COLUMBIA LIBRARIES OFFSIIE 
 
 HEALTH SCIENCES STANDARD 
 
 RC73 .W83 
 
 HX641 28407 
 
 The clinical history 
 
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CLLNICAL HISTORY L\ OUTLINE 
 
THE 
 
 CLINICAL HISTORY 
 
 IN OUTLINE 
 
 By I 
 
 PAUL G. WOOLLEY, S. B., M. D. | 
 
 Professor of Pathology, College of Medicine, University M 
 
 of Cincinnati; Director of Laboratories, = 
 
 Cincinnati General Hospital, J 
 
 Cincinnati, Ohio = 
 
 ST. LOUIS 
 
 C. V. MOSBY CO. 
 
 1914 
 
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Copyright, 1914, by C. V. Mosby Company 
 
 h 
 
 - 30TS ^ 
 
 I'rcss of 
 
 The C. V . Mosby Company 
 
 St. Louis 
 
PREFACE. 
 
 The object in taking a clinical history has always 
 been to discover the condition from which a person 
 is suffering, and to discover, if may be, the causes of 
 the condition in order that treatment, medical or sur- 
 gical, may be instituted and the diseased condition 
 cured. It is, however, becoming realized more and more 
 generally that a thorough clinical history may have a 
 distinct value in forming the basis of educational meas- 
 ures Avhich will teach a patient how to avoid recurrences 
 of a disease from which he is suffering, and how to avoid 
 sequela? of the disease. 
 
 In some instances the diseased condition is an obvious 
 one which demands but few questions to decipher it. 
 In other instances no detail is so small that it is unim- 
 portant, and yet in the former instances many questions 
 and a very complete history may be necessary to dis- 
 cover the cause or causes. In the latter case the same 
 thing is obvious. Therefore it happens that judgment 
 is necessary in taking a history, as well as in treating a 
 patient. Judgment and tact are both necessary, the 
 proportions varying with the character of the patient. 
 
 Such a volume as this makes no attempt to take auto- 
 matically a clinical history. It is intended merely as 
 a sort of reminder of points to be considered, and also 
 it is intended to offer a systematic scheme by following 
 which a student may be enabled to arrange the facts 
 concerning a patient in an orderly way. It is not in- 
 tended to replace such excellent volumes as McKisack's 
 "Systematic Case Taking." It is modelled upon Striim- 
 pell's "Leitfaden f. d. klin. Krankenuntersuchungen. " 
 
 The Cincinnati Hospital. P. G. W. 
 
CONTENTS 
 
 CHAPTER I. 
 
 Page 
 
 Foreword 9 
 
 Data Required in History Taking 10 
 
 CHAPTER II. 
 
 The Complaint of the Patient in His Own V/ords 11 
 
 The Family History 12 
 
 Personal History 13 
 
 History of Present Illness 15 
 
 The Physical Examination 16 
 
 The General Appearance of the Patient 16 
 
 Anatomic Data 17 
 
 Outline of Organs, Especially of Liver and Stomach.. 22 
 
 Special Examinations 23 
 
 Acute Infectious Diseases 24 
 
 Diseases of the Respiratory System 25 
 
 Diseases of the Cardiovascular System 26 
 
 Gastro-Intestinal Diseases 27 
 
 Central Nervous System 28 
 
 Past History of Other Nervous Disturbances 28 
 
 Urinary Diseases 30 
 
 CHAPTER III. 
 
 Data Referring to Certain Frequent Symptoms 32 
 
 Data Referring to Pain 41 
 
 CHAPTER IV. 
 
 Post-Mortem Examinations and Records 48 
 
 Form of Post-Mortem Record 50 
 
 (7) 
 
CLINICAL IIISTOIIY IN OITLIXK 
 
 CHAPTER I. 
 
 Foreword 
 
 In taking the clinical history of a patient there are 
 several items which demand close attention. The most 
 important of these is never ask leading questions. Many 
 a person can be made to tell a story which is sometimes 
 untrue, often misleading, by asking (luestions which 
 seem to indicate the answer desired by the physician. 
 Another is, ahvaijs insist upon definite ansiocrs, when- 
 ever it is possible. Another is, never ask embarrassing 
 questions in the presence of a third party. Learn to 
 use tact. If a patient is very ill, wait for his own his- 
 tory, and rely largely upon relatives, or friends, or, 
 as often must happen, upon the physical examination. 
 If you receive ({uestionable answers, repeat your query 
 in new and different forms, and at different times. But 
 above all treat every patient as you would treat any 
 other human being. Don't l)e rough or sharp except 
 when occasion demands. Such occasions are few. At 
 the same time, don't trust a patient's statement over- 
 much. It is especially true in public hospitals that the 
 patients are dull and ignorant. The physical examina- 
 tion is the most important part of any history. When in 
 doubt, trust that. 
 
 Don't forget that your ((uestions may be misunder- 
 stood; that the patient may be very ignorant; that he 
 may be intentionally misleading you (malingering) ; 
 that he is afraid or embarrassed. Take everything with 
 a grain of salt except what you discover with the add 
 of your special senses. 
 
 (9) 
 
10 CLINICAL HISTORY IN OUTLINE. 
 
 Data Required in History Taking 
 
 In taking the history of a patient it is customary to 
 place the following data at the head of the first sheet : 
 
 Name. 
 
 Age. 
 
 Date. 
 
 Address. City. Street. No. 
 
 Social Condition: Single — Married — Widower or 
 
 Widow — Divorced. 
 Race. 
 
 Occupation. 
 Place of Birth. 
 Name of nearest relative or friend. 
 
 Remarks. 
 
 Certain of these data are for the purpose of identify- 
 ing patients, and for placing the physician or hospital 
 authorities in a position to communicate with relatives 
 or friends. In some instances a certain amount of sug- 
 gestive information is furnished in the answers. 
 
 The age has a certain, more or less definite, relation 
 to the incidence of certain diseases, for instance, types 
 of tumors. 
 
 The address may be of value in epidemiologic studies 
 of series of cases, for instance, of typhoid, cerebro-spinal 
 fever, etc. 
 
 The ejeeupation may have a relation to occupational 
 intoxications (lead, phosphorus, benzol) or to occupa- 
 tional neuroses (eyestrain, writer's cramp, etc.). 
 
 The place of birfh may suggest such pathologic pos- 
 sibilities as hydatid disease, kala-azar, leprosy, malaria, 
 etc. 
 
CHAPTER ir. 
 
 A. Anamnesis includes the information derived from 
 
 the patient or his relatives or friends. 
 
 I. The Comph'iint. 
 II. Family History. 
 
 III. Personal History (or Past History). 
 
 IV. Present Hlness. 
 
 B. Status pra'sens (present condition) includes the 
 
 information derived from an examination of 
 the patient. 
 
 I. Physical examination. 
 
 II. Special examination. 
 
 The Complaint of the Patient in His 
 Own Words 
 
 Remarks. 
 
 This is always the first item of the history and should 
 invariably be in the words of the patient and should 
 be elicited by a question w^hich is not leading ; i. e., the 
 physician asks, "Why have you come to the hospital?" 
 and the patient says, "For a pain in the stomach." 
 This item is therefore placed at the head of the history, 
 "The patient complains of 'a pain in the stomach,' " 
 not ' ' The patient says he has an abdominal pain. ' ' 
 
 With certain patients it may be useful to allow them 
 to tell their whole story at this time, although this story 
 belongs under Present Illness (q. v.). 
 
 (11) 
 
12 
 
 CLINICAL HISTORY IN OUTLINE. 
 
 Fatlu'i- 
 Mother 
 Brothers 
 Sisters 
 
 The Family History 
 
 (Hereditary Rehitionships.) 
 
 Living or dead ; if alive — state of health. 
 If dead, cause of death. 
 
 Remarks. 
 
 Ill the case of each individual note the occurrence of 
 any abnormality, or deformity that has show^i any 
 hereditary tendency (supernumerary fingers, or toes; 
 hemophilia; color blindness; albinism; alcaptonurnia : 
 pentosuria; diabetes; gout). 
 
 Make especial note of infectious diseases, or other con- 
 ditions which have shown a tendency to affect other 
 members of the family ( ' ' tuberculosis " ; ' ' lung f evei' ' ' ; 
 "spinal disease"; ''consumption"; "rheumatism"; 
 "kidney disease"; "stomach troubles"; "cancers"; 
 "nervous disease"; "brain troubles"; "insanity"). 
 
 The family history is of especial value in nervous and 
 mental conditions; in states due to precocious arterio- 
 sclerosis; and in tu])erculosis. It has a certain general 
 scientific value in the study of congenital and, especially, 
 hereditary disorders. It is I'dntivdy unimportant in 
 most infectious diseases. 
 
THE PERSONAL lILsTORY. 13 
 
 Personal History 
 
 The Previous History (including former diseases suf- 
 fered by the patient and in certain eases the 
 name and address of the physician who was in 
 attendance, or the hospital in which he was eared 
 for, and the dates). 
 
 Diseases of ehiklhood. These should be specified. 
 
 Measles. 
 Mumps. 
 
 Whooping cough. 
 Diphtheria. 
 Scarlet fever. 
 Chicken-pox. 
 
 Olher infectious discoses. (More than one attack?) 
 
 Pneumonia. (More than once?) 
 Pleurisy. ( Character. ) 
 Tonsillitis. (More than once"?) 
 Typhoid. (In bed how long?) 
 Malaria. (Chills— how often?) 
 Smallpox. (Pock-marks?) (Vaccination.) 
 Rheunuitism. (Distribution.) 
 Syphilis. (When?) 
 Gonorrhtea. (More than once?) 
 Dysentery. (Type.) 
 
 Sequela? of the foregoing. 
 
 Hys f e m diseas es . — 
 
 Digestive disorders — Sour stomach, belching, 
 vomiting (character), diarrha^a constipa- 
 tion, pain. 
 
14 CLINICAL HISTORY IN OUTLINE. 
 
 Respiratory disorders — Cough, expectoration, 
 coryza, pain in chest, shortness of breath. 
 
 Cardiovascular disorders — Palpitation, short- 
 ness of breath. 
 
 Renal (urinary) disorders — Frequency of uri- 
 nation (day and night), swelling of feet, diffi- 
 culty of urination, pain, headache. 
 
 Nervous disorders — Headache, dizziness, con- 
 vulsions, paralysis, epilepsy, dreams (char- 
 acter). 
 
 Traumata (accidental). 
 
 Menstrual History. — 
 
 Appearance (age), regular, irregular, charac- 
 ter, duration, pain. 
 
 Marital History. — 
 
 Number years married. 
 Health of husband or wife. 
 Leucorrhoea — date of appearance. 
 Miscarriages (age of fetuses). 
 Number of children. 
 Labors — ( normal — instrumental ) . 
 Puerperium — fever, chills, time in bed. 
 (Domestic relationships. Happy, unhappy. 
 Reasons.) 
 
 Residences. — 
 
 Location. 
 
 Sanitary surroundings (open closets, baths, 
 
 etc.) 
 Water supply. 
 
TiiK i'i:rs()nal history. 15 
 
 Tlohil^. (c-r. also occupations.) 
 
 Hours ot* work. 
 
 Hours of leisure ( I'ecreatioiis). 
 
 Food — No. niejils, appetite, likes niul dislikes, 
 
 cotl^ee, tea. 
 Di'ug's — C'ocain, iiiorpliiii. heroin, elilorororin, 
 
 etc. 
 Alcohol — No. glasses beer oi' spirits per day. 
 How niiieli water eousuiued. 
 Plow much sleep. 
 
 0('('\(pali(tn. — 
 
 Sui'rouiidiugs — \vn\ ilat ion, illumination, toi- 
 let facilities, drinking cups, coniuion towels. 
 Continuous woi-k ; rest ]HM'iods ; I'est rooms. 
 Safety devices. 
 Sickness anu)ng associates. 
 Habits of associates — spitting on tioor, etc. 
 
 History of the Present Illness 
 
 Date of onset. 
 
 Manner of onset — first symptom. 
 When was w^ork discontinued ? 
 When did patient take to bed? 
 
 Can walk now? How far? 
 Ts present illness similar to other previous ones? 
 
 Character, duration of each ; dates. 
 The general opinion of ihv palioif regarding ids ill- 
 ness and its cause. 
 
16 CLINICAL HISTORY IN OUTLINE. 
 
 The Physical Examination 
 The General Appearance of the Patient. — 
 
 Position or attitude (in bed or standing). 
 
 Lies on side, on back, on face. Legs and arms 
 drawn up or extended. Stands erect, bent ; 
 jactitation. 
 
 Gait.— 
 
 Si3astic, ataxic, reeling, pseudo-ataxic, step- 
 page, waddling, lameness. 
 
 ( U) n ditio n of nutntio n . — 
 
 Well-nourislied, wasted, emaciated, weight, 
 obese, anasarcous. 
 
 Skin. — 
 
 Dry, moist, hot, cold, pale, flushed, cyanotic, 
 greenish-yellow, yellowish, p i g m e n t e d, 
 bronzed, jaundiced, rough, smooth, satiny, 
 desquamation, erythema, petechia?, haemor- 
 rhages, tumors, parasites, birth-marks, na?vi, 
 papules, macules, vesicles, wheals, pustules, 
 scars. 
 
 Snhrutancous sivelUnf/s. — 
 
 Periosteal nodules, painful jioinls. 
 
 Expression. — 
 
 Anxious, vacant, stupid, staring, placid, ex- 
 cited, pinched, mask-lik(\ satui-nine. pnffy. 
 acromegalic, hippocratic, paralytic. 
 
TFIE PHYSICAL EXAMINATION'. 17 
 
 Menial Condi Hon. — 
 
 Intelligent, apathetic, dull, stupid, emotional, 
 
 delirous. . 
 Hallucinations, hypochondriac, comatose. 
 Memory. 
 
 Odor surrounding the patient. 
 
 Speech. — 
 
 Articulation, aphasia. 
 
 Anatomic Data. — 
 
 Lymph nodes. — 
 
 (Cervical, suboccipital, supraclavicular, axil- 
 lary, epitrochlear, inguinal mesenteric.) 
 
 Small, large, firm, soft, fluctuating, tender, 
 painful, not adherent, adherent, discrete, 
 conglomerate. 
 
 Head.— 
 
 Large, small, symmetrical, asymmetrical, hy- 
 drocephalic, rachitic. 
 
 Fontanelles — Open, closed. Areas of tender- 
 ness. Cranio-tabes. 
 
 Hair — Scanty, abundant, thin, thick, fine, 
 coarse, color. 
 
 Face — Symmetric, asymmetric. 
 
 Eyes. — 
 
 Pupils, dilated, contracted, ei|ual, unequal, 
 shape, reflexes (Argyll-Robertson). 
 
18 CLINICAL HISTORY IN OUTLINE. 
 
 Arcus senilis. 
 
 Strabismus, nystagmus, exophthalmus. 
 Amaurosis, hemianopsia, retinitis. 
 Conjunctiva — Pale, congested, inflamed. 
 Eyelids — Edema, ptosis, chalazion. 
 
 (Special ophthalmic examination when necessary,) 
 
 Ears. — 
 
 Tophi, stigmata (Darwinian tubercle). 
 
 Deafness, discharge, wax, foreign bodies. 
 
 Tympanum. 
 
 Mastoid tenderness. Position of concha. 
 
 (Special otologic examination when necessary.) 
 
 Nose. — 
 
 Deformities — ' ' Saddle-back, " " Bardolphian. ' ' 
 Ozaena, epistaxis, discharge. 
 
 (Special rhinologic examination when necessary.) 
 
 Mouth. — 
 
 Salivation, stomatitis. 
 
 Lips — Color, deformities (hare-lip), fissures 
 
 (rhagades), herpes, ulcerations. 
 Breath — Sweet, clean, foetid, alcoholic, acetone 
 
 ( diabetic ) , urinous. 
 
 Tongue. — 
 
 Color, dry, moist, clean, coated, smooth, rough, 
 fissured, ulcerated, ''geographical," leuco- 
 plakia, mucous patches, strawberry. 
 
 Protrusion, symmetrical, deviation, tremor. 
 
THE PHYSICAL EXAMINATION. 19 
 
 Gums.- 
 
 Color, inflamed, spongy, hsemorrhagic, pig- 
 mented (lead), pyorrhoea alveolaris. 
 
 Teeth.— 
 
 Number, condition, decay, fillings, deformities 
 (Plutchinson's). 
 
 (Special dental examination when necessary.) 
 
 Pharynx. — 
 
 Adenoids, tonsils, inflammation, membrane, ab- 
 scesses. 
 Reflexes, paralyses. 
 Uvula, long, short, inflamed, congested, edema. 
 
 Larnyx. — 
 
 Voice, husky, aphonia. 
 
 (Special examination when necessary.) 
 Neck. — 
 
 Shape — Long, thin, short, thick. Supraclavi- 
 cular fossae. 
 
 Muscles — Prominence in dyspnoea. 
 
 Blood vessels — Venous pulsation. Diastolic 
 (venous stasis). Systolic (tricuspid insuffi- 
 ciency). 
 
 Salivary glands — Tumors, pain. 
 
 Thyroid — Tumors, assoc. with exopthalmus. 
 
 Thymus — Enlargement. 
 
 Larynx — Tracheal tug. 
 
 Spinal column — Curvatures. 
 
 Cysts — Branchial. 
 
20 CLINICAL HISTORY IN OUTLINE. 
 
 Thorax — (Heart and Lungs). 
 
 Inspection. — 
 
 Shape — Pigeon breast, rickety chest (rickety 
 rosary), funnel chest, barrel chest (emphy- 
 sema), scoliotic, kyphotic, paralytic, later- 
 ally compressed, symmetric, asymmetric, 
 bulging. 
 
 Expansion — Rhythmic, arrhythmic, symmetri- 
 cal, asymmetrical, slow, rapid, free, labored, 
 costal, costo-abdominal, Cheyne-Stokes ', 
 Biot's. 
 
 Apex beat, normal position, displaced. Broad- 
 bent's sign. 
 
 Palpation. — Fremitus, thrills, pulsations, friction 
 rubs. 
 
 Pulse — Small, large, hard, soft, (|iiiek, slow, 
 anacrotic, dicrotic, collapsing, regular, irreg- 
 ular. 
 
 Auscultation. — 
 
 Breath sounds, vesicular, puerile, broncho- 
 vesicular, tubular, amphoric, cog-wheel, 
 stridor. 
 
 Voice sounds — vocal resonance (increased or 
 decreased) , bronchophony, pfH'torophmiy, 
 aegophony. 
 
 Adventitious sounds — Rhonchi, i' Ics (crepi- 
 tant, su])crepitant, mucous, metallic). Fric- 
 tion sounds, bell sounds, metallic tinkling, 
 succussion. 
 
THE PHYSICAL EXAMINATION, 21 
 
 Heart sounds — Normal, accentuated, weak, 
 rhythm, tachycardia, bradycardia, redupli- 
 cation, gallop, murmurs, localization. 
 
 Percussion. — 
 
 Resonance — Tympanitic, dull, increased, Sko- 
 diac, decreased, amphoric, metallic, Win- 
 trich's sign, cracked-pot. 
 
 Cardiac dullness, lateral measurements from 
 mid-sternal line. 
 
 Exploratory puncture. — Pleura. Pericardium. 
 
 Abdomen. — (Stomach, intestines, liver, spleen, kid- 
 neys.) 
 
 Inspection. — 
 
 Enlarged veins, caput medusse. 
 Linai alhicantes, eruptions, rose-spots. 
 Shape, retraction, '^scaphoid," meteorism. 
 Movements — respiratory — pulsations, muscu- 
 lar, gastric, intestinal. 
 ' Enlarged, organs — position of organs. 
 
 Palpation. — 
 
 Tumor masses, tenderness, ascites, rigidity. 
 Spleen, kidneys, liver edge, surface of liver, 
 
 gall bladder. 
 Vaginal exploration. 
 Rectal exploration. 
 
 Auscultation. — 
 
 Friction rubs, aneurismal bruits, fetal heart, 
 borborygmi, splashing sounds. 
 
22 CLINICAL HISTORY IN OUTLINE. 
 
 Percussion. — 
 
 Areas of dulness. 
 (Auscultatory percussion.) 
 
 Exploratory puncture. — 
 
 Ascites; splenic enlargements. 
 
 Outline of Organs, Especially of Liver and Stomach. 
 
 Genitalia. — 
 
 Abnormalities. 
 
 Scars. 
 
 Tumors. 
 
 Evidence of discharge (signs of irritation). 
 
 Bacteriological examination. 
 Digital examination of prostate, tubes, ovaries, 
 uterus. 
 
 Central Nervous System. — 
 
 Disturbances of motion — weakness, paralyses, etc. 
 Disturbances of sensation — anaesthesia, pariethesia. 
 ''Trophic" disturbances. 
 Disturbances of special senses — seeing, hearing, 
 
 taste, smell. 
 Reflexes — skin, tendon, inuscle, 
 When necessary, examination of cerebrospinal fluid : 
 
 Wassermann. 
 
 Globulin. 
 
 Cell count. 
 
 Bacteriologic. 
 
THE PHYSICAL EXAMINATION. 23 
 
 Blood. 
 
 Hemoglobin per cent. 
 
 Leucocytes per cu.inm. 
 
 Red cells per cu.mm. 
 
 When necessary, serum reactions: 
 
 Wassermann. 
 
 Widal. 
 
 Urine. — 
 
 Amount — 24 hours. 
 
 Albumin. 
 
 Casts. 
 
 Reaction (Litmus, methyl red). 
 
 Sugar. 
 
 When necessary, complete urine examination. 
 
 Feces. — 
 
 Appearance, formed or unformed; consistency. 
 Microscopic. 
 
 Undigested food. 
 
 Parasites. 
 When necessary, complete examination. 
 Blood. 
 
 Special Examinations 
 
 There are but few, if any, cases in which a general 
 history is not of value. Often it suggests certain sys- 
 tem diseases or diseases of a specific nature. Under such 
 conditions additional data should be collected and added 
 to the general history. 
 
24 clinical history in outline. 
 
 Acute Infectious Diseases. 
 
 Especial Reference to Previous Diseases of an In- 
 fectious Character. — 
 
 Tyj^hoid, measles, scarlet fever, usually occur 
 but oiice in the same individual. 
 
 Pneumonia, acute articular rheumatism, erysip- 
 elas are not infreiiuently recurrent. 
 
 Social Surro undings. — ■ 
 
 Hygienic conditions — (Brill's disease, typhus, 
 
 tuberculosis, smallpox) . 
 Occupation. 
 
 Early Symptoms. — 
 
 Chills, headache, pain, vomiting, diarrhoea, 
 eruption. 
 
 Appearance at Time of Ejcamination. — 
 
 Temperature, pulse, respiration. 
 
 Condition of nutrition. 
 
 Mental condition. 
 
 Color of cheeks and lips. 
 
 Type of re.spiration. 
 
 Herpes labialis. 
 
 Physical Examination. — 
 
 Evidence of foci of infection. 
 
 Middle ear disease. 
 
 Tonsils, carious teeth, pyori'ho'a alveolaris, 
 adenoids. 
 
 Glandular involvement. 
 
 Genital infection. 
 Joint or muscle pain. 
 
SPECIAL EXAMINATIONS. 25 
 
 Blood Examination. — 
 
 Leucocytes. 
 Differential count. 
 Cultures. 
 Serum reactions — 
 
 Wassermann. 
 
 Widal. 
 Complement deviations. 
 
 Urine Examination. — 
 
 Albumin, casts. 
 
 Reaetion (preferably with Methyl red). 
 
 Bacteriologic. 
 
 Feces. — 
 
 Bacteriologic. 
 
 Animal I hoc iil at in us. 
 
 Sputum. — 
 
 Bacteriologic. 
 
 m 
 
 Diseases of the Respiratory System. 
 
 Occupation. 
 
 Social Snrroundincjs. 
 
 Onset. — Gradual or rapid. 
 
 Symptoms — cough, chill, i)ain, etc. 
 
26 CLINICAL HISTORY IN OUTLINE. 
 
 Special detmJed examination of thorax, and upper 
 respiratory tract. 
 
 Sputum. — 
 
 Time of expectoration ; night, morning. 
 
 Effect of position. 
 
 Appearance — color, consistency. 
 
 Odor. 
 
 Microscopic — 
 
 Parasites. 
 
 Bacteria. 
 Bacteriologic examination complete. 
 
 Special laryngologic examination , including the 
 character of voice. 
 
 Diseases of the Cardiovascular System. 
 
 History of Past Infectious Diseases. — 
 
 Rheumatism, scarlet fever, diphtheria, influ- 
 enza, tonsillitis, syphilis, gonorrhoea. 
 
 Habits. — 
 
 Alcohol, tobacco, over-eating, athletics. 
 
 Psychic conditions. — 
 Worry. 
 
 Special Detailed Examination of Peripheral Vascu- 
 lar System. — 
 
 Pulse. 
 
SPECLVL EXAMINATIONS. 27 
 
 Character of vessels — (temporal and radial 
 
 vessels). 
 Polygraphic studies. 
 
 Special Detailed Examination of Heart and 
 Lungs. — 
 
 Evidence of general cardiac involvement. 
 
 Evidence of special valvular or myocardial con- 
 ditions. 
 
 Galvanometric studies. 
 
 Evidence of pulmonary congestion, liver, spleen, 
 
 Sputum — Character. 
 
 Urine — Chronic congestion. Secondary ne- 
 phritis. 
 
 Blood — Bacteriologic. 
 
 Blood Cultures. 
 
 Gastro-Intestinal Disease>s. 
 
 Past History of Dietary Hahits, including alcohol- 
 ism and tobacco. 
 
 Sedentary life ; nervous conditions ; amount of 
 sleep. 
 
 Occupation. — 
 
 (Lead, arsenic, mercury, antimony.) 
 
 State of Nutrition and General Appearance. 
 
 Special Gastric and Intestinal Examinatio7is. — 
 Symptoms in detail. 
 
28 CLINICAL HISTORY IN OUTLINE. 
 
 Chemical examination of gastric juice — 
 Acids, ferments, etc. 
 
 Microscopic and bacteriologic examination 
 of gastric washings. 
 
 Motility- 
 Radiographic examination. 
 
 Special chemical tests — 
 
 Blood lipase (liver conditions). 
 Phenosulphoi)hthalein. 
 
 Special Examination of feces. — 
 
 Character and quantity. 
 
 Microscopic. 
 
 Blood. 
 
 Bacteriologic. 
 
 Parasites — 
 
 Amoebae. 
 
 Ova. 
 
 Central Nervous System. 
 
 Fauiilfj History. — 
 
 Valual)le in cases of epilepsy, general nervous- 
 ness, hysteria, and vHi-ious psychic disorders.. 
 
 Past History. — 
 
 Infectious diseases, especially syphilis. 
 Rheumatism. 
 
 Past History op Other Nervous Disturbances. 
 
 Convulsions in childhood. 
 Migraine. 
 
SPECIAL EXAMINATIONS. 
 
 Traumata. 
 
 Psychic disturhances — 
 
 Shock. 
 Worry. 
 Grief, etc. 
 
 Intoxications. — 
 
 Lead. 
 
 Arsenic. 
 
 Alcohol. 
 
 Habits and Surroundings. — 
 
 Nervous — irritable. 
 
 Headaches. 
 
 Epileptic attack (order — sequeiice) 
 
 Cerehral System. — 
 
 Headache. 
 
 Dizziness. 
 
 Loss of memory. 
 
 Sight. (Reflexes.) 
 
 Hearing-— Taste. 
 
 Speech — Sense of smell. 
 
 Vomiting. 
 
 Paralyses. 
 
 Sensation. 
 
 Aphasias. 
 
 Spinal. — 
 
 Pain. 
 
 Girdle sensations. 
 
 21) 
 
30 CLINICAL HISTORY IN OUTLINE. 
 
 Retention of urine, incontinence. 
 Constipation, involuntary excretion. 
 Sexual side — increase or decrease of desire or 
 ability. 
 
 Motor. — 
 
 Weakness. 
 Paralysis. 
 Cramps. 
 Convulsions. 
 
 Sensory. — 
 
 Paraesthesia. 
 Anesthesia. 
 
 Urinary Diseases. 
 
 Past History. — 
 
 Infectious Diseases — Syphilis, diphtheria, scarlet 
 fever. 
 
 Habits. — 
 Alcohol, diet. 
 
 Occupational Jufoxications — Lead, etc. 
 
 Exposure to extremes of temperature. 
 
 Swelling of Feet, Ankles. 
 
 Frequency of urination. 
 
 Amount of urine ; color ; sediment. 
 
SPECIAL EXAMINATIONS. 31 
 
 Headache, dizziness, loss of appetite. 
 
 Asthma, dyspnoea. 
 
 Vision. 
 
 Physical Examination. — 
 
 Paleness; pnffiness of eyelids. 
 Arteriosclerosis. 
 Albuminuric retinitis. 
 Cardiac hypertrophy. 
 Character of pulse. 
 Ascites, General edema. 
 
 Special Urinanj Examination. (Total amount in 24 
 hours. ) 
 
 Microscopic. 
 
 Complete chemical examination. 
 
 Phthalein tests. 
 
 Special Examination of Bladder^ Ureters and 
 Kidneys. — 
 
 Digital exploration. 
 
 Cystoscopy. Ureteral catheterization. 
 
 Radiographic examination. 
 
CHAPTER III. 
 
 The following data refer to certain frequent symp- 
 toms. In each case the symptom precedes the names of 
 conditions with which the symptom may be associated. 
 These lists are merely suggestive and do not pretend to 
 be complete. For fuller discussions of symptoms one 
 may consult Cabot's "Differential Diagnosis'' and other 
 similar volumes. 
 
 Ascites. — 
 
 Portal obstruction. 
 
 Cardiac disease. 
 
 Tuberculous peritonitis. 
 
 Carcinomatous peritonitis. 
 
 Chronic peritonitis. 
 
 Ovarian tumors. 
 
 Chronic pulmonary disease. 
 
 Hydra?mia. 
 
 Chronic Bright 's disease. 
 
 Distomiasis. 
 
 Hradjjcardia. (Pulse below 60 per minute.) 
 
 Convalescence from fevers (Diphtheria, influenza). 
 
 Circulatory diseases (Chronic myocarditis, Stokes- 
 Adam's disease, aortic stenosis). 
 
 Urinary diseases (Chronic ncplii-itis). 
 
 Nervous diseases (Intracranial i)ressure, menin- 
 gitis). 
 
 Cretinism. 
 
 Intoxications (Alcohol, tobacco, digitalis). 
 
 (32) 
 
FREQUENT SYMPTOMS. 33 
 
 Tachycardia. (Pulse above 120 per minute.) 
 
 Fevers. 
 Tuberculosis. 
 Anaemia. 
 Neurasthenia. 
 Graves' disease. 
 Hysteria. 
 
 Shock and collapse. 
 Abdominal distension. 
 Peritonitis. 
 
 Certain cardiac diseases (Endocarditis, pericardi- 
 tis). 
 
 Chills.— 
 
 Sepsis. 
 
 Infectious disease. 
 Gall-stone disease. 
 
 Color of Skin. — 
 
 Yellow — jaundice. 
 
 Lemon yellow — anaemia, esp. chlorosis. 
 
 Bronzing — Chronic tuberculosis. 
 
 Addison's disease. 
 
 Extozoic infections (pediculosis). 
 
 Pregnancy. 
 
 Hodgkin's diseases. 
 
 Hepatic cirrhosis. 
 
 Diabetes (bronzed). 
 Blue-gray — Argyria. 
 
 Coma. — 
 
 Alcoholism. 
 Apoplexy. 
 
34 CLINICAL HISTORY IN OUTLINE. 
 
 Uraemia. 
 Diabetes. 
 Meningitis. 
 General paralysis. 
 Brain tumors. 
 Poliomyelitis. 
 
 Contimied Fever. — 
 
 Typhoid. 
 
 Sepsis. 
 
 Tuberculosis. 
 
 Meningitis. 
 
 Influenza. 
 
 Infectious arthritis. 
 
 Renal suppurations. 
 
 Hepatic suppurations. 
 
 Leukaemia. 
 
 S3'philis. 
 
 Cardiac infections. 
 
 Diseases of Infancy. — 
 
 Diarrhoea. 
 
 Rickets. 
 
 Scurvy. 
 
 Convulsions ( eelampsic ) . 
 
 Disorders of dentition. 
 
 Thymic enlargements. 
 
 Diseases of Pifherfij. — 
 
 Chlorosis. 
 Tuberculosis. 
 Nervous diseases. 
 
FREQUENT SYMPTOMS. 35 
 
 Diseases of Childhood. — 
 
 The erythematous fevers. 
 
 Diseases of Old Age. — 
 
 Arteriosclerosis. 
 Carcinoma. 
 Chronic arthritis. 
 Emphysema (pulmonary). 
 
 Hereditary Diseases. — 
 
 Certain Nervous Diseases. 
 
 Diabetes. 
 
 Gout. 
 
 Hemophilia. 
 
 Albinism. 
 
 Pentosuria. 
 
 Neoplasia. 
 
 Progressive muscular dystrophy. 
 
 Cerebellar ataxia. 
 
 Friedrich's ataxia. 
 
 Vocational or Occupational Diseases. — 
 
 Occupational neuroses — 
 
 Writer's cramp. 
 
 Telegrapher's cramp. 
 
 Singer's cramp. 
 Caisson disease. 
 Housemaid's knee. 
 Konioses — (Pneumokoniosis) — Dust diseases. 
 
 Anthracosis (miners). 
 
 Siderosis (iron-workers, grinders). 
 
 Aluminosis (potters). 
 
36 CLINICAL HISTORY IN OUTLINE. 
 
 Silicosis (stonecutters). 
 
 Tobaccosis (tobacco workers). 
 
 Other forms occur in Avood workers, sawyers, 
 furriers, hair pickers, etc. 
 Industrial poisonings — 
 
 Lead (painters, type-founders, compositors, 
 paint makers). 
 
 ]>enzol (painters, varnish workers, rubber 
 workers). 
 
 Arsenic (dyers, etchers, taxidermists, textile 
 printers) . 
 
 Anilin (dye makers). 
 
 Chromium (workers in chemical works). 
 
 Wood alcohol (varnishers, polishers). 
 
 Brass (polishers). 
 
 Mercury (felt hat makers, mirror platers, mak- 
 ers of mercury vapor lamps, photographers). 
 
 Phosphorus (match makers). 
 
 (For further data see ''Industrial Poisons," by E. F. 
 McCampbell, Ohio State Board of Health, Columbus, 
 Ohio.) 
 
 Infections — 
 
 Anthrax (workers wilh hides and skins). 
 
 Blood Pressvrr. — 
 
 ''Roughly speaking, the cases with blood pressure 
 permanently above 200 m.m. of mercury are mainly 
 those of increased intracranial pressure, chronic 
 nephritis, and aoi'tic insufficiency; those between 
 ir)0 and 200 iii.m., beside these conditions are arte- 
 riosclerosis, Basedow's disease, elironie ])olycythemia 
 and high pressure stasis." (Ilirschl'elder.) 
 
^ 
 
FREQUENT SYMPTOMS. '^^ 
 
 Hypotension. 
 
 Acute infectious diseases. 
 
 Shock and collapse. 
 
 After hemorrhage. 
 
 After severe diarrhoea or dysentery. 
 
 After profuse vomiting. 
 
 In pleurisy. 
 
 In pericarditis. 
 
 All acute cardiac disease. 
 
 Chronic mitral stenosis. 
 
 Cachectic conditions. 
 
 Cyanosis, enlargement of the liver and ascending edema 
 characteristic of failure of the right heart. 
 
 Dyspnoea. — 
 
 Dyspna-a and other respiratory disturbances in 
 heart failure are due chiefly to stasis in the pul- 
 monary capillaries and veins; i. e., due to pul- 
 monary edema. 
 
 An early sign of mitral lesions. In aortic lesions 
 a sign of broken compensation ; i. e., of secondary 
 mitral insufficiency. 
 
 Cough, dyspnoea, cardiac asthma, pulmonary edema, 
 pulmonary haemorrhage, together constitute a 
 group of symptoms characteristic of stasis in pul- 
 monary veins (Hirschf elder). 
 
 Cardiac diseases. 
 
 Tuberculosis (pulmonary). 
 
 Chronic bronchitis. 
 
 Pneumonia. 
 
 Chronic nephritis. 
 
38 CLINICAL HISTORY IN OUTLINE. 
 
 Asthma. 
 Emphysema. 
 Infectious diseases. 
 Exertion and excitement. 
 
 Hcemoptysis. — 
 
 Puhnonary tuberculosis. 
 
 Aneurism. 
 
 Heart disease. 
 
 Pneumonia. 
 
 Carcinoma. 
 
 Bronchiectasis. 
 
 HwmorrhageSy Cutaneous. — 
 
 Hemophilia. 
 
 Purpura ha*niorrhagica. 
 
 Malignant endocarditis. 
 
 Henoch's purpura. 
 
 Scurvy. 
 
 Nephritis. 
 
 Diabetes. 
 
 Foot-and-mouth disease. 
 
 Syphilis (neonatorum). 
 
 Schonlein 's disease. 
 
 Hcematemesis. — 
 
 Peptic ulcer (gastric, duodenal). 
 
 Cirrhosis (esophageal hemorrhoids). 
 
 Splenic enlargements. 
 
 Anaemic. 
 
 Purpura. 
 
 Typhoid. 
 
 Aneurism. 
 
FREQUENT SYMPTOMS. 39 
 
 Hamaturia. — 
 
 Renal — 
 
 Acute nephritis. 
 
 Chronic nephritis. 
 
 Toxic (turpentine). 
 
 Infarction. 
 
 New growths. 
 
 Tuberculosis. 
 
 Nephrolithiasis. 
 
 Filariasis. 
 
 Bilharziosis. 
 
 Pelvic varices (renal epistaxis). 
 
 Leukaemia. 
 
 Ureteral — 
 Calculi. 
 
 Urethral — 
 
 Acute urethritis. 
 Calculi. 
 
 Vesical — 
 Calculi. 
 Acute C3^stitis. 
 Trauma. 
 Tumors. 
 
 Herpes. — 
 
 Malaria. 
 
 Cerebrospinal fever. 
 
 Pneumonia. 
 
 Also in acute miliary tuberculosis and typhoid. 
 
 Hypoiliermia. — 
 
 Malaria. 
 
 Convalescence from acute fevers. 
 
40 CLINICAL HISTORY IN OUTLINE, 
 
 Collapse. 
 
 Toxic conditions (opium, alcohol). 
 
 Cholera. 
 
 Myxoedema. 
 
 Diabetic coma. 
 
 Chronic cardiac disease. 
 
 Cerebral and spinal conditions. 
 
 Idiosyncrasies. — 
 
 Strawberry. 
 
 Rhns (poison ivy). 
 
 Crab meat and shell fish. 
 
 Quinin, morphin, iodoform, potassium iodide. 
 
 Certain plants or grasses (hay fever, rose cold, etc ) 
 
 Itching. — 
 
 Quinin, morphin. 
 Diabetes. 
 Jaundice. 
 Pediculosis, etc. 
 
 Jaundice. — 
 
 Epidemic jaundice — Weil's disease. 
 
 Catarrhal. 
 
 Gall-stone. 
 
 Hypertrophic cirrhosis. 
 
 Hematogenic. 
 
 Pancreatic tumors and cysts. 
 
 Carcinoma of liver, stomach, duodenum. 
 
 Acute yellow atrophy. 
 
 Icterus neonatorum. 
 
 Chloroform necrosis of liver. 
 
FREQUENT SYMPTOMS. 41 
 
 Liver. — 
 
 Enlarged and smooth. 
 
 Chronic passive congestion. 
 Amyloid. 
 Cirrhosis. 
 Fatty liver. 
 Enlarged and rough. 
 Abscesses. 
 Echinococcus. 
 Syphilis (gummata). 
 New growths. 
 Cysts. 
 
 Mydriasis. — 
 Glaucoma. 
 Optic atrophy. 
 Anaemias. 
 Neurasthenia. 
 - Aortic insufficiency. 
 Irritation of cervical sympathetic. 
 Emotional disturbances. 
 
 Myosis. — 
 
 Congestion of iris. 
 
 Paralysis of cervical sympathetic. 
 
 Paralysis of fifth nerve. 
 
 Plethora. 
 
 Venous obstruction. 
 
 Mitral valve disease. 
 
 Spinal disease. 
 
 Pain 
 General Abdominal Pain. — 
 
 Constipation. 
 
 Enteritis. 
 
42 CLINICAL HISTORY IN OUTLINE. 
 
 Appendicitis. 
 T>T)lioid. 
 
 General peritonitis. 
 Lead poisoning. 
 Intestinal obstruction. 
 Tuberculous peritonitis. 
 Tabes crises. 
 
 Extrauterine pregnancy. 
 Gastric neuroses. 
 Mucous colitis. 
 Gall-bladder disease. 
 
 Epigastric Pain (beside the above). — 
 
 Acute gastritis. 
 
 Peptic and duodenal ulcer. 
 
 Hyperacidity. 
 
 Pericarditis. 
 
 Pancreatitis. 
 
 Pyloric adhesions. 
 
 Left Hypochondriac Pain. — 
 
 Flatulence. 
 
 Angina pectoris. 
 
 Renal suppurations and calculi. 
 
 Sub-diaphragmatic abscess. 
 
 Right Hypochondnac Pain. — 
 
 Chronic hepatic congestion. 
 Gall-bladder disease. 
 Carcinoma of the liver. 
 Renal suppuration and calculi. 
 Sub-diaphragmatic abscess. 
 
PAIN. 43 
 
 Left Iliac Pain. — 
 
 Pyosalpinx. 
 Ectopic gestation. 
 Dysmenorrhcea. 
 Ovarian cysts. 
 Ureteral calculi. 
 Sigmoid carcinoma. 
 Diverticulitis. 
 
 Right Iliac Pain. — 
 
 Appendicitis. 
 Pyosalpinx. 
 Dysmenorrhcea. 
 Ectopic gestation. 
 Ovarian cysts. 
 Mucous colitis. 
 Chronic colitis. 
 Ureteral calculi. 
 
 Lumbar Pain.- — 
 
 Sacro-iliac disease. 
 Spondylitis. 
 Spinal arthritides. 
 Strains. 
 Herpes zoster 
 Lumbago. 
 Psychoneuroses. 
 Renal suppurations. 
 Renal tumors. 
 Spinal tumors. 
 Retroperitoneal tumors. 
 Fatigue. 
 
44 CLINICAL HISTORY IN OUTLINE. 
 
 Defective balance, scolioses, etc. 
 
 Infectious diseases. 
 
 Aneurisms. 
 
 Pelvic disorders. 
 
 Tabes dorsalis. 
 
 Myelitis. 
 
 Headache. — 
 
 Aneurisms. 
 
 Psychoneuroses. 
 
 Nephritis. 
 
 Meningitis. 
 
 Sinusitis. 
 
 Neuralgias. 
 
 Syphilitic periostitis. 
 
 Brain tumors. 
 
 ''Indurative" headaches. 
 
 Eyestrain. 
 
 Indigestion and constipation. 
 
 Menstruation. 
 
 Onset of infectious disease. 
 
 Intoxications (lead, alcohol). 
 
 Fatigue, hunger, bad air. 
 
 Tkoracic Pain. — 
 
 Digestive disorders (flatulence). 
 
 Angina pectoris. 
 
 Hepatic and ])iliary disorders. 
 
 Aneurisms. 
 
 Pleuritis and pneumonia. 
 
 Pericarditis. 
 
 Intercostal ' ' rheumatism. ' ' 
 
PAIN. 45 
 
 Herpes zoster. 
 Fractured ribs. 
 
 BracMal Fain. — 
 Arthritis. 
 Bursitis. 
 Neuritis. 
 Angina pectoris. 
 Neuralgia. 
 Osteomyelitis. 
 Occupational neuroses. 
 Fractures. 
 Cervical rihs. 
 
 Fain in Lrgs and Feet. — 
 
 Flat foot. 
 
 Arthriticles. 
 
 Varicose veins. 
 
 Phlebitis. 
 
 Sciatica. 
 
 Osteomyelitides. 
 
 Sprains and strains. 
 
 Syphilitic periostitis. 
 
 Tendosynovitis. 
 
 Neuritis. 
 
 Tumors. 
 
 Gout. 
 
 Metatarsalgia. 
 
 Intermittent claudication. 
 
 Erythromelalgia. 
 
 Figment afio n . — 
 
 Lead (lime in gums). 
 Argyria. 
 
46 CLINICAL HISTORY IN OUTLINE. 
 
 Addison's disease. 
 
 Cachexias. 
 
 Xanthomatosis. 
 
 Chloromatosis. 
 
 Melanoma tosis. 
 
 Tattooing. 
 
 Gun powder burns. 
 
 Sequelce of Infections Disease. — 
 
 Diptheria (nephritis, myocardial disease, paralyses). 
 Scarlet fever (nephritis, otitis media). 
 Articular rheumatism (mj^ocardial disease, endo- 
 carditis, chorea). 
 Whooping cough (pulmonary tuberculosis). 
 Measles (pulmonary tuberculosis). 
 Gonorrhoea (arthritis, peritonitis, endocarditis). 
 
 Splenic Enlargements. — 
 
 Myelogenous leukaemia. 
 
 Malaria. 
 
 Banti's disease. 
 
 Gaucher 's splenomegaly. 
 
 Lymphosarcomatosis. 
 
 Ilodgkin's disease. 
 
 Acute infections. 
 
 Chronic congestion. 
 
 Amyloid. 
 
 Syphilis. 
 
 Vertigo. — 
 
 Arteriosclerosis. 
 Nephritis. 
 
PAIN. 47 
 
 Meniere's disease. 
 
 Stokes-Adams' disease. 
 
 Transient monoplegia and hemiplegia. 
 
 Hemianopsia. 
 
 Errors of refraction. 
 
 Certain gastric disorders. 
 
 Aortic insnfficiency. 
 
 Vomiting. — 
 
 Gastric neuroses. 
 
 Appendicitis. 
 
 Cardiac diseases. 
 
 Gastric ulcer. 
 
 Intestinal obstruction. 
 
 Gastric cancer. 
 
 Uraemia. 
 
 Tabes Dorsalis. 
 
 Brain tumors. 
 
 Pregnancy. 
 
 Acute gastritis. 
 
 Alcoholism. 
 
 Onset of acute infections. 
 
 Post-operation. 
 
 Errors of refraction. 
 
CHAPTER IV. 
 
 Post-Mortem Examinations and Records. 
 A post-mortem examination is the final method of sub- 
 stantiating- a elinioal diagnosis. The application of this 
 method has lead to collections of statistics by several well- 
 known clinicians who have discovered that their clinical 
 diagnoses have Ixn^n imperfect in a considerable number 
 of instances. 
 
 The record of a post-mortem examination is the last 
 necessary thing in the complete history of a fatal clinical 
 case. The items in the form of Post-Mortem Record 
 sliowji on ])ages 50, 51, 52 and 53, which is a duplicate 
 of that used ill th(^ Cincinnati Hospital, indicate the 
 data wliieli should be secured in making an autopsy. 
 
 (48) 
 
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The Mosby Company's New Books on Diagnosis 
 
 LABORATORY METHODS 
 
 With Special Reference to the Needs of the General 
 Practitioner 
 
 By B. G. R. WILLIAMS, M. D., 
 
 Member of Illinois State Medical Society, American Medical Association, Etc. 
 
 Assisted by E. G. C. WILLIAMS. M. D., 
 
 Formerly Tathologist of Northern Michigan Hospital for the Insane, 
 Traverse City, Michigan, Etc. 
 
 With an Introduction by 
 VICTOR C. VAUGHAN, M. D., LL.D.. 
 
 Professor of Hygiene and Thysiological Chemistry and Dean of the Depart- 
 ment of Medicine and Surgery, University of Michigan ; Tresident- 
 Elect of the American Medical Association. 
 
 SECOND EDITION, REVISED AND REWRITTEN. 
 
 Octavo, 250 pages, with 50 engravings. Cloth, $2.50 
 
 Milk and Its Home Modifi- 
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 Some Simple Water Anal- 
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 Every-Day Stool Tests. 
 
 Technic of the Private Post- 
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 To Find the Treponema in 
 Six Minutes. 
 
 Laboratory Prophylaxis. 
 
 Indications for Laboratory 
 Aids. 
 
 Tables and Miscellaneous. 
 
 FROM REVIEWS 
 
 This book may be freely commended to those who may desire a working 
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 General practitioners are under an everlasting debt of gratitude to the 
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 of necessity to succeed. — Maryland Medical Journal. 
 
 
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 Chapter 
 
 
 Chapter 
 
 I. 
 
 General Considerations. 
 
 XI. 
 
 II. 
 
 The Sputum. 
 
 
 III. 
 
 Searching for Germs. 
 
 XII. 
 
 lY. 
 Y. 
 
 Yascular Dramas. 
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 XIII. 
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 YI. 
 
 Essence of Tissue Diagnosis. 
 
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 Throat, Monrovia, California. 
 
 Octavo, 250 pages, with 35 engravings and 1 color plate. 
 Price, Cloth, $2.50. 
 
 CONTENTS 
 
 Chapter 
 
 I. Importance of the Tuber- 
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 II. Subcutaneous Tuberculin 
 Test. 
 
 III. C u t a neous Tubei'culin 
 
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 IV. Percutaneous Tuberculin 
 
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 VI. Tuberculin in the Treat- 
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 VII. Hypersensitiveness. 
 
 Chapter 
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 IX. 
 
 X. 
 
 XI. 
 
 XII 
 
 Appendix. 
 
 Certain Conditions Which 
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 Evidences of the Thera- 
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 Fever in its Relationship 
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 Temperature Curve in 
 
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 Technic of Administering 
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 Koch's Announcement of 
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 We have enjoyed reading this work. Dr. Pottenger has the reputation of 
 being e.xceptionally thorough in his diagnostic work and we are given the 
 benefit of this in the book. The author makes it plain that the use of tuber- 
 culin for diagnostic purposes is corroborative only, that to in any measure 
 neglect the history and physical findings invites failure. M'e heartily rec- 
 ommend thus book to the attention of general practitioners. — Journal of the 
 Iowa State Medical Association. 
 
The Mosbu Company's Xcic Books on Diagnosis 
 
 THE WASSERMANN REACTION 
 
 Its Technic and Practical Application in the Diagnosis of 
 
 Syphilis 
 
 By JOHN W. MARCHILDON, B. S., M D., 
 
 Assistant Professor of Bacteriology, St. Louis University Medical School, 
 
 St. Louis. 
 
 Id.") payes, with 11 illustrations and 1 colored frontispiece. 
 
 Price, Cloth, $1.50. 
 
 CONTENTS 
 
 Chapter 
 
 I. Materials Required for Mak- 
 ing the Was«3rmann Re- 
 action. 
 II. The Preparation of the Hem- 
 olytic Amboceptor or Hem- 
 olysin. 
 III. The Preparation of Comple- 
 ment. 
 lY. The Preparation of Red Blood 
 
 Corpuscles. 
 y. The Preparation of Serum 
 
 from the Patient. 
 YI. The Preparation of the Anti- 
 gen. 
 
 Chapter 
 
 YII. To Obtain the Dosage of an 
 Extract. 
 
 YIII. The IMethod of Making a Was- 
 sermann Reaction. 
 IX. The Modification of the Was- 
 
 serraann Reaction. 
 X. The Wasserniann Reaction in 
 
 Syphilis. 
 XI. The \Yassermann Reaction in 
 Diseases other than Syphilis. 
 XII. The Influence of Anti-Syphi- 
 litic Treatment on the Was- 
 serniann Reaction 
 
 FROM REVIEWS 
 
 ^Ye can commend this excellent little work to those who wish to become 
 more independent of the larger laboratories and to place themselves in a posi- 
 tion better to understand and perform this most important diagnostic test. — 
 Journal American ^ledical Association. 
 
 This volume should be on the shelves of every physician. — Interstate Medi- 
 cal Journal. 
 
 We commend the work to those of our readers interested (and what physi- 
 cian is not) in the accurate diagnosis of syphilis. — The American Practitioner. 
 
 This little volume, big enough, sets forth in clear terras the technic of the 
 Wassermann reaction. The author has peeled away much that was designed 
 to befog the man of limited acquirements in the laboratory, thereby enabling 
 the man of patience and average ability to do all of his own laboratory work. 
 Hi? style is clear, cogent and apt to teach. — Journal of the Texas State ^ledi- 
 cal Association. 
 
 This primer of the Wassermann reaction can be recommended as a very 
 clear and concise statement of the rationale and technic of that complicated 
 test. — American Journal of Surgery. 
 
The Moshij Company's Nciv Books on Diagnosis 
 
 VACCINE AND SERUM THERAPY 
 
 Including also a Study of Infections, Theories of Immunity, 
 Specific Diagnosis, and Chemotherapy 
 
 By EDWIN HENRY SCHORER, 
 
 B. S. (University of Wisconsin), M. D. (Johns Hopkins University), 
 Dr. P. H. (Harvard University). 
 
 Formerly Assistant Tliomas Wilson Sanitarium for Children, Mt. Wilson, 
 
 Maryland; Asst. Rockefeller Institute for Medical Research, New York 
 
 City; and at one time Member of the Faculty of the University of 
 
 Missouri, of the University of Kansas, and of the Department 
 
 of Preventive Medicine and Hygiene of Harvard 
 
 University, Boston. 
 
 Octavo, 2.50 pages, with 18 engravings and a colored plate. 
 
 Price, Cloth, $3.00. 
 
 SECOND REVISED EDITION. 
 
 Chapter 
 
 
 I. 
 
 Infections. 
 
 II. 
 
 Immunity. 
 
 III. 
 
 Specific Diagnosis. 
 
 IV. 
 
 Specific Therapy. 
 
 CONTENTS 
 Chapter 
 
 V. Specific Diagnosis, Treat- 
 ment and Prophylaxis in 
 the Different Infections. 
 Appendix. Syphilis and Malaria. 
 
 FROM REVIEWS 
 
 It contains all that is necessary for physicians to know about this new 
 and fascinating method of treatment. The text is well done and the illustra- 
 tions are adequate. Doctor Schorer has had a large and varied experience 
 and is the master of the technique of the laboratory. — The Canadian Medical 
 Association Journal. 
 
 The whole subject has been treated in a very practical and comprehensive 
 manner, and we heartily recommend the book to all who may be interested 
 in tlie subject. — Journal of the Indiana IMedical Association. 
 
 This revised second edition will be welcomed by all interested in the 
 treatment of disease, medical and sui-gical. Altogether this will prove u 
 valuable addition to the literature on vaccine and serum therapy.— The 
 American Practitioner. 
 
The Mosby Company's New Books on Diagnosis 
 
 DIAGNOSTIC METHODS 
 
 A Guide for History Taking, Making of Routine Pliysical 
 
 Examinations and the Usual Laboratory Tests Necessary 
 
 for Students in Clinical Patliology, Hospital Internes, 
 
 and Practicing Physicians 
 
 By HERBERT THOMAS BROOKS, A. B., M. D., 
 
 Professor (jf I'athology, University of Tennessee, College of Medicine, 
 Memphis, Tennessee. 
 
 SECOND EDITION, REVISED AND REWRITTEN. 
 85 pages, Limp Binding, Price, $1.00. 
 
 CONTENTS 
 
 Chapter 
 
 I. Outline for History Taking. 
 II. Physical Examination of the 
 Patient. 
 
 III. Sputum. 
 
 IV. Urine. 
 
 V. Gastric Contents. 
 VI. Blood. 
 VII. Serous Fluids. 
 
 Chapter 
 
 VIII. Intestinal Contents. 
 IX. Tuberculin Diagnosis. 
 X. The Wassermann Reaction. 
 XI. Complement Fixation- Test for 
 
 Gonorrhea. 
 XII. Apparatus and Chemical Re- 
 agents Necessary for Physi- 
 cian's Laboratory. 
 
 FROM REVIEWS 
 
 An excellent laboratory guide for the practitioner who needs a brief re- 
 view of his laboratory technique. It is equally good as a working guide to 
 the student. The study of its first pages will benefit the student or interne 
 in taking histories-. — Illinois Medical .Journal. 
 
 It is a clear, trustworthy exhibition of the simplest and best method of 
 laboratory diagnosis. Following it closely any high-school pupil could do the 
 Wassei'mann reaction. No matter how many books on diagnosis one may 
 have, this book will prove a valuable addition. — Texas State .Journal of 
 Medicine. 
 
The Moshy Company's Neio Books on Diagnosis 
 
 ARTERIOSCLEROSIS 
 
 Etiology, Pathology, Diagnosis, Prognosis, Phophylaxis 
 and Treatment. 
 
 With a Special Chapter on Blood Pressure 
 
 By LOUIS M. WARFIELD, A. B., M. D.. 
 
 Assistant Superintendent and Resident Physician, to Milwaukee County Hos- 
 pital ; Assistant Professor of Medicine, Wisconsin College of Physicians 
 and Surgeons, Milwaukee; Formerly Medical House Officer, 
 Johns Hopkins Hospital, Baltimore, Md. 
 
 With an Introduction 
 
 By W. S. THAYER, M. D., 
 
 Johns Hopkins University. 
 
 221) pages, with 28 engravings. 
 
 SECOND REVISED EDITION. 
 Price, $2 50. 
 
 CONTENTS 
 
 Chapter 
 
 I. Anatomy. 
 II. Physiology of the Circulation. 
 
 III. Pathology. 
 
 IV. Etiology. 
 
 V. The Physical Examination of 
 
 the Heart and Arteries. 
 VI. Symptoms and Physical Sings. 
 VII. Symptoms and Physical Signs 
 — Continued. 
 
 Chapter 
 
 VIII. Diagnosis and Differential Di- 
 agnosis. 
 IX. Prognosis. 
 X. Prophylaxis. 
 XI. Treatment. 
 XII. Arteriosclerosis in Its Relation 
 
 to Life Insurance. 
 XIII. Practical Suggestions. 
 
 FROM REVIEWS 
 
 It will surely be found useful, especially in those chapters which deal with 
 prophylaxis and practical suggestions as to treatment. — Johns Hopkins Hos- 
 pital Bulletin. 
 
 Dr. Warfleld has brought together, in ,i compact volume, a very readable 
 account of modern views on the subject, and makes many suggestive observa- 
 tions, which deserve further attention. — British Medical Journal. 
 
The Moshy Company's Neio Books on Diagnosis 
 
 MUSCLE SPASM AND DEGENERATION IN 
 INTRATHORACIC INFLAMMATIONS 
 
 Their Importance as Diagnostic Aids and Tiieir Influence in 
 
 Producing and Altering the Well Established Physical 
 
 Signs, also a Consideration of Their Part in the 
 
 Causation of Changes in the Bony Thorax 
 
 AND LIGHT TOUCH PALPATION 
 
 The Possibility and Practicability of Delimiting Normal 
 
 Organs and Diagnosticating Diseased Conditions Within 
 
 the Chest and Abdomen by Very Light Touch 
 
 By FRANCIS MARION POTTENGER, A. M., M. D., LL D.. 
 
 Medical Director of the Pottenger Sanatorium for Diseases of the Lungs and 
 Throat, Monrovia, California. 
 
 110 pages, with sixteen original illustrations. 
 Price, Cloth, $2.00. 
 
 CONT 
 
 Chapter 
 
 I. Spasm and degeneration of the 
 muscles of the neck and 
 thorax in the presence of 
 intrathoracic inflammations. 
 
 II. Cause of muscle spasm and 
 
 degeneration. 
 III. What can be determined by 
 noting the condition of the 
 neck and chest muscles in 
 acute and chronic inflam- 
 mations of the lungs and 
 pleura. 
 
 IT. Effect of muscle spasm and 
 degeneration. 
 
 V. Cause of lagging as a sign 
 of apical involvement. 
 
 ENTS 
 ' Chapter 
 
 VI. Cause of flattening of the 
 che.st wall on the affected 
 side. 
 YII. The relation of the muscle 
 change to the anomalies of 
 the upper aperture of the 
 thorax. 
 YIII. Neck, chest, and shoulder 
 pains of reflex origin. 
 IX. The effect of muscle change 
 upon percussion findings in 
 the physical examination of 
 the chest. 
 X. The effect of muscle change 
 upon the data derived from 
 auscultation. 
 XI. Light touch palpation. 
 
 FROM REVIEWS 
 
 A casual review cannot do this book ]u»tice ; the thanks of the profession 
 are due to the author and publisher for such a valuable piece of literature 
 in the field of diagnosis. It is like a refiner's furnace to the old methods 
 of physical examination and shows the refined possibilities of light touch 
 palpation. — Journal of the Texas State Medical Association. 
 
 Pottenger gives a logical explanation of careful observations of the 
 chest in disease, and the book will be of value to all who are keenly inter- 
 ested in physical diagnosis. — .Journal of the American Medical Association. 
 
The Mosby Company's New Books on Diagnosis 
 
 GENITOURINARY DIAGNOSIS AND 
 
 THERAPY 
 
 For Urologists and General Practitioners. Including also a 
 
 Chapter on "The Serological Diagnosis and Specific 
 
 Treatment of Gonococcic Infections" 
 
 By DOCTOR ERNST PORTNER, 
 
 Specialist for Urology, Berlin, Germany. 
 
 Translated and Edited by 
 
 BRANSFORD LEWIS, M. D., B. Sc, 
 
 Professor of Genito-urinary Surgery, Medical Department of St. Louis Uni- 
 versity, St. Louis ; Genito-urinary Surgeon to St. John's Hospital and 
 Frisco Hospital ; Member American Urological Association ; Ameri- 
 can Association of Genito-urinary Surgeons ; American Medical 
 Association, Etc. 
 
 240 pages, with 43 engravings. 
 Price, Cloth, $2.50. 
 
 CONTENTS 
 
 Chapter 
 
 I. Disinfection of Urologic In- 
 struments. 
 
 Anesthesia in TTrology. 
 
 Lubricants. 
 
 Catheterization of the Male. 
 
 Diseases of the I'rethra and 
 Penis. 
 
 Diseases of the Testes and 
 Epididymis. 
 
 Diseases of the Prostate Gland 
 
 Diseases nf the Seminal Ves- 
 icles. 
 
 II. 
 III. 
 IV. 
 
 V. 
 
 VI. 
 
 VII. 
 VIII. 
 
 Chapter 
 
 IX. Diseases of the Urinary Blad- 
 der. 
 X. Diseases of the Kidneys. 
 XI. Diseases of the Ureters. 
 XII. Disturbances of the Genital 
 Function in the Male. 
 
 XIII. Diseases of the Urinary Or- 
 
 gans in the Female. 
 
 XIV. Diseases of the Urinary Or- 
 
 gans in Childhood. 
 XV. The Serological Diagnosis and 
 S|)ecifi(' Treatment of Gono- 
 coccic Infections. 
 
 FROM REVIEWS 
 
 This book sets forth in concise— even terse— terms the best practice in 
 dealing with diseases of the genito-urinary system. — The Canadian Medical 
 Association Journal. 
 
 Tiie mere fact that Doctor Lewis has considered it wnrtli while to trans- 
 late and edit Portnor's book is sufficient reconnnendation to ensure its accep- 
 tance and approval by American practitioners.— New York Post-Graduate 
 Medical JournaL 
 

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