A text-book of the practice of medicine.

  • Anders, James M. (James Meschter), 1854-1936
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the practice of medicine. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Of gastro-intestinal symptoms vomiting is the most common. It usu- ally lasts only tor a brief period at the onset, though it may recur later at longer or shorter intervals, and is of nervous origin. The appetite mav be good, but in many cases it is soon lost, the tongue, in a large ])ro- portion of the .instances, being only slightly coated. In cases assuming the adynamic or typhoid type the tongue is apt to become dry and of a brown' color, with the formation of sorties. Under these circumstances the abdomen is tympanitic and the bowels relaxed, and diarrhea may be urgent, resisting all eflbrts aimed at its relief. Retraction of the belly is common, and constipation instead of diarrhea is the general rule; the spleen may often be felt a little distance below the costal margin. Renal symptoms are not prominent, though the amount of urine passed is often above the normal despite the febrile movement. It may be below, though rarely, while in still other cases it is about normal; and retention on the one hand and incontinence on the other have been observed. AJbumiauria is sometimes met with, and rarely glycosuria. Arthritis is not uncommon, particularly in the severer cases. Kernig's Sign.—In 1884 Kernig first pointed out the impossibility of obtaining complete extension of the leg on the thigh when the patient is sittimi and the thiirli is flexed at a right angle to the trunk. The sign is produced by irritation of the meninges of the lower portion of the spinal cord and of the nerve-roots that constitute the cauda equina, Roglet thinks that one cause for this sign is intraventricular pressure.^ Under this irritation, increased by the stretching eifect of the sitting posture, the tonicity of the flexor muscles of the leg is increased, and as a consecjuence complete extension of the leg becomes impossible. The contracture disaj)pears when the patient assumes the dorsal decubitus. If the patient cannot be propped up in bed, the thigh may be flexed upon the abdomen, when, if meningitis be present, complete extension of the leg will be prevented by contraction of the flexor muscles. Head's^ statistics, embracing 156 cases, show that Kernig's sign is present in 84 per cent, of the cases of meningitis. It is not confined to cerebro- spinal meningitis, but is present in all meningeal aff'ections. The time of its appearance is variable; hence, in order to be certain that the sign is not present, it should be looked for repeatedly. Again, the time of its disappearance varies; it may disappear during the preagonal period. The value of the sign is real, but its absence does not justify the exclusion of meningitis, while it may be present in other diseases (typhoid, tctanuw). Herrick ^ points out that from its persistence into convalescence it may be utilized to make a retrospective diagnosis. Macewens sign (vide Tuberculous meningitis, p. 253). a hollow note on percussing over the inferior frontal or parietal bone, is an indication of fluid in the ventricle, but is not always present. Brudzinski's Sign.—On attempting to bend the neck flexure move- ments in the ankle, knee, and hip-joints occur (identical reflex). Another, though less constant, sign is produced by passive flexion of one leg, which causes the fellow limb to draw up, and so remain (contralateral reflex). Complications.—Many of these have already been mentioned in the portrayal (d' the symptoms—e. g., destructive inflammations of the eye 1 P. Roglet, Gaz. heb. de Med. el de Chir., July 15, 1900. 'St. Paul Med. Jmir., Sept., 1900. ^ Amer. Jour. Med. Sci., July, 1899.
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