An index of differential diagnosis of main symptoms / by various writers ; edited by Herbert French.

Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: An index of differential diagnosis of main symptoms / by various writers ; edited by Herbert French. Source: Wellcome Collection.

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    existent hematuria; there may or may not have been a sudden pain in the back at the same time. Around each infarct there develops acute nephritis, so that in some cases all the characters of the latter malady may be superposed upon those of the fungating endocarditis. If the patient is already known to have heart disease, the diagnosis is easy enough; the difficulties arise in cases in which, notwithstanding the fungating endocarditis, there is no bruit. If fungating endocarditis is suspected, the points that confirm the diagnosis are: pyrexia, which may be of any type—though absence of pyrexia does not exclude the disease; enlargement of the spleen; cutaneous, retinal, or other hemor- rhages ; progressive anemia; definite cardiac bruits, especially if the latter at any time undergo any radical change in their character, such as becoming musical instead of blowing, or vice versa ; optic neuritis ; and multiple embolism, for instance, in the brain, spleen, or a peripheral artery. There is no marked leucocytosis as a rule. Venous blood may be cultivated bacteriologically as a means of confirming the diagnosis. Thrombotic infarcts are less severe in their effects; they may produce. no hematuria at all, and the albuminuria may be slight, and unaccompanied by tube-casts. They generally arise in cachectic conditions, or in blood diseases such as leukemia or pernicious anemia, in which cases the diagnosis wiil be arrived at on other grounds, and albuminuria will not be the prominent feature of the case. Lardaceous Disease of the Kidneys used to be common enough in the days of septic surgery, but it is decidedly uncommon now. It is a risky diagnosis to make, therefore, unless there is some obvious cause for it, such as long-standing suppuration in association with a spinal, hip-joint, or empyema sinus, bronchi- ectasis, phthisis with cavitation, or the like; or else clear evidence of tertiary syphilis of the viscera with cachexia. There is nothing characteristic about the urine, although statements are made to the contrary. In the earlier stages there may be but a trace of albumin in an otherwise normal urine; later, the albumin increases, and it may reach very large amounts, such as 20 parts per 1000, casts being very few in proportion, the total amount of urine increased, its colour pale, and its specific gravity low—1o05 to ror2; later still, possibly as the result of a superposed nephritis, the amount of urine falls until only a few ounces may be passed each day, of high colour and specific gravity 1020 to 1035, loaded with albumin, and now containing hyaline, waxy, granular, fatty, and epithelial casts. Lardaceous casts may or may not occur, but they are not diagnostic, for they have also been found in cases of nephritis without lardaceous disease, hyaline degeneration of the renal tissue being not uncommon in cases of chronic nephritis. Indeed, the diagnosis of lardaceous kidney resolves itself into one of guesswork in a case in which there has been prolonged suppura- tion or severe syphilis to give rise to it, and in which there may be smooth firm enlargement of the liver, moderate enlargement of the spleen, and more or less severe diarrhoea, to indicate corresponding lardaceous change in the other organs that are generally affected at the same time as the kidneys. Chronic Ascending Nephritis arises from precisely the same causes as acute ascending nephritis or surgical kidney, and probably results from recurrent focal inflammations which heal, each leaving behind a smaller or larger scar; with the result that, in the course of months or years, the kidneys are converted into a mass of irregular fibrotic scars, which together produce the same local and general changes and effects as are to be found in cases of ordinary red granular contracted kidney. This is not always kept clearly in mind. At first sight it might seem that there could be little connection between prolapsus uteri and cerebral hemor- rhage ; but the latter may be due to the former, by the following sequence of