Part 236

PURPURA, 186 Definition, 186, 187 Etiology, 190 Heredity, influence on causation, 190 Hereditary predisposition to, 191 Specific nature, 191 Pathology, 191 Forms, 187 Symptoms, 187 Purpura Simplex, 187 Mode of onset, 187 Eruption, character, 187 duration, 187 General condition, 187 Purpura Hæmorrhagica (Morbus Maculosus Werlhofii), 188 Mode of onset, 188 Eruption, character and seat, 188 Epistaxis, occurrence of, 188 Hæmatemesis, occurrence of, 188 Hæmaturia, occurrence of, 188 General condition, 188 Duration, 189 Temperature, 189 Purpura Rheumatica (Peliosis Rheumatica), 189 Mode of onset, 189 Joints, condition of, 189 Pains in joints, 189 Eruption, character and seat, 189 duration, 189 Cardiac murmurs, 189 Sub-varieties, 189 In children, 190 Purpura urticaria, 190 Purpura papulosa, 190 Complications, 190 Gangrene of intestines, 190 Diagnosis, 192 From scurvy, 192 From hæmophilia, 192 From effusions and ecchymoses of acute exanthemata, 192 From erythema nodosum, 192 From erythema multiforme, 192 Prognosis, 193 Treatment, 193 Of mild cases, 193 Diet, 193 Necessity of quiet, 193 Of complications, 194 Of purpura rheumatica, local, 194 Use of sulphuric acid, 193 of acetate of lead, 193 of ergotin, 193 of turpentine, 193 of iron, 194 Transfusion of blood, 194

Purpura hæmorrhagica, complicating gastric cancer, 560 in children, 190 papulosa, 190 urticaria, 190

Purulent form of local peritonitis, 1159 infiltration, in phlegmonous form of acute oesophagitis, 413

Pus, characters of, in acute peritonitis, 1136 evacuation of, in abscess of liver, 1021 mode of escape, in phlegmonous form of acute oesophagitis, 413 of acute pancreatitis, character of, 1118 of hepatic abscesses, 1007

Pustular syphilides in hereditary syphilis, 279 diagnosis of, 279, 280

Putrefaction, influence on causation of dysentery, 787, 789

Pyæmia complicating mercurial stomatitis, 346 influence on causation of acute peritonitis, 1138 occurrence of, in dysentery, 797, 804

Pylephlebitis, 1095 in simple ulcer of stomach, 502 suppurative, 1097

Pylethrombosis, in gastric cancer, 560

Pylorus, cancer of, influence on causation of occlusion of common biliary duct, 1085 distortion of, as cause of dilatation of stomach, 588 hypertrophic stenosis of, 615 Synonyms, 615 Etiology, 615 Cicatrization of gastric ulcer, 615 Morbid anatomy, 615 Hypertrophy of gastric walls, 615 Fibrous tissue, new growth of, 615 Symptoms, 615 Of chronic gastritis, 615 Presence of a tumor, 615 Diagnosis, 615 Prognosis, 615 Treatment, 615 hypertrophy and ulceration of, in chronic gastritis, 472 obstruction of, in gastric cancer, 566 influence on causation of dilatation of stomach, 587 resection of, in dilatation of stomach, 609 scirrhous state of, in chronic gastritis, 471 spasm of, influence on causation of dilatation of stomach, 588 stenosis of, in simple ulcer of stomach, 503 influence on causation of dilatation of stomach, 587

Pyo-pneumothorax subphrenicus in perforation of simple ulcer of stomach, 499

Pyrethrum, use, in chronic pharyngitis, 406

Pyrexia in acute gastritis, treatment of, 469, 470 in parenchymatous glossitis, 362 in acute oesophagitis, treatment of, 416 in tuberculous pharyngitis, 401 in catarrhal stomatitis, 323 in mercurial stomatitis, 346

Pyrosis in functional dyspepsia, 449

Quicksilver, use of, in intestinal obstruction, 863

Quiet, necessity of, in purpura, 193

Quinia, use of, in ascites, 1179 in catarrh of bile-ducts, 1057 in dysentery, 812 in functional dyspepsia, 457 in gastralgia, 462 in parenchymatous glossitis, 365 in gout, 135 in acute intestinal catarrh, 689, 692 in chronic intestinal catarrh, 715 in intestinal indigestion, 636 obstruction, 865 in lithæmia, 973 in acute yellow atrophy of liver, 1030 in abscess of liver, 1020 in aborting abscess of liver, 1020 in amyloid liver, 1045 in cirrhosis of liver, 1000 in fatty liver, 1051 in acute pharyngitis, 398 in pruritus ani, 917 in purpura, 194 in suppurative pylephlebitis, 1101 in rectal paralysis of malarial origin, 908 in acute rheumatism, 61 in chronic articular rheumatism, 74 in gonorrhoeal rheumatism, 107 in rheumatoid arthritis, 98 in gangrenous stomatitis, 344 in tape-worm, 942 in tonsillitis, 388

Quinsy, 379

Race, influence on causation of diabetes mellitus, 204 of cancer of stomach, 535 of acute intestinal catarrh, 669 of scrofula, 235

RACHITIS, 137 Definition, 137 Etiology and pathology, 137 Inflammatory nature of, 137, 138 Defective calcification, causes of, 138, 139 Lime, method of elimination, 138 Phosphoric acid, method of elimination, 139 Nitrogen, method of elimination, 139 Anatomical causes, 139 Arteries, increased width of, influence on causation, 139 Artery, pulmonary, enlargement of, influence on causation, 139 Thoracic and abdominal viscera, relation to causation, 140 Liver, enlargement of, 139 Spleen, enlargement of, 140 Kidneys, enlargement of, 140 Direct causes, 140 Early life, influence on causation, 141, 142 Climate, influence of, on causation, 143 Air, bad, influence of, on causation, 143 Defective maternal nutrition, influence of, on causation, 143 Intestinal catarrh, influence of, on causation, 144 Improper food, influence of, on causation, 144 Pulmonary diseases, influence of, on causation, 144 Hereditary nature of, 144 Gout, influence of, on causation, 144 Syphilis, influence of, on causation, 144 Malaria, influence of, on causation, 145 Intra-uterine and congenital forms, causes and symptoms, 141-143 Symptoms, 146 Mode of development in infants, 146 in older infants, 146 Head, appearance of, 146 sweating of, 146 condition of sutures, 147 of fontanels, 147 of cranial bones, 147 Craniotabes, 147 Cranial sclerosis, 148 Brain and meninges, condition of, 148, 149 Brain compression, 149 Intellect, state of, 149 Convulsions, 149 Laryngismus stridulus, 149 Face, alterations in, 150 Maxillary bone, lower, changes in, 150 Teething, anomalies of, 150, 151 Vertebral columns, changes in, 151 Kyphosis, occurrence of, 151 Ribs, changes in, 152 tenderness of, 152 beading of, 152 Chest, alterations in shape, 152 Heart and lungs, condition of, 152 Pneumonia, catarrhal, frequency of, 153 Bronchial and tracheal catarrh, tendency to, 152 glands, enlargement of, 152 Abdomen, enlargement of, 153 Pelvis, deformities of, 153 Liver, changes in, 153 degeneration, amyloid, 153 Spleen and kidneys, degeneration, amyloid, 153 Tonsils, enlargement of, 153 Tongue, condition of, 153 Stomach, condition of, 153 Intestinal tract, condition of, 153 Constipation, significance of, 154 Kidneys, changes in, 154 Extremities, appearance of, 155 bones of, changes in, 155 Bones, curvatures of, 155 causes of, 155 Skin, disorders of, 156 Alopecia, circumscribed, 156 Of rachitis, acute, 156 Nature, 156 Prognosis, favorable nature of, 157 Influence of complications on, 158 Treatment, 158 Preventive, 158 Pre-natal, 158 Of intestinal disorders, 158 Diet, 159 Milk, use of, 159 mode of administration, 159, 160 Weaning, proper time for, 160 Of craniotabes, 162 perspiration, 162 laryngismus stridulus, 163 convulsions, 163, 164 complications, 164 constipation, 164 by diet, 164 by strychnia, 164 deformities, 165, 166 by gymnastic exercises, 166 by mechanical apparatus, 166 Use of alkalies, 161 of acids, 161 of baths, salt, 163 hot, 163 mode of applying, 163 of beef-tea, 161 mode of preparation, 161 of bromides of potassium and sodium, 163 of chloral hydrate, 163 of cod-liver oil, 162 of iron, 162 of lime, 162 of lime-water, proper dose, 161 of malt extracts, 162 of phosphate of lime, 162 of phosphorus, 165 Fresh air, value of, 163 Sea-bathing, value of, 163

Ranvier and Cornil on causes of scrofulous inflammation, 239

Rat and mouse, Trichina spiralis in, 958

Raw beef, use of, in acute intestinal catarrh, 691

Rectal alimentation, 928 conditions necessary to success, 928 emptiness of bowel, 928 time of administering, 928 syringe, variety of, 928 amount of enemata, 928 frequency of enemata, 928 substance employed, 929 contraindications, 929 use of nutrient suppositories, 929 in gastric cancer, 576 in organic stricture of oesophagus, 425 heat and fulness, in constipation, 645 inflammation, 887 irrigation in dysentery, 809 in chronic intestinal catarrh, 717 in jaundice, 983 pouches, dilatation of, 885 treatment in acute intestinal catarrh, 697

RECTUM AND ANUS, DISEASES OF, 877 Forms of, 877 Anatomy of, 877-879 Congenital Malformations, 879 Imperforate anus, 879 Abnormal anal openings, 880 Absence of anus, 880 Greater liability of males to, 880 Prognosis, 880 Treatment, 880 Primary Diseases of Rectum and Anus, 881 Prolapse and Procidentia of Rectum, 881 Etiology, 881 Age, infancy and senility, 881 Worms, 881 Diarrhoea, 881 Constipation, 881 Coughing and crying, 881 Loss of tone of anus and rectum, 881 Abuse of cathartics, 881 Urethral stricture, 881 Polypi, 881 Tumors, 881 Symptoms, 881 Size, 881 Appearance of mucous membrane, 881 Polypi of Rectum, 882 Varieties, 882 Gelatinoid form, 882 Fibroid form, 882 Nature, 882 Physical characters, 882 Symptoms, 882 Frequent desire to stool, 882 Heat and tenesmus, 882 Hemorrhage, 882 Number, 882 Seat, 882 Hemorrhoids or Piles, 882 Etiology, 882 Abnormal state of blood-vessels, 882 External, 883 Sex, influence of, on causation, 883 Age, influence of, on causation, 883 Exciting causes, 883 Tendency to inflammation, 883 Obliteration of vessels in, 883 Structure of, 883 Symptoms, 883 Pain, 883 Tenesmus, 883 Inability to urinate, 883 Suppuration of, 883 Internal, 883 Physical characters, 883 Structure of, 883 Color, 883 Etiology, 884 Constipation, 884 Diseases of liver, 884 Abdominal tumors, 884 Horseback riding, 884 Dysentery, 884 Diarrhoea, 884 Sedentary life, 884 Age, 884 Sex, 884 Rich food, 884 Symptoms, 884 Pain, 884 Tenesmus, 884 Spasm of sphincters, 884 Hemorrhage, 884 Weight and fulness, 884 Dilatation of the Rectal Pouches, 885 Rarity of, 885 Causes, 885 Symptoms, 885 Weight and uneasiness of rectum, 885 Pain, 885 Mucus, increased secretion of, 885 Exploration of bowel with blunt hook, 885 Non-malignant Stricture of Rectum, 885 Nature, 885 Etiology, 885 Traumatism, 885 Following operations, 885 Secondary of pelvic inflammation, 885 of syphilis, 885 Constipation, 886 Sex, influence of, on causation, 886 Symptoms, 886 Physical characters, 886 Violent straining at stool, 886 Wire-drawn feces, 886 Irregular bowels, 886 Appetite, impaired, 886 Digestive disturbances, 886 Pain, 886 Mucous discharges, 886 Seat, 886 of syphilitic, 886 Characters of syphilitic, 886 Proctitis, 887 Frequency, 887 Etiology, 887 Intestinal worms, 887 Rhus toxicodendron, 887 Gonorrhoeal poison, 888 Unnatural intercourse, 888 Symptoms, 887 Pain, 887 Tenesmus, 887 Mucous and bloody discharges, 887 Fissure of Anus and Rectum, 888 Frequency, 888 Character, 888 Position, 888 Etiology, 888 Uterine disease, 888 Frequency in women, 888 Constipation, 888 Syphilis, 888 Symptoms, 888 Pain, 888 Spasm of sphincters, 888 Mental depression, 889 Rodent or Lupoid Ulcer of Rectum, 889 Frequency, 889 Seat, 889 Characters, 889 Symptoms, 889 Pain, 889 Spasm of sphincters, 889 Obstruction of Rectum, 889 Etiology, 889 Foreign bodies, 889, 890 Sex, 889 Loss of nervous and muscular tone, 889 Impaction of feces, 889 Concretions, 890 Enteroliths, 890 composition, 890 Gall-stones, 891 Intestinal worms, 891 Tumors, pelvic, 891 Symptoms, 891 Appetite impaired, 890 Digestive disturbances, 890 Melancholia, 890 Vomiting, 890 Tenesmus, etc., 890 Sloughing of rectum, 891 Cutaneous Eruptions and Parasitic Conditions of Anus, 892 Eczema, 892 Erythema intertrigo, 892 Prurigo podicis, 892 Herpes, 892 Furunculi, 892 Hairs on mucous membrane, 892 Sarcoptes hominis, 892 Acarus autumnalis, 892 Rhus toxicodendron, 892 Ulceration of Rectum and Anus, 893 Frequency, 893 Etiology, 894 Syphilis, 894 Struma, 894 Traumatic, 894 Foreign bodies, 894 Impacted feces, 894 Symptoms, 893 Initial, 893 Diarrhoea, 893 Stools, character, 893 Pains, 893 Muco-purulent discharges, 894 Sphincters, loss of power in, 893 Abscesses, formation, 893 Ulcers, physical character, 893 Enlargement of rectal glands, 893 Follicular Ulcerations, 894 Etiology, 894 Origin, 894 From chancroidal invasion, 895 Symptoms, 895 Peri-anal and Peri-rectal Abscess, 895 Etiology, 895 Acute form, 895 Anatomical causes, 895, 896 Sex, influence on causation, 896 Cold and wet, 896 General debility, 896 Hepatic disorders, 896 Symptoms, 896 Sudden onset, 896 Chills, 896 Heat and fulness, 896 Pain, 896 Dysuria, 896 Appetite impaired, 896 Malaise, 896 Chronic form, 896 Etiology, 896 From traumatic causes, 896 ulceration of rectum, 896 Seat, 896 Symptoms, 896 Hectic, 896 Emaciation, 896 Slow formation, 896 Difficult to heal, 897 Fistula in Ano, 897 Great frequency, 897 Etiology, 897 Abscesses, 897 From traumatic causes, 897 Age, 897 Male sex, 897 Phthisis, 897 Forms, 897 complete, 897 incomplete, 897 Multiple, 897 Seat of external opening, 897 internal opening, 898 Course, 898 Discharges, character of, 898 Pain in, 899 Diagnosis, 898 Use of probe, 898 Hemorrhage from Rectum, 899 Primary and Secondary, 899 Secondary Diseases of Rectum and Anus, 900 Syphilis of Rectum and Anus, 900 Frequency, 900 relative, in the sexes, 900 Seat and character, 900, 901 Mucous patches, 900 Gummatous deposits, 900 Condylomata, 901 Scrofulous and Tuberculous Affections, 901 Pathology of tubercular form, 901 Description and course, 901 Causation from ingestion of morbid products of tuberculous lungs, 902 Seat, 902 Cancer, Malignant Stricture and Malignant Ulceration, 902 Forms, 902 Relative frequency of forms, 903 Sex, influence on causation, 903 Age, influence on causation, 903 Scirrhous, method of growth, 903 Pain in, 903 Difficult defecation, 904 Odor of patient, 904 Exhaustion, 904 Encephaloid, rapid growth of, 904 hemorrhage in, 904 Lymphatic glands, enlargement of, 904 Disease of rectum, by extension from colon, 904 Ulceration of rectum following typhoid fever and dysentery, 905 Ulceration from mechanical causes, 906 Effects of Abnormal Conditions of Spinal Cord and Membranes on Rectum and Anus, 906 Constipation in, 906 Loss of control, 907 Paralysis of rectum in pressure myelitis, 907 rectal, in spinal meningitis, 907 in fracture of vertebræ, 908 Sphincters, condition of, in convulsions of epilepsy, 908 Paralysis, in chronic heart disease, 908 in malaria, 908 Spasm of Rectum and Anus, 909 Pruritus Ani, 909 Etiology, 909 Neurotic origin, 909 Digestive derangements as causes, 909 Overwork, 909 Spinal irritation, 909 Worms, 909 Rheumatism, 909 Diabetes mellitus, 909 Neuralgia of Rectum, 909 Frequency of, 910 Causes of, 910 Malaria, 910 Reflex, 910 Uterine disease, 910 Symptoms, 910 Effect of Cholera and Certain Poisons and Remedies on Rectum, 910 Of cholera, 910 Of arsenic, 910 Of corrosive sublimate, 910 Of croton oil, 910 Of strychnia, 911 Of morphia, 911 Of jaborandi, pain in rectum, from, 911 Of mineral acids, 911 Treatment, therapeutical and surgical, 911 Of anal fissure, 911 Cauterization with nitrate of silver, 912 Incision and dilatation, 912 Of rectal ulcer and deep anal fissure, 912 Cleanliness, 912 Bougies of soap, 912 Cauterization, 912 Glycerite of tannin, 912 Astringent, 912 Red precipitate ointment, 912 Use of acid nitrate of mercury, 912 Nitric acid, 912 Incision, 912 method of, 913 Dilatation, method of, 912 Of tuberculous ulcer of rectum, 913 Of chronic ulcer of rectum, 913 use of Ward's paste, 913 Of rodent ulcer, 913 excision in, 913 Of cancer of rectum, 913 use of anodynes, 913 enemata of warm water, 914 bougies, use of, 914 excision, 914, 915 method of, 915 lumbar colotomy, 915 method of, 916 Of dilatation and inflammation of rectal pouches, 916 incision, 916 Of loss of co-ordination in muscles of defecation, 916 Of sphincterismus, 916 Use of purgatives, 916 of hot hip-baths, 916 of bougies, 916 of incision and dilatation, 916 Of pruritus ani, 917 Use of enemata, 917 of carbolic acid, 917 of turpentine, 917 of hot water, 917 of sulphate of zinc and alum, 917 of chloroform, 917 of iron and quinine, 917 of mercurial ointment, 917 of tincture gelsemium, 917 Of non-malignant rectal stricture, 917 Use of bougies, 917 of dilatation, 917 Of syphilitic form, 917 Of peri-anal and peri-rectal abscess, 918 Use of poultices, 918 of incision, 918 Of gonorrhoea of rectum, 918 Astringent injections, 918 Of impaction of feces, 918 Use of dilatation of sphincter, 918 of enemata, 918 of purgatives, 918 of iron and quinine, 919 of electricity, 919 Of irritable rectum, 919 Anodyne enemata, 919 Cauterization with nitric acid, 919 Of concretions of rectum, 919 Of proctitis, 919 Use of copaiba, 919 of black pepper, 919 of ice, locally, 919 Of prolapsus ani and procidentia, 919 Use of astringent solutions, 919 of anal pad and T-bandage, 920 of cauterization, 920 method, 920 of excision, 920 method, 920 of dilated gum pessary, 920 of ergotin, locally, 920, 921 of strychnia, locally, 921 of nitric acid, locally, 920 of nitrate of silver, 920 Of polypus, 921 Ligation, 921 Clamp and cautery, 921 Of fistula in ano, 921 Palliative, 921 Operative, 921 by incision, 922 by ligation, 922 methods, 922 question of operation in phthisical cases, 922 Of hemorrhoids, 923 Palliative, 923 Astringent ointments, 923 Enemata of potassium chlorate, 923 of lime-water, 923 Use of copaiba, 923 of black pepper, 923 Oil of amber, locally, 923 Use of hamamelis virginica, 923 of ergotin, 923, 924 of aloes, 923 of cold water, 924 Rest after defecation, 924 Of prolapsing, 924 Operative, 924 Of external, 924 Of internal, 924 by strangulation, 924 method, 925 by clamp and cautery, 925 by écraseur, 925 by caustics, 926 by nitric acid, 926 by caustic potash, 926 Of hemorrhage from rectum, 926 Ice, use of, 927 Injections of ice-water, 927 of perchloride of iron, 927 Use of tampon, 927 method, 927 of Agnew's rectal chemise, 927 of ligature, 927

Rectum, heat of, in dysentery, 802 in pseudo-membranous enteritis, 765 painful disease of, influence on causation of constipation, 642 suppuration of, as a cause of suppurative pylephlebitis, 1098 stricture of, symptoms, 856

Recurrence of spasmodic stricture of oesophagus, frequency of, 421 of tonsillitis, frequency of, 387

Reflex causes of enteralgia, 660 nervous disturbance, due to biliary concretions, 1078 symptoms in morbid dentition, 374 spasm of muscles in general form of rheumatoid arthritis, 80