Willis Webster Grube.

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

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dolence, or irritable.

Causes. — Axe predisposing and exciting. Predisposing causes
are: 1. Age. 2. Malnutrition. 3. Poor blood supply.

The exciting causes are: 1. Injury — mechanical, chemical,
and thermic. Mechanical injury, as a splint, pressure, blows T
etc. Chemical injury, as the extravasation of urine. Thermic
injury, as frost-bite, burns, lightning, etc. 2. Disturbances in
the circulation, as varicose veins, atheroma of the vessels, weak-
ened heart action. 3. Disturbances in the nutrition. These may
be local or general. Under local disturbances are oedema, con-
gestion, hemorrhage and inflammation. Under general disturb-
ances are syphilis, scurvy, gout, rheumatism and tuberculosis.
4. Disturbance of innervation, associated with diseases of the
spinal cord, as bed-sores, etc. We find ulcer in the stump due to

Causes of ulcers on the leg are due to traumatism, syphilis,
or varicose veins. Traumatic and varicose ulcers are situated in
the lower third, and syphilitic ulcers are situated in the upper
third of the leg, as a rule ( Bryant and Dennis).


Description of an Ulcer. — The base may be shallow or deep;
the margin may be everted, undermined, or indurated; the dis-
charge may be muco-purulent or bloody.

Treatment. — 1. Relieve the congestion. The best way is to
take a sharp knife and cut the indurated edge. 2. Encourage
healthy granulations by an antiseptic poultice. 3. Elevate the
limb and so encourage the circulation. We cannot cure an ulcer
without rest. Stimulate granulations by balsam of Peru, aro-
matic wine, cinchona bark, iodoform, bismuth, or oxide of zinc.
Inquire into the constitution of the patient. If he has syphilis,
gout or tuberculosis, you must treat these diseases. If the pa-
tient suffers from varicose ulcers support the blood-vessels per-
manently by elastic stockings, if it returns ligate the veins twenty
to forty times.

Skin-grafts may be used. Take the skin from the thigh and
plant it over the ulcer (Bryant and Dennis).


By uraemia is understood the accumulation in the blood of
exerenientitious substances of the urine.

Causes. — The primary cause is a failure of the kidneys to
perform their normal function of elimination, and the consequent
accumulation in the circulation of some or all of the poisonous
elements of the urine. This condition may occur in the course
of any disease in which suppression of the renal secretion takes
place ; but it is more frequent in acute Bright's disease

Symptoms. — Acute uraemia is usually preceded by certain
signs, such as oedema in various parts of the body, restlessness,
or an almost irresistible desire to sleep, vertigo, headache, deli-
rium, nausea, vomiting, diarrhoea and impaired vision. The
countenance has a pale, waxy or dingy appearance, and the urine
is scanty, high-colored, bloody, albuminous, and contains casts.
The convulsions may consist of a single paroxysm, and may simu-
late epilepsy. There is a strong urinous odor emanating from the
perspiration. The temperature may be as high as 107° F.

Urcemic coma may come on gradually or suddenly. The
patient may be easily aroused. Urcemic coma is always accom-


paiiied by stertor. The stertor is peculiar; it is not the " snor-
ing " of apoplexy, but a sharp, hissing sound. The respirations
are at first accelerated but they soon become slow and labored.
After a time the temperature falls below the normal standard;
the face is pale (Loomis).

Differential Diagnosis. — Uraemia may be mistaken for epi-
lepsy, cerebral apoplexy, hysterical convulsions. In epilepsy
the temperature is not elevated. The initial cry and corpse -like
pallor of the face in epilepsy are wanting in uraemia. In cere-
bral apoplexy coma always precedes convulsions. In hysterical
convulsions the patient falls with a scream into a convulsive con-
dition and afterwards passes a large quantity of pale urine

Prognosis. — Will depend upon the amount of the poison in
the system.

Treatment. — Diaphoresis, by the hot-air baths and by the
use of pilocarpin is of service. Digitalis acts efficiently — is
diuretic without stimulating the kidneys. It increases the power
of the heart's action. The diminished secretion of urine is due
to obstruction in the capillary circulation of the kidneys. Digi-
talis, by increasing the heart power, overcomes such obstruction.
Chloroform is not a good remedy in uraemia. Loomis believes
morphine administered hypodermically to be the most efficient
remedy for the treatment of uraemia. It arrests muscular spasm.
It establishes profuse diaphoresis. It facilitates the action of
cathartics and diuretics. Dry and wet cupping over the loins
aid in establishing the renal function (Loomis).


Called also hives and nettle-rash, is an ephemeral eruption
of the skin, with wheals and itching, from malassimilation, etc.

Causes. — The cause may be neurotic. The vaso- motor nerves
are principally at fault. This vaso-motor nerve disturbance may
result from direct irritation of the skin, or may be reflex, arising
from the irritation of distant organs and tissues. The sting of
the common nettle is the most familiar instance of local irrita-
tion. It is often called forth, in those who are predisposed, by


scratching the skin, or by the bite or sting of insects, such as the
flea, the bug, the mosquito and the wasp. The washing of the
face with warm water often brings out hives. The internal
causes which may produce nettle-rash by reflex action are: irrita-
tion of the uterine nerves; in some persons mental emotion; in-
digestion, certain kinds of food, such as oysters, crabs and lob-
sters, nuts, onions, pork, sausages, and medicines, such as valerian,
copaiba, cubebs, turpentine and quinine (Anderson).

Symptoms. — The rash is familiar to all. The centre of each
wheal is pale, while the periphery is red. The rash comes out
with great rapidity, and may disappear in a few hours

Treatment. — Discover and remove the cause or causes. A
sharp purge is of use. Atropia and bromide of potassium are
sometimes useful. Locally the parts may be sponged with vine-
gar and water, or with a lotion of carbolic acid (Anderson).


Called also vulvismus, is a spasmodic contraction of the
muscles of the pelvic floor — not of the sphincter vaginas muscle
alone. It is seen alike in single and in married women, and is
caused by violence in sexual intercourse, as when, in a newly
married couple, there is some difficulty of entering the vagina,
and repeated attempts set up an irritation resulting in reflex
contraction whenever the penis strikes the anterior margin of
the peringeuru. It is sometimes seen after child-birth caused by
injury to the pelvic floor. It may be caused by local disease of
the parts, or it may be due to some disease of the spinal cord.
The spasm of the muscles is usually accompanied by pain, often
severe, and rendering the accomplishment of the sexual act not
only difficult, but impossible (Morris).

Varieties. — Vaginismus inferior r where the muscles of the
pelvic outlet alone are involved, and vaginismus superior, where
the levator ani muscle participates in the contraction; the last is
a rare affection, and particularly that form where the latter
muscle only is at fault. This variety sometimes comes on at the
end of the sexual act, and the penis may be grasped by its con-
traction and retained in the vagina for some time.

vulvitis. 589

Treatment. — Discover and remove the cause. If an irritable
hymen is the cause of the trouble, the patient should be ether-
ized and the hymen dissected out. If no inflammation is present
gradual dilatation of the vagina does good.


Is an inflammation of the vulva. It may be either ca-
tarrhal, follicular, diabetic or aphthous.

Cause. — /. Of Catarrhal Vulvitis. — Want of cleanliness;
gonorrhoea, exposure to cold; extension of inflammation from
other parts; masturbation.

Symptoms. — Those of an ordinary catarrhal inflammation,
viz: swelling, redness, heat, pain and dryness of the parts, fol-
lowed by increased discharge.

Treatment. — The parts must be kept perfectly clean and
warm hip-baths should be freely employed. Dusting with bis-
muth subnitrate and borated cotton between the labia are of
service. If the disease be of specific origin (see vaginitis).

II Follicular vulvitis is that form in which the sebaceous
follicles are involved.

Treatment. — The best treatment consists in warm sedative
applications, warm baths, and alkaline washes.

III Diabetic Vulvitis. — Is dependent upon the presence
of a fungus developed from the sugar in the urine, and spreading
from the orifice of the urethra to the vulva. The parts become
dry and hard and of an intensely red color. The affection is
attended with intense and very troublesome itching.

Treatment. — The general condition of the system must be
treated as well as the local (Morris).

IV. Aphthous Vulvitis. — Is a disease of childhood follow-
ing the exanthemata, or any debilitated condition of the system.

Treatment. — Constitutional remedies are as important as
local means. Cod-liver oil, quinine, and iron should be given
and the most scrupulous local cleanliness insured (Morris).



Are an enlarged and tortuous state of the veins, which are
usually thickened, rigid, and formed into irregular pouches.

Situation. — They are most frequently seated on the lower
extremities, scrotum and rectum. Varicose veins of the leg are
accompanied by pain, weight, and fatigue on taking exercise;
they cause ulcers and excoriations of the skin; they sometimes
burst, causing profuse hemorrhage, and occasionally blood clots
in the veins, which may terminate in an abscess.

Treatment. — The palliative treatment consists in applying
strips of leather over the part or a common roller or an elastic
stocking, which should be applied in the morning before the
patient rises. For the radical cure many methods have been

devised (Morris).


Is a varicose state of the veins of the spermatic cord. It is
more common on the left side.

Treatment. — Keep the bowels open; wash the scrotum fre-
quently with cold water; support the scrotum with a suspensory
bandage. For the radical cure, it is recommended to pass a
ligature subcutaneously. Operations on the veins are always
attended with some risk. Many surgeons cut down on the veins
andligate them with cat-gut (Morris).


Has been well denned as the consciousness of disordered
equilibration. It is not properly a substantive disease, but may
be the only symptom of the morbid state to which it is referable.
It is a subjective state, in which the individual affected, or the
objects about him, seem to be in raj3id motion, of a rotary, circu-
lar, or to-and-fro kind. In common language vertigo is known
as dizziness. It may be momentary or of long duration (Bar-
tholow and Loomis).

Causes. — Vertigo is a purely functional affection. It has
been divided into ocular, aural, stomachic, nervous, epileptic,
cardiac, cerebral and gout//.


I. Paralysis of a single muscle may cause ocular vertigo.

II Aural vertigo is named after its discoverer — Meniere's
disease, and may be caused by disease of the semicircular canals,
or other ear troubles.

III. Gastric vertigo is the most common, and is an almost
invariable attendant on dyspepsia and hepatic disorder.

IV. Nervous vertigo is induced by physical or nervous
excesses, and Ramskill ranks vertigo from overwork as next to
gastric in frequency. It is also caused by excessive use of tea,
coffee, tobacco and alcohol.

V. Epileptic vertigo precedes an epileptic seizure.

VI Cardiac vertigo is a condition of ana3mia of the brain
and is closely allied to fainting. The subjects of cardiac vertigo
have a swimming sensation in the head, darkness falls on the
eyes and they become chilly and weak. It is associated with
fatty heart and dilatation of the right cavities.

VII Cerebral vertigo occurs as a symptom in cerebral
anaemia and cerebral congestion; in meningitis, in tumor of the
brain; in abscess of the brain; in cerebral hemorrhage; in scler-
osis of the brain; in chorea, hypochondriasis and chronic alco-

VIII Gouty vertigo is due to the blood changes which
characterize the gouty diathesis. The vertigo of the aged is a
result of disordered cerebral circulation produced by the senile
condition of the heart and vessels. Chronic malarial infection
may induce vertigo (Bartholow and Loomis).

Symptoms. — The sensation may be that of objects moving
around the patient, or of the patient moving around objects
which remain stationary. There is no loss of consciousness.
Nausea, vomiting, and ringing in the ears are frequent. The
first symptom in ocular vertigo will be the running together of
the letters on the page, headache, nausea, and pains in the eyes.
In Meniere's disease, tinnitus aurium accompanies the vertigo.
After the attack of vertigo passes off deafness remains. Gastric
vertigo is accompanied by dyspeptic symptoms, nausea, pyrosis,
heartburn, flatulence, diarrhoea, or constipation. The mental
state is often deplorable, and true melancholia may ensue.


Nervous vertigo is apt to occur after excessive mental effort

Treatment. — Gastric vertigo demands the treatment given
under the head of dyspepsia. In ocular vertigo, rest for the eyes
and proper glasses will remove it. In aural vertigo, full doses
of bromide of potassium are of service. In nervous vertigo, iron,
quinine, strychnine, and the removal of the cause are sufficient.
The vertigo of old age is benefitted by the bichloride of mercury
and tincture of iron, with small doses of Burgundy wine (Loomis.)


Is not a disease but a symptom in a large number of dis-
eases. As a symptom it often demands treatment.

Treatment. — Tablespoonful doses of iced champacjne every
fifteen minutes will sometimes arrest the vomiting of pregnancy,
of sea- sickness, of cholera, yellow fever, etc. A little chloroform
(2Ttij.-ZUv.) dropped on sugar and swallowed, will remove some
kinds of nausea and vomiting.

The bromides are serviceable in cerebral vomiting, and in
cholera infantum in children, and in some cases of reflex vom-

Chloral is highly useful in vomiting of sea- sickness, cholera,
and reflex vomiting.

A minim of wine of ipecac, given every half hour or hour
in a little water, will sometimes relieve the vomiting of preg-
nancy, vomiting of drunkards, of migraine, etc.

Drop doses of Foivler^s solution, given before meals, will
stop vomiting of irritative dyspepsia, of pregnancy, of chronic
gastric catarrh, etc.

Hydrocyanic acid can be prescribed in the vomiting of acute
stomach troubles.

Pepsin, milk and lime-water, and bismuth are proper in the
vomiting of indigestion, of stomach inflammation, of acidity and
of acute intestinal disorders.

Calomel in very minute doses, every half hour or hour, will
stop some kinds of vomiting.


Cerium oxalate, mix vomica and carbolic will in certain
cases control vomiting. Coniiter-irritation at epigastrium often
allays vomiting (Ringer and Bartholow).


Known in common language as chicken-pox or swine-pox, is
a febrile affection, characterized by the appearance of a vesicular
eruption with the first elevation of temperature, the vesicles
drying up and falling off in from three to five days. It has been
called spurious variola. Varicella is the shortest and mildest of
the eruptive fevers (Bartholow and Smith).

Causes. — It is due to a specific poison. It is highly contag-
ious, so that few children escape who are exposed to it. It is a
disease of childhood. It occurs sporadically and epidemically.
It attacks the same individual but once. Inoculation has given
negative results. The period of incubation varies from eight to
seventeen days (Bartholow, Loomis and Smith).

Symptoms. — Twenty -four hours preceding the eruption
there is usually lassitude and a feeling of malaise. The eruption
generally appears first on the body then on the head. About the
second day vesicles may appear upon the tongue, lips and palate.
The vesicles appear in crops. They vary in size from a pin's
head to that of a pea, or even larger, and contain a clear watery
and sometimes yellowish fluid. The number of vesicles vary
from ten to a thousand. The duration of the disease is eight or
ten days (Bortholow, Loomis and Smith).

Differential Diagnosis. — Varicella may be mistaken for vario-
loid. The stage of invasion of varioloid is longer than the stage
of varicella. The mildness of the symptoms in varicella is diag-
nostic. The vesicular character of the eruption from the start is
characteristic of varicella. In varioloid the vesicles are preceded
by papules. In varioloid the eruption appears first on the face,
in varicella it appears first on the body. The umbilicated ap-
pearance of the vesicles is wanting in varicella (Flint).

Treatment. — Varicella claims no treatment. Rest in bed,
cleanliness, and a non- stimulating diet are important.



Is an eruptive disease characterized by the presence of pus-
tules which make their appearance at the end of the third
exacerbation of the initial fever, when the temperature declines,
but this apyrexia is followed by a secondary fever, or fever of
maturation. It is known in common language as small-pox

Morbid Anatomy. — The characteristic lesion of small -pox is
the eruption. The successive stages of the eruption are the
macule, the papule, the vesicle and the pustule. The pustule
undergoes desiccation. The macule is a reddish, slightly -elevated
spot due to congestion of a circumscribed portion of the skin.
A characteristic appearance of the small-pox vesicle is produced
by a central depression in its roof, the so-called umbilication of
the vesicle (Flint).

Causes. — Small -pox is spread by a peculiar virus whose
nature is unknown. In the open air the distance of contagion is
about two and one-half feet. Rarely does an individual have a
second attack. The period of incubation varies from five to
thirty days, average fourteen days. The negro and Indian races
are particularly susceptible to the disease (Bartholow, Flint and

Symptoms. — Stage of Invasion. — The disease is ushered in
by a chill in the great majority of cases, and the chill is usually
more marked than in the other eruptive fevers. Fever follows
the chill. It is known as the primary fever. It is often intense,
104° or 105° F. There are nausea, vomiting, coated tongue, pain
in the stomach, also in the limbs andloins, headache and delirium.
The duration of this stage, as a rule, is two days. The eruption
begins to appear on the third or fourth day.

Stage of Eruption. — The eruption, as a rule, appears first
on the face, about the lips and chin, then on the neck and wrists;
next on the chest and arms; then over the body. At first the
eruption appears in the form of small red spots or specks. It is
now a maculated eruption. The central part of the maculae be-
comes hard, elevated and pointed. It is now a papular erup-
tion. The papulae feel like small shot under the skin. Next a


clear liquid becomes visible in the papulae, which now become
vesifiulce. On the fifth day of the stage of the eruption the vesi-
cles are one-quarter to one-third of an iuch in diameter. More
or less of the vesicles present a depression in the centre. They
are said to be umbilicated. This appearance is highly characteris-
tic, indeed, almost pathognomonic. After this the vesicles be-
come pustules. In other words suppuration takes place. On
the appearance of the eruption the primary fever falls almost to
the normal. This is a highly diagnostic feature of small-pox.

Stage of Suppuration. — Usually on the sixth day after the
first appearance of the eruption, there is a recurrence of the fever
called suppurative or secondary fever. The face, hands and feet
swell. The duration of this stage is four or five days.

Stage of Desiccation.— -This stage begins on about the
twelfth day of the disease. The pus collects into a thick scab.
During this stage the skin exhales a sickening characteristic
odor. The whole duration of small -pox is between seventeen
and twenty-four days (Flint and Loomis).

Prognosis. — Varies — from ten to twenty-five per cent. die.

Treatment. — There is no special plan of treatment. The dis-
ease will run its course and hence the expectant plan is to be
pursued (Flint).


Is modified small -pox. Small -pox is modified as a rule
when produced by inoculation. Inoculation had been practiced
from time immemorial in China and Persia. The eruption in
cases of inoculated small -pox is usually slight. The pocks rarely
exceed one hundred. Many of them abort.

As a rule, variolation or inoculation affords complete pro-
tection ever thereafter against small-pox. It was a great bless-
ing prior to the discovery of vaccination. At the present day in
most cases of varioloid the modification is due to vaccination.

Vaccination does not always afford complete protection
against small -pox, but in general the disease is materially modi-

The treatment of varioloid is the same as ordinary small-pox



Vaccinia and cowpox are names of a disease of the cow
which, communicated to man, destroys in the great majority of
cases for a certain period the susceptibility to small-pox. Cow-
pox is transferred to man by the introduction of a virus. The
operation for its communication is called vaccination. For the
employment of vaccination as a means of preventing small-pox
the world is indebted to the immortal Jenner, who published his
discovery in 1798. The history of vaccinia in man is as follows:
On the third day after vaccination red points or small papules
are apparent where the vaccine virus was inserted. On the
fourth day the papules are more developed. On the fifth day
vesicles appear, and on the eighth day they are fully developed.
On the ninth or tenth day the contents of the vesicles become
purulent, or pustules are formed. The pustules desiccate and
fall off about the twenty-fifth day from the date of vaccination.
Cowpox is not identical with small-pox, although allied to it.
In a large majority of cases vaccination affords, for a time at
least, absolute protection against small -pox. In a minority of
cases the susceptibility to small -pox is not destroyed, but the
disease is materially modified, constituting what is called vario-
loid. Revaccinating every five years is to be advocated. The
bovine virus should be used. The dangers following some cases
of vaccination are abscesses, erysipelas, and blood-poisoning


Include those alterations in the structure of the valves them-
selves or of the orfices which render the former incapable of per-
forming their office in the closure of the latter. The lesions may
be of two kinds — obstructive or regurgitant; that is, the orifice
may be so narrowed as to obstruct the passage of the blood, or
the valves may be so damaged as to permit the blood to regurgi-
tate. The narrowing of an orifice is termed stenosis; the incom-
petence of a value to close the orifice is termed insufficiency.
There are four points at which these lesions may occur, viz:
mitral, aortic, tricuspid, and pulmonic orifices (Bartholow).


Cardiac Murmurs. — A cardiac murmur is an abnormal sound
produced within the heart or blood- vessels, either by obstruction
to the blood-current, an abnormal direction of the blood-current,
or a change in the blood constituents. Should any obstruction
exist at either of the auricula- ventricular orifices, the blood while
passing through the opening at the end of a cardiac diastole,
will impinge on such obstruction and cause a presystolic murmur.

During a cardiac systole, if the semilunar valves obstruct
the outgoing current, or if the mitral or tricuspid valves do not
wholly close the auriculo ventricular orifices, then, in the one
case, the blood-current as it passes over the obstruction at the
semi-lunar orifices, will produce a systolic murmur, and in the

Online LibraryWillis Webster GrubeA compendium of practical medicine for the use of students and practitioners of medicine → online text (page 49 of 57)