop of purpuric spots lasts from a week to
ten days, and usually first apppear on the legs. Purpura is
common in fruit seasons (Bartholow, Da Costa and Flint).

Differential Diagnosis. — Purpura may be confounded with
scurvy and skvn diseases. From scurvy it is distinguished by the
absence of spongy gums and painful swellings. The fact that
there is no itching, no desquamation, no suppuration or discharge,
and no change in purpuric spots upon pressure suffices to dis-
tinguish them from the eruption of any form of skin disease

Prognosis. — Most cases terminate in recovery.

Treatment. — The diet should be nutritious and varied, and
digestion is to be aided by tonic remedies, together with wine or
spirits in small quantities. Dilute sulphuric acid may be given
in doses of from five to fifteen drops every two hours combined
with quinia. Ergot, gallic acid, and tincture of the chloride of
iron may be of service (Flint).


Is an infectious disease, characterized by the formation of
infarctions, metastatic abscesses and diffuse local infiammation.
Venous thrombosis and embolism are essential features of this
disease, and cause metastatic abscesses in the lungs, liver,
kidneys, spleen, muscles, heart and brain. Metastatic abscesses
vary in size from a pea to a large walnut (Loomis).

Causes. — Many regard the pyaeinic and septicaeinic poison as
identical, and pyaemia as nothing but a metatistic septicaemia.
Inflammation of bone is a very frequent cause of a phlebitis
which leads to pyaemic infection. Cellulitis, carbuncle, erysipe-
las, malignant pustule, and dissecting wounds are often compli-
cated by pyaemia. Endometritis or lacerations about the genital
tract are fruitful sources of pyaemia in the puerperal state

Symptoms. — Pyaemia is ushered in by a distinct chill or rigor
followed by a gradual rise of temperature to 101° or 10-1 ° F. The


chills of pyaemia occur irregularly, aucl are followed, after the
first two or three, by profuse and exhausting sweats. The pulse
is frequent, 120 to 140, small and often intermittent. The skin
may be jaundiced. The breath has a peculiarly sweet, sickish
• odor. The tongue becomes coated, glazed, dry, brown and fis-
sured. Sordes collect on the teeth. There are anorexia and
great thirst. There is usually diarrhoea with nausea aud vomit-
ing (Loomis).

Differential Diagnosis. — The diagnostic points of pyaemia are,
irregularly recurring chills and sweats, great variations in tem-
perature, with the signs of multiple abscess in the internal
organs. Pyaemia may be confounded with septicaemia, intermit-
tent fever, acute yellow atrophy of the liver, acute articular
rheumatism, typhus and typhoid fever.

JPywmia is ushered in by a distinct chill; septicaemia by
slight shivering, or mild rigors only. In pyaemia the chills recur;
in septicaemia there is but one chill. In pyaemia there are
profuse sweats which recur; in septicaemia, they are slight and
never recur. In pyaemia the temperature gradually rises to
102° to 104° F.; in septicaemia it is high at the onset, 105° to
107° F. In pyaemia the skin is jaundiced; not so in septicaemia.
There is a sweet, sickish odor to the breath in pyaemia, absent
in septicaemia. In pyaemia multiple abscesses develop, never in
septicaemia (Loomis).

Prognosis. — Is always unfavorable.

Treatment. — Cleanliness, good ventilation, sunlight and quiet
are important measures. Quinia, carbolic acid, salicylic acid
and oil of turpentine may be used internally. A good diet and
stimulants should be administered in large quantities (Loomis).


The regurgitation of a considerable quantity of a liquid
which is either insipid or saltish or brackish and is sometimes
acid when the stomach is empty of food and usually in the morn-
ing is called pyrosis or waterbrash. This liquid consists mainly
of saliva. Sometimes there is not only a feeling of oppression in
the thorax but a severe pain is referred to the heart accompanied


by palpitation and dyspnoea. In such cases the patient is very
apt to imagine he has heart disease. Pyrosis is not a disease but
a symptom of certain cases of gastric dyspepsia (Flint and


Exists where the prepuce gets behind the corona glandis
and cannot be replaced (Keyes).

Causes. — An unnaturally tight preputial orifice is a predis-
posing cause. Young boys who retract the prepuce for. the first
time often find themselves unable to replace it. Rings of metal
forced upon the penis retracting the prepuce may be a cause.
Inflammatory paraphimosis may depend upon balanitis, gon-
orrhoea, herpes, chancroid, chancre, etc. (Keyes).

Symptoms. — In rjaraphirnosis the glans penis is swollen and
livid. If the patient is seen at once, there may be no inflamma-
tion, either of the prepuce or the glans. If the stricture of the
prepuce is tight enough to arrest the circulation it will cause
gangrene (Keyes).

Treatment. — /. Of paraphimosis with strangulation. In
strangulation the glans penis is turgid, swollen, blue-black, cold
and devoid of sensibility. Ice should be first used locally to
produce shrinkage and a few small punctures may be made to
let out serum from the ridge in front of the stricture. In these
cases ether should always be given to relax the tissues and reduc-
tion attempted. If a prolonged, careful attempt at reduction
fails, the strictured point must be divided. After reduction the
treatment consists in position, rest and cleanliness, syringing the
preputial cavity with warm water.

II. Of paraphimosis without strangulation. — In recent
cases reduction must be effected or inflammation will surely set
in. Reduction may be accomplished by using the above means


Exists where the orifice of the prepuce is so small that the
glans penis can not be uncovered. Phimosis is congenital or
acquired, simple or inflammatory, complicated by other diseases,

phimosis. 460

or by adhesions. With very young children, phimosis is so
common that it may he considered normal. The foreskin of a
child is developed out of all proportion to the rest of the penis.
This long prepuce is often a source of anxiety to young mothers.
A positive indication for operation, in the case of a child, does
exist, where the preputial orifice is smaller than that of the
urethra. This condition is known to exist when the prepuce
"balloons" during micturition. When the prepuce is too tight
in the adult, an operation may be called for as a prophylactic
against future disease, such as chancre, chancroid, gonorrhoea, or
an attack of herpes (Keyes).

Causes. — Phimosis may be caused by frequent attacks of
preputial inflammation, leaving a thick, long, indurated, inelastic
prepuce, interfering not only with sexual intercourse, but some-
times with urination. Another common cause of acquired phi-
mosis is the cicatrization of multiple chancroid around the orifice
of the prepuce. Diabetes is said to be a cause of phimosis.
Marx reported a case of phimosis where a passionate and jealous
woman made her lover wear a gold padlock (sometimes two)
with which she secured the preputial orifice, keeping the key
herself. The victim of her charms carried his padlocks, which
were replaced from time to time through new punctures, during
four or five years, until such a degree of irritation had been set
up as to require removal of the prepuce. Inflammatory phimosis
is a transient condition, but may leave true phimosis behind

Treatment. — It is better not to circumcise when the prepuce
is inflamed, if it can be avoided. Keep the patient in bed, and
elevate the penis. Evaporating lotions may be used locally, con-
taining a little spirit or a (gr. x.-xx. ) solution of tannin, fre-
quently washing out the cavity of the prepuce by means of a
syringe with dilute lead-water or carbolic acid (gr. ij. to the gj-.).

Remote Results of Phimosis. — It leads to imperfect develop-
ment of the glans j^enis, is an obstacle to sexual intercourse,
causes spermatorrhoea, frequent desire to urinate and cystitis.
According to Dr. Sayre, of New York, phimosis may cause
curvature of the spine in children, and priapism (Keyes).



Is a triangular thickening of the conjunctiva, which ad-
vances from the caruncle to the cornea and encroaches more or
less upon the surface. The favorite site is the inner side of the
eyeball. The structure grows very slowly. It may impair sight
before it reaches the pupilary area. The apex is more or less
rounded and seems to dip into the substance of the cornea. The
edges near the apex will be found to be rolled under and will
admit a fine probe to be thrust beneath for a short distance. It
appears mostly in persons who are exposed much to the weather,
or to dust, and who are of advanced age. A variety of fleshy
ptergium may occur at any portion of the eye (Noyes).

Treatment. — Is surgical and preferably by excision. Seize
the corneal portion with toothed forceps and as it is lifted, push
beneath it a cataract knife and shave it from the cornea. Cut
away as much of the base as may be needful. The raw surface
may be covered by flaps of the adjacent conjunctiva sutured by
silk. Cocaine will annul the pain. An opacity of the cornea is
left, which will continue for months. It may ultimately dis-
appear (Noyes).


Is an inflammation of the mucous membrane of the pelvis of
the kidney. There is hyperemia of the mucous membrane, and
exudation of pus and mucous takes place. In many cases with
profuse production of pus there is an obstacle to the passage of
the urine, and the pus is retained in the dilated pel vis, causing the
condition known as pyonephrosis (Flint).

Causes. — Pyelitis is seldom, if ever, a primary disease. Its
most frequent cause is the presence of calculi in the pelvis of the
kidney. Obstruction to the flow of urine is a cause of pyelitis.
Such obstructions are furnished by calculi, tumors pressing on
the ureter, enlarged prostate, stricture of the urethra, phimosis,
and paralysis of the bladder in cases of paraplegia. In these
cases the urine is retained and decomposes, and thus produces
irritation. The pressure of a retroverted or pregnant uterus may
cause obstruction to the flow of urine. Pyelitis may be due to


gonorrhoea, specific vaginitis, and urethritis in females. In these
cases cystitis is nearly always present. Copaiba, turpentine, and
cantharides passing through the kidneys may cause pyelitis.
Pyelitis may be a complication in jDysernia, puerperal fever and
the exanthemata (Bartholow, Flint and Loomis).

Symptoms. — Pain in the back is present in the mild as well
as in the severe cases. This pain, as a rule, is severest over one
or both lumbar regions, is often of an aching character, and
shoots down along the course of the ureters. The voiding of
urine is almost incessant, and is attended by severe pain. Acute
pyelitis is usually ushered in with rigors. Symptoms of hectic
fever may also mark the occurrence of permanent obstruction of
the ureter and the development of that condition termed pyone
phrosis. There is lassitude and more or less pain on motion.
There are changes in the urine. In its early stage the urine
contains blood mixed with mucus and epithelium cells from the
pelvis of the kidney. The presence of these epithelial cells is
its most certain diagnostic indication. The specific gravity of the
urine ranges from 1025 to 1030, and usually has an acid reac-
tion. The urine may be ammoniacal. Calculous pyelitis is
attended with more pain and hemorrhage than the other forms.
In the advanced stage of pyelitis, the discharge of pus is con-
stant, but if the ureter becomes blocked, for a time the urine
may be quite normal, but the removal of the obstruction is fol-
lowed by a copious flow of purulent urine. If there be perma-
nent obstruction in the ureter, a tumor develops in the lumbar
region. The existence of the tumor is determined by the pres-
ence of bulging between the crest of the ilium and the false ribs
on the side involved. Palpation shows deep-seated fluctuation
over the tumor and tenderness on pressure. Percussion shows
dullness over the tumor. A hypodermic needle will complete
the diagnosis (Bartholow, Flint and Loomis).

Differential Diagnosis. — The diagnosis of pyelitis in the acute
stage rests mainly on the presence of the characteristic epithe-
lium of the pelvis mixed with blood and mucus. In a more
advanced stage, in addition to the above, there is pus. The
presence of pus and acid urine, with pain in the lumbar region,
accompanied by the development of a tumor at the seat of pain,


which tumor gradually increases in size and suddenly disappears
at the same time that a copious discharge of pus takes place from
the bladder, which discharge is attended by a sense of great
relief to the patient, renders the diagnosis of pyonephrosis very

.Pyonephrosis may be confounded with hydronephrosis,
hydatid cyst and perinephritic abscess. Hydronephrosis is dis-
tinguished from pyonephrosis by the non-purulent character of
the urine, and by the absence of constitutional symptoms. An
aspirating needle will generally decide the diagnosis. In
perinephritic abscess neither pus, blood, mucus, epithelia nor al-
bumen will be found in the urine; in pyonephrosis they are
common and constant. Pain on motion and fever are marked
symptoms in abscess and slight or absent in pyonephrosis. In
women a pyonephrotic tumor has been confounded with an
ovarian cyst. The exploring trocar will very quickly remove all
doubts. Pyelitis is distinguished from cystitis by the absence
of vesical pain and frequent micturition and by lumbar pain. In
pyelitis the urine is acid; in cystitis it is alkaline (Loomis).

Prognosis, — Depends much on its causes.

Treatment. — Eemove the cause if possible. In acute pyelitis
if there be fever, pain, and bloody urine, wet cups should be ap-
plied to the loins followed by a hot bath and a hypodermic of
morphine to relieve pain. Alkaline drinks should be given and
the patient kept in bed. If the urine is acid, liq. potassii citratis
should be given. In ammoniacal urine benzoic acid is extremely
serviceable. In chronic pyelitis, eucalyptol, oils of turpentine,
copaiba and cubeb limit the formation of pus. Cod-liver oil and
quinine should be given with a nutritious and non- stimulating
diet. Alkaline mineral water and milk should be freely given.
If a tumor exist aspiration may be performed (Bartholow and


Are terms applied to perversions of appetite. Malacia de-
notes a morbid craving for certain articles of food, whereas pica
denotes a desire for innutritions substances. The era vino- for
strange kinds of food during pregnancy and in hysterical women


is familiar to all. The innutritious substances frequently craved
are charcoal, chalk, slate, and certain kinds of earth. In some
cases of pica the articles are at first taken with the idea of im-
proving the complexion and in this way the habit is formed; but
in other cases a morbid uneasiness in the stomach leads to their
use. This appetite is chiefly confined to young females and is
generally associated with anseinia or chlorosis.

Treatment. — Treat the associated disorders and prohibit the
use of the above substances (Flint).


Called also bulimia denotes a craving for food beyond the
wants of the system. These terms are not correctly applied to
the increased appetite during convalescence from fevers or other
acute diseases. In true bulimia the amount of food craved far
exceeds the requirements for nutrition. BuMmiam&y be another
name for gluttony. The love of eating may be cultivated to such
an extent that little else is thought of, and persons who fall into
this habit may be said to live to eat, rather than to eat to live.
Habits of gluttony may lead to dyspepsia, obesity, fatty degen-
eration of the heart and to various affections. Bulimia may be
a symptom of mental disease, or of diabetes. Cases have been
reported in which the morbid appetite appeared to be insatiable,
all kinds of food — raw meat, candles etc., — being eaten in some
cases with avidity and in enormous quantity (Flint).

Treatment. — Recovery from this condition is to be expected.
The indications are to regulate the diet, to establish the general
health, to correct any disorder of digestion, and to palliate the
excessive craving for food by opium, or sometimes by nauseant
remedies. Swallowing pieces of ice has been found effective as
a palliative measure (Flint).


Sometimes called Parkinson's disease, or shaking pals)', or
the trembles, is a disease of advanced life characterized by motor
weakness and tremors of the voluntary muscles, especially of the
limbs, occurring independently of muscular exertion (Loomis).


Morbid Anatomy. — Paralysis agitans is a neurosis, a func-
tional disorder. As yet no constant changes have been dis-
covered. Some authorities consider it of spinal, others of cere-
bral origin (Bartholow and Loomis).

Causes. — It rarely occurs before forty, and is more common
in men than women. It is not known to be hereditary. The
jjrincipal causes are strong emotion, fright, grief, anxiety, dis-
tress of mind, great bodily fatigue, and exj)osure to cold and
dampness (Bartholow and Loomis).

Symptoms. — Tremor is the chief symptom of paralysis agi-
tans. The trembling consists of fine small movements. Paraly-
sis agitans comes on slowly, and progresses slowly. It usually
begins in one foot, hand or possibly a single finger, and gradu-
ally becomes general. The tremors are often confined to one
side of the body for a long time — hemiplegic type; less fre-
quently to both lower extremities — paraplegic type. Any effort
of the will, as grasping, writing, or walking, will stop the irreg-
ular motions. Sometimes the disease sets in abruptly in conse-
quence of some sudden shock. Mental emotion and exercise in-
crease the trembling, and sleep and chloroform narcosis suspend
it. The trembling consists in muscular contractions and relaxa-
tions. The hands are apt to assume a position as in writing.
As a rule, the head and neck are not affected. The countenance
assumes a fixed, staring look of distress, the head is drawn for-
ward and the trunk fiexed. The voice is often tremulous and
speech is slow, hesitating and laborious. The muscles are easily
tired. The patient rises slowly and is deliberate in starting, but
when under way, he goes in a dog- trot with the head and body
bent forward (festination). Complaints are made of cramps, of
muscular stiffness, of a sense of excessive heat, and of restless-
ness. The knee-jerk is normal (Bartholow, DaCosta, Flint and

Prognosis. — Although the disease may last for twenty or
thirty years, death most commonly results from some intercur-
rent disease. The outlook is never favorable (Loomis).

Differential Diagnosis. — Paralysis agitans may be confounded
with disseminated sclerosis, senile trembling, alcoholic, lead and
meruwrial trembling '. In disseminated sclerosis tremors occur


onlv when the muscles are in use; the disease beo-insin the lower
limbs, affects younger persons, and paralysis occurs early. The
patient has no tendency to run forward and does not have the
peculiar countenance. In paralysis agitans the tremor is not
dependent on volition; it begins in the upper limbs, and per-

Online LibraryWillis Webster GrubeA compendium of practical medicine for the use of students and practitioners of medicine → online text (page 38 of 57)