Miscellaneous Diseases

The symptoms are directly referable to want of oxygen produced by the diminished pressure of the atmosphere.

[Symptoms] usually begin at altitudes of 12,000-15,000 feet. Dyspnea is usually the first symptom, made markedly worse by exertion and accompanied by cyanosis. Headache, nausea, vomiting, hyperpnea, epistaxis and frequent micturition follow with marked muscular weakness, so that even slight exertion is difficult. The muscular weakness has been particularly marked in mountain climbing at high altitudes. Of especial interest are the mental changes, which are common in aviation, especially when a high altitude is reached quickly. There is mental inaccuracy with lethargy and disturbance of the physical functions, especially judgement and memory. Syncope may result. Ringing in the ears followed by deafness is common. Death has occurred in balloon ascents.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 382-383). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/08/2021

Entered by: Rachel Johnson 07/12/2021

A disease of caisson workers and divers, due to a saturation of the tissues with nitrogen under the increased pressure. If the decompression takes place quickly, a too-rapid escape of bubbles of nitrogen occurs into the tissues and into the blood causing air embolism. […] In slight cases within from half an hour to one hour after leaving the caisson, the patient has headache, giddiness and feels faint; symptoms which may pass off and leave no further trouble. In other instances the patient have severe pains in the extremities, usually the legs and the abdomen, sometimes associated with nausea and vomiting – attacks which the workmen usually speak of as “the bends.” The pains may be of the greatest intensity and associated with giddiness and vomiting. Paralysis, usually of the legs, comes on rapidly, and varies in degree from weakness to complete loss both of motion and sensation. […] Monoplegia and hemiplegia are rare. In extreme instances the attacks resemble apoplexy; the patient rapidly becomes comatose and death occurs in a few hours. The paraplegia may be permanent, but in slight cases it gradually disappears and recovery may be complete. Late resulting features are spinal cord changes, chronic arthritis and deafness.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 381-382). New York: D. Appleton & Company.

Created by: Taha Jilani, 09/30/2021

Entered by: Rachel Johnson 11/30/2021

When attacked with heat-exhaustion the patient feels giddy, and perhaps staggers and falls. He is pale, his pulse is small, soft, and perhaps fluttering, his breathing is shallow, perhaps sighing, never, stertorous; his pupils are dilated; skin is cold ; his temperature is sub-normal; and he may be partially, more rarely wholly, unconscious. Usually, after a short time he gradually recovers, very likely with a splitting headache and feelings of intense prostration.

Manson, P. (1898). Tropical diseases. United Kingdom: W. Wood and Company.

Entered by: Bernardo Galvan, 6/16/2020

The cardinal symptom of this curious and rather rare condition is a profuse and uncontrollable bleeding following the most trivial injury. Often, indeed, the worst hemorrhage comes from the merest scratch, and may even occur spontaneously.

External bleedings may be spontaneous, but more commonly follow cuts or wounds of the skin or mucous membranes. Bleeding from the nose is most common; next in order of frequency from the mouth, intestines, stomach, urethra, and lungs. No part of the body is exempt. Interstitial bleedings occur in the form of large extravasations of blood (haematomata) following slight bruises, or appear spontaneously as petechial spots. The joints are not infrequently involved, particularly the larger ones, and the lesion may closely stimulate an attack of acute articular rheumatism. Pain, fever, or hemorrhage from other parts of the body may soon follow the arthritis. The blood shows a marked slowness in coagulation, the normal period of from 3 to 5 minutes extending to 10 or 15, or even to 45 minutes in hemophilia, and the blood plates may be scanty or absent. If severe hemorrhage has occurred the usual signs of traumatic anemia will be found.

The disease is more common in males than in females (10 to 1) and usually develops before puberty. In making the diagnosis the family history is of great importance, as a marked heredity is characteristic of the disease. The tendency is transmitted through the female to the male […].

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine: A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (3rd ed., pp. 1004). New York and London : D. Appleton and Company.

Created by: Taha Jilani, 06/14/2021

Entered by: Rachel Johnson 10/04/2021

Morbid Anatomy.—Small quantities of lead occur in the body in health, J.J. Putnam's reports show that of 150 persons not presenting symptoms of lead-poisoning traces of lead occurred in the urine of 25 per cent.

 In chronic poisoning lead is found in the various organs. The affected muscles are yellow, fatty, and fibroid. The nerves present the features of a peripheral degenerative neuritis. The cord and the nerve-roots are, as a rule, uninvolved. In the primary atrophic form, the ganglion cells of the anterior horns are probably involved. In the acute fatal cases there may be the most intense entero-colitis.

 Clinical Forms.-Acute Poisoning.- We do not refer here to the accidental or suicidal cases, which present vomiting, pain in the abdomen, and collapse symptoms. In workers in lead there are several manifestations which follow a short time after exposure and set in acutely. There may be, in the first place, rapidly developing anemia. Acute neuritis has been described, and convulsions, epilepsy, and a delirium, which may be, as Stephen Mackenzie has noted, not unlike that produced by alcohol. There are also cases in which the gastro-intestinal symptoms are most intense and rapidly prove fatal. There was admitted under my care in the Philadelphia Hospital a painter, aged fifty, suffering with anemia and severe abdominal pain, which had lasted about a week. He had vomiting, constipation at first, afterward severe diarrhea and melaena, with distention and tenderness of the abdomen. There were albumen and tube-casts in the urine. The temperature was usually subnormal. Death occurred at the end of the second week. There was found the most intense entero-colitis   with hemorrhages and exudation. These acute forms develop more frequently in persons recently exposed, and, according to Mackenzie, are more frequent in winter than in summer.

 

Chronic poisoning presents the following symptoms:

(a)   Anemia, the so-called saturnine cachexia, which may be profound. As a rule, however, the corpuscles do not sink below 50 per cent.

(b)   Blue line on gums, which is a valuable indication, but not invariably present. Two lines must be distinguished: one, at the margin between the gums and teeth, is on, not in the gums, and is readily removed by rinsing the mouth and cleansing the teeth. The other is the well-known characteristic blue-black line at the margin of the gum. The color is not uniform, but being in the papillae of the gums the line is, as seen with a magnifying-glass, interrupted. The lead is absorbed and converted in the tissues into a black sulphide by the action of sulphuretted hydrogen from the tartar of the teeth. The line may form rapidly after exposure and disappear within a few weeks or may persist for many months. Philipson has noted the occurrence of a black line in miners, due to the deposition of carbon.

The most important symptoms of chronic lead-poisoning are colic, lead-palsy, and the encephalopathy. Of these, the colic is the most frequent. Of Tanquerel’s cases, there were 1,217 of colic, 101 of paralysis, and 72 of encephalopathy.

(c)   Colic is the most common symptom of chronic lead-poisoning. It is often preceded by gastric or intestinal symptoms, particularly constipation. The pain is over the whole abdomen. The colic is usually paroxysmal, like true colic, and is relieved by pressure. There is often, in addition, between the paroxysms a dull, heavy pain. There may be vomiting. During the attack, as Riegel noted, the pulse is increased in tension and the heart’s action is retarded. The pupils are usually unequal.

(d)   Lead-palsy-This is rarely a primary manifestation. The onset may be acute, subacute, or chronic. It usually develops without fever. In its distribution it may be partial, limited to a muscle or to certain muscle groups, or generalized, involving in a short time the muscles of the extremities and the trunk. Madame Dejerine-Klumpke recognizes the following localized forms:

a.      Anti-brachial type, paralysis of the extensors of the fingers and of the wrist. In this the musculo-spiral nerve is involved, causing the characteristic wrist-drop. The supinator longus usually escapes.

b.      Brachial type, which involves the deltoid, the biceps, the brachialis anticus, and the supinator longus, rarely the pectorals. The atrophy is of the scapula-humeral form. It is bilateral, and sometimes follows the first form, but it may be primary.

c.       The Aran-Duchenne type, in which the small muscles of the hand and of the thenar and hypothenar eminences are involved. It produces a paralysis closely resembling that of the early stage of polio-myelitis anterior chronica. The atrophy is marked, and may be the first manifestation of the lead-palsy. Mobius has shown that this form is particularly developed in tailors.

d.      The peroneal type. According to Tanquerel, the lower limbs are involved in the proportion of thirteen to one hundred of the upper limbs. The lateral peroneal muscles, the extensor communis of the toes, and the extensor proprius of the big toe are involved, producing the steppage gait.

e.      Laryngeal form. Adductor paralysis has been noted by Morell Mackenzie and others in lead-palsy.

Generalized Palsies.—There may be a slow, chronic paralysis, gradually involving the extremities, beginning with the classical picture of wrist-drop. More frequently there is a rapid generalization, producing complete paralysis in all the muscles of the parts in a few days. It may pursue a course like an ascending paralysis, associated with rapid wasting of all four limbs. Such cases, however, are very rare. Death has occurred by involvement of the diaphragm. Oliver reports a case of Philipson’s in which complete paralysis supervened. Dejerine-Klumpke also recognizes a febrile form of general paralysis in lead-poisoning, which may closely resemble the subacute spinal paralysis of Duchenne.

There is also a primary saturnine muscular atrophy in which the weakness and wasting come on together and develop proportionately. It is this form, according to Gowers, which most frequently assumes the Aran-Duchenne type.

The electrical reactions are those of lesions of the lower motor segment, and have been described under lesions of the nerves. The degenerative reaction in its different grades may be present, depending upon the severity of the disease.

Usually with the onset of the paralysis there are pains in the legs and joints, the so-called saturnine arthralgias. As a rule, however, sensation is unaffected and the sensory nerves are not involved.

(e)   The cerebral symptoms are numerous. Optic neuritis or neuro retinitis may develop. Hysterical symptoms occasionally occur in girls. Epilepsy is not uncommon, and in fits developing in the adult the possibility of lead-poisoning should always be considered. An acute delirium may occur with hallucinations. The patients may have trance-like attacks, which follow or alternate with convulsions. A few cases of lead encephalopathy finally drift into lunatic asylums. Tremor is one of the commonest manifestations of lead-poisoning.

(f)   Arterio-sclerosis— Lead-workers are notoriously subject to arterio-sclerosis with contracted kidneys and hypertrophy of the heart. The cases usually show distinct gouty deposits, particularly in the big-toe joint; but in this country acute gout in lead-workers is rare. According to Sir William Roberts, the lead favors the precipitation of the crystalline urates of the tissues. Ralfe has shown that lead diminishes the alkalinity of the blood, and so lessens the solubility of the uric acid.

Prognosis—In the minor manifestations of lead-poisoning this is good. According to Gowers, the outlook is bad in the primary atrophic form of paralysis. Convulsions are, as a rule, serious, and the mental symptoms which succeed may be permanent. Occasionally the wrist-drop persists.

Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and student of medicine. New York, NY: D. Appleton and Company.

Entered by: Kate Holder, 7/17/2020

A rare condition, which may be acute, usually due to injury, less commonly to infectious diseases, especially erysipelas, smallpox, measles, and rheumatism; or chronic, generally of tuberculous origin; and is most frequently seated in the anterior mediastinum.

In acute abscess there is sharp, often throbbing, substernal pain, with fever, perhaps also with chills, profuse sweats, and prostration, if the abscess is of sufficient size there may be cough and dyspnea from pressure. If, as may happen, the abscess points at an intercostal space, or erodes and perforates the sternum, a fluctuating and pulsating swelling may appear, or it may become palpable in the episternal notch. Previous to the appearance of a swelling, dullness upon percussion over the seat of the abscess may be the only physical sign. The pus may discharge into the trachea or esophagus after perforation, and in rare instances has made its way into the abdomen.

A chronic abscess may afford signs similar to those of mediastinal growths.

A fluctuating and pulsating abscess may be differentiated from aneurism by the absence of diastolic shock, expansile pulsation, and murmur; and in the acute abscess by a history of injury and presence of chill, fever, and sweat. […] An acute abscess is separated from a mediastinal growth by the febrile symptoms; a chronic abscess, by puncture.

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (Ed. 3, pp. 953). New York : D. Appleton and Company.

Created by: Taha Jilani, 06/11/2021

Entered by: Rachel Johnson 08/29/2021

After prolonged and, perhaps, daily exposure to the sun for a certain space of time, or after working or sleeping in the sun, the individual experiences a sharp tingling and prickling pain in the exposed skin, accompanied occasionally with a sense of giddiness and nausea, and his gait is staggering when he attempts to walk. He is restless and feverish at night, and for some weeks or months he experiences loss of appetite, nausea, burning heat at the epigastrium and in the throat, diarrhea, a frequent repetition of giddiness, sometimes disturbance of vision, insomnia, frightful dreams, noises in the head, fugitive neuralgic pains, muscular spasms, cramps, lassitude, and depression of spirits. Subsequently, in conjunction with the diarrhea, there exists excessive appetite, with a clean but red and fissured tongue.

Wilson, E. (1868). On diseases of the skin: A system of cutaneous medicine. Philadelphia: Henry C. Lea.

Entered by: Bernardo Galvan, 07/15/2020

[...] It is characterized by slowly progressive impairment of muscular power and of all the vital functions, death taking place by asthenia within a period varying from three months to a year.

The following sketch embraces the more important of the symptoms in cases of pernicious anemia: the facies shows intense anemia, being in some instances as devoid of color as a cadaver; it is sometimes jaundiced, and sometimes has a sallow or straw-colored hue. Edema of the face occurs frequently, and in the latter period of the disease there may be considerable general dropsy. As the disease progresses the prostration becomes extreme; syncope is liable to occur on exertion, and the patients sometimes suffer from adistressing sense of impending death. The pulse is more or less accelerated, and it is notably compressible. The impulse and sounds of the heart also show great weakness of this organ, which is explained by the fact that fatty degeneration of its muscularstructure is generally found after death. The anemic murmurs are marked. Hemorrhages are liable to occur from the nose, mouth, and kidneys; petechiae are sometimes observed, and the ophthalmoscope may show ecchymosis in the retinae, although vision is unaffected. The intellectual faculties are usually intact up to a late period, when there may be passive delirium. Coma takes place in some cases before death, attributable, perhaps, to cerebral hemorrhage. The patient suffers more of less from dyspnea and palpitation. The appetite is lost, and the anorexia often amounts to a loathing of food. Notwithstanding the fact just stated, the bulk of the body is not greatly diminished; the affection does not lead to great emaciation. During the progress of the affection fever occurs in irregular paroxysms, the temperature rising from 101 to 103 or 104 degrees F. Women are more liable to the affection than men. The liability to it is greater in middle age but it is not limited to any period of life. [...] An examination of the blood shows notable diminution in number, and variations in size, of the red corpuscles, but an inconsiderable, if any, increase of leucocytes; hence leucocythemia is excluded. Counted by means of the hematometre the red corpuscles have been found diminished to a fourth, a sixth, and even a tenth of their normal number.

Flint, A. (1879). Clinical Medicine: A Systemic Treatise on the Diagnosis and Treatmentof Diseases (pp. 181-182). Philadelphia: H. C. Lea.

Created by: Taha Jilani, 06/23/2021

Entered by: Rachel Johnson 11/05/2021

There are various grades of the disease, of which mild, moderate, and severe types may be recognized. In the mild forms the disease never gets beyond the stage of such vascular disturbance as is frequently seen in chilblains. The hands alone may be affected. In the winter, on the slightest exposure, there is acro-cyanosis, which gives place in the warmth to active hyperaemia, sometimes with swelling, throbbing, and aching. The so-called "beefsteak" hand is often a great annoyance to women. It is a vaso-motor disturbance representing a potential case of Raynaud’s disease. In these mild attacks one finger may be white and the adjacent ones red and blue. The condition may persist for years and never pass on to necrosis. In a case of moderate severity a woman, aged say twenty or twenty-five, after a period of worry or ill health, has pains in the fingers, or a numbness or tingling; then she notices that they are white and cold, and in an hour or so they become red and hot. Within a day or two a change occurs; they remain permanently blue perhaps as far as the second joint or to the knuckles. There is pain, sometimes severe enough to require morphia.

The cyanosis persists and the tip of one finger or the terminal joint of another gets darker and a few blebs form. The other fingers show signs of restored circulation, but necrosis has occurred in the pad of one finger and perhaps the terminal inch of another. The necrotic parts gradually separate, and the patient may never have another attack, or in a year or two there is a recurrence. The severer form is a terrible malady, and may affect fingers and toes at once and with them sometimes the tip of the nose and the ears. The pain is of great severity. Both feet may be swollen to the ankle with the toes black. It may look as if both feet would become gangrenous, but as a rule the process subsides [...]. A severe attack of this sort may last three or four months [...]. Parts other than the extremities may be attacked, as the chin, lips, nates, and eyelids [...]. Albuminuria may occur during the attacks. Hemoglobinuria has been present in a number of cases [...]. Scleroderma of the fingers may follow recurring attacks [...]. Arthritis has been present in certain cases.

Osler, W. (1892). The Principles and Practice of Medicine. New York and London: D. Appleton and Company. Pg. 1112-1113.

Entered by: Sonia Y. Khan, 6/25/2020

Edited by: Rachel Johnson 6/18/2021

Description 1

The disease is insidious in its onset. Early symptoms are loss in weight, progressive weakness, and pallor. Swelling of the pinna of the ear, which may extend to the scalp, has been noted early. Very soon the gums become swollen and spongy, bleed easily, and in extreme cases present a fungous appearance. These changes, regarded as characteristic, are sometimes absent. The teeth may become loose and even fall out. […] The breath is excessively foul. The tongue is swollen, but may be red and not much furred. The salivary glands are occasionally enlarged. Hemorrhages beneath the mucous membranes of the mouth, especially on the hard palate, are common. The skin becomes dry and rough, and ecchymoses soon appear, first on the legs and then on the arms and trunk, and particularly into and about the hair-follicles. They are petechial, but may become larger, and when subcutaneous may cause distinct swellings. In severe cases, particularly in the legs, there may be effusion between the periosteum and the bone, forming irregular nodes, which may break down and form foul-looking sores. The slightest bruise or injury causes hemorrhages into the injured part. […] epistaxis is, however, frequent. Conjunctival hemorrhage is not uncommon. […] Hematuria, often microscopic, is common and bleeding from the bowels may occur in severe cases. Palpitation of the heart with feeble and irregular impulse is common. The heart may be enlarged, especially in the right ventricle, and the rate increased. A hemic murmur can usually be heard at the base. Secondary anemia is usual; the leucocytes vary and there may be leucopenia or an increase with lymphocytosis. […] The appetite is impaired, and owing to the soreness of the gums the patient is unable to chew. Constipation is more frequent than diarrhea. […] There are mental depression, indifference, and in some cases headache, and in the later stages delirium. […] Remarkable ocular symptoms are occasionally met with, such as night-blindness or day-blindness, associated with anemia or the retina. […] Advance necrosis of the bones may occur, and in young persons even separation of the epiphyses. […] Fever is not present, except in the later stages, or when secondary inflammations in the internal organs appear. The temperature may be below normal. Acute arthritis is an occasional complication.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 411-413).New York: D. Appleton & Company.

Created by: Taha Jilani, 06/08/2021

Entered by: Rachel Johnson, 07/12/2021

Description 2

This disease may be known by unusual weariness, heaviness, and difficulty of breathing, especially after motion; rottenness of the gums, which are apt to bleed on the slightest touch; a stinking breath; frequent bleeding at the nose; crackling of the joints; difficulty of walking; sometimes a swelling, and sometimes a falling away of the legs, on which there are livid, yellow, or violet-coloured spots; the face is generally of a pale or leaden colour. As the disease advances, other symptoms come on; as rottenness of the teeth, hæmorrhages, or discharges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, especially about the breast, dry scaly eruptions all over the body, &c. At last a wasting or hectic fever comes on, and the miserable patient is often carried off by a dysentery, a diarrhoea, a dropsy, the palsy, fainting fits, or a mortification of some of the bowels.

Buchan W. (1793). Domestic Medicine, or, a treatise on the prevention and cure of diseases by regimen and simple medicines. (14th Ed., pp. 329). Boston : Printed by Joseph Bumstead, for James White, and Ebenezer Larkin.

Created by: Sara Ahmed, 06/08/2021

Entered by: Rachel Johnson, 07/19/2021

[...] It requires an idiosyncrasy which in some instances is inherited. The idiosyncrasy consists in a peculiar susceptibility, in consequence of which certain causes in the atmosphere excite and inflammatory condition of the air passages, frequently giving rise to paroxysms of asthma, these atmospherical causes being innocuous to those not having this idiosyncrasy. The causes are present in the atmosphere only during summer or autumnal months, that is, either in May and June, or in August and September; hence, the significance of the names summer and autumnal bronchitis. [...] It seems to be pretty clearly established that the causes are the pollen of grasses and other plants.

[...] The diagnosis is doubtful only when the affection is experienced for the first time. In other cases the periodical recurrence in the past experience of the patient is sufficient, taken in connection with the symptomatic phenomena. The clinical history, however, has features distinguishing it from a simple bronchitis, and the differential diagnosis is limited to this disease. The bronchial affection, as in common “colds,” is preceded by coryza. This is generally accompanied by frequent sneezing, and by a copious discharge of a serous liquid. The conjunctiva is reddened, and there is abundantlachrymation. These symptoms have not an uniform intensity, but they either occur in paroxysms, or there are marked exacerbations. The throat becomes inflamed, with often more or less swelling of the tonsils. A peculiarity is the occurrence of paroxysms or exacerbations of sneezing and lachrymation at irregular intervals, and their abrupt termination. They are most apt to occur when the patient is in the open air. Cough follows, and is more or less frequent and violent, accompanied generally with butlittle expectoration. Paroxysms of asthma follow cough in a certain proportion of cases, different cases differing much in respect of their frequency, severity, and duration. The fever which exists is not intense, and is evidently symptomatic, not essential. All the symptoms are aggravated by exercise out of doors. The histories of cases show very conclusively the local effects of the extrinsic causes acting first upon the nasal passages, and successively upon the pharynx, larynx, and trachea, and the bronchial divisions, extending frequently to the tubes of small size, producing in the latter spasms of the muscular fibres, but not the phenomena of capillary bronchitis.

Flint, A. (1879). Clinical Medicine: A Systemic Treatise on the Diagnosis and Treatment of Diseases(pp. 103-104). Philadelphia: H. C. Lea.

Created by: Sara Ahmed, 06/14/2021

Entered by: Rachel Johnson, 11/05/2021