INTRODUCTION 1
Ⅰ．Definition of Diagnosis 1
Ⅱ．Approach to Diagnosis of Disease 4
Ⅲ．Procedures Involved in Diagnosis 7
REFERENCES 15
Chapter 1 AORTIC INSUFFICIENCY 17
Rheumatic Aortic Insufficiency 18
Syphilitic Aortic Insufficiency 20
Bacterial Aortic Insufficiency 21
Calcific Aortic Stenosis and Insufficiency 22
Congenital Defects with Aortic Insufficiency 22
Arteriosclerotic Aortic Insufficiency 23
Relative Aortic Insufficiency 23
Traumatic Aortic Insufficiency 24
ILLUSTRATIVE CASES 25
Ⅰ．Aortic Insufficiency Due to Syphilis 25
Ⅱ．Healed Dissecting Aneurysm 33
Ⅲ．Bacterial Endocarditis 38
REFERENCES 42
Chapter 2 HEART FAILURE 43
Congestive Heart Failure 43
Failure Associated with Valvular Defects 45
Failure Associated with Arterial Hypertension 49
Failure Associated with Hypertension in the Pulmonary Circulation 50
Failure Associated with Pericarditis 51
Failure Associated with Congenital Defects 51
Failure Due to Disease of the Myocardium 52
Failure Associated with Miscellaneous Rare Conditions 53
Tumors of the Heart 53
Deformities of the Thorax 54
Trauma 56
Constrictive Endocarditis 56
Peripheral Circulatory Failure in Patients with and without Heart Disease 56
ILLUSTRATIVE CASES 60
Ⅰ．Chronic Rheumatic Heart Disease 60
Ⅱ．Pheochromocytoma 65
Ⅲ．Pulmonary Embolism 69
Ⅳ．Fibrinous Pericarditis;Tuberculosis of the Adrenals 76
Ⅴ．Syphilitic Myocarditis 82
Ⅵ．Rheumatic Fever with Acute Myocarditis 87
Ⅶ．Sulfonamide Reaction with Focal Myocarditis;Myocardial Infarction 91
Ⅷ．Amyloidosis with Infiltration of the Myocardium 95
Ⅸ．Sarcoidosis 99
Ⅹ．Myxoma of the Left Auricle 105
Ⅺ．Ruptured Syphilitic Aneurysm of the Aorta 110
REFERENCES 115
Chapter 3 PAIN IN THE CHEST 117
Pain Originating in the Tissues of the Neck or Chest Wall 119
Pain Originating in the Heart 121
Relative Myocardial Ischemia 121
Absolute Myocardial Ischemia 121
Pericarditis 125
Pain Originating in Other Intrathoracic Structures 126
Pain Referred from Subdiaphragmatic Structures 128
ILLUSTRATIVE CASES 130
Ⅰ．Dissecting Aneurysm 130
Ⅱ．Syphilitic Aneurysm of the Aorta 134
Ⅲ．Strangulated Diaphragmatic Hernia of the Stomach 139
REFERENCES 141
Chapter 4 SUDDEN DEATH 143
ILLUSTRATIVE CASE 146
Ⅰ．Dissecting Aneurysm with Rupture into Pericardium 146
REFERENCES 150
Chapter 5 FAILURE OF URINARY EXCRETION 151
Acute Failure of Urinary Excretion 153
Chronic Failure of Urinary Excretion 157
ILLUSTRATIVE CASES 161
Ⅰ．Acute Tubular Necrosis 161
Ⅱ．Periarteritis Nodosa;Glomerulonephritis 168
Ⅲ．Arteriosclerotic and Arteriolosclerotic Nephritis 172
Ⅳ．Congenital Polycystic Kidneys 177
REFERENCES 180
Chapter 6 HEMATEMESIS AND MELENA 181
ILLUSTRATIVE CASES 186
Ⅰ．Chronic Duodenal Ulcer 186
Ⅱ．Ulcer and Carcinoma of the Stomach 191
Ⅲ．Diverticula of the Colon 195
REFERENCES 198
Chapter 7 JAUNDICE 199
ILLUSTRATIVE CASES 207
Ⅰ．Fatty Infiltration of the Liver 207
Ⅱ．Biliary Calculi;Portal Cirrhosis 211
Ⅲ．Subacute Necrosis of the Liver 217
Ⅳ．Carcinoma of the Ampulla of Vater 221
Ⅴ．Chronic Calcareous Pancreatitis 226
Ⅵ．Duodenal Diverticulum 230
REFERENCES 235
Chapter 8 HEPATOMEGALY AND ASCITES 237
Hepatomegaly 237
Ascites 241
ILLUSTRATIVE CASES 247
Ⅰ．Hemochromatosis 247
Ⅱ．Nodular Cirrhosis of the Liver;Acute Pancreatitis 255
Ⅲ．Syphilis of the Liver 259
Ⅳ．Amebic Abscess of the Liver 263
Ⅴ．Primary Carcinoma of the Liver;Liver Necrosis 268
REFERENCES 271
Chapter 9 LYMPHADENOPATHY AND SPLENOMEGALY 273
Lymphadenopathy 273
Splenomegaly 276
ILLUSTRATIVE CASES 279
Ⅰ．Lymphosarcoma 279
Ⅱ．Non-pigmented Melanoma or Monocytoma 285
REFERENCES 288
Chapter 10 FEVER OF OBSCURE ORIGIN 291
Bacteremia 293
Localized Infections with or without Abscess Formation 294
Specific Infections 295
Toxic and Allergenic Agents 296
Diseases of the Blood-Forming Organs and Lymph Nodes 297
Malignant Tumors 298
Mesenchymal or Collagen Disease 298
Chills 299
Comments on Diagnostic Methods 300
ILLUSTRATIVE CASES 302
Ⅰ．Appendicitis;Pylephlebitis with Liver Abscesses 302
Ⅱ．Bacterial Endocarditis 307
Ⅲ．Periarteritis Nodosa;Glomerulonephritis;Hypersensitive Pneumonitis 312
Ⅳ．Lymphosarcoma 317
Ⅴ．Primary Carcinoma of the Gallbladder 322
REFERENCES 326
Chapter 11 DISEASES INVOLVING THE LUNGS OR MEDIASTINUM 327
Pneumonitis 327
Pulmonary Suppuration with Abscess Formation 334
Mediastinal Tumors 336
ILLUSTRATIVE CASES 342
Ⅰ．Tularemia 342
Ⅱ．Virus Pneumonia Due to Influenza A 346
Ⅲ．Lobar Pneumonia 350
Ⅳ．Actinomycosis 355
Ⅴ．Carcinoma of the Lung 360
Ⅵ．Carcinoma in the Anterior Mediastinum 364
REFERENCES 367
Chapter 12 MENINGITIS 369
ILLUSTRATIVE CASES 374
Ⅰ．Meningitis(Torula Infection) 374
Ⅱ．Tuberculous Meningitis 378
Ⅲ．Lymphosarcoma 381
REFERENCES 384
Chapter 13 SPECIAL DIAGNOSTIC PROBLEMS,INCLUDING THE DIAGNOSIS OF CERTAIN RARE DISEASES 387
Tumors and Granulomatous Diseases 390
Infections 400
Endocrine,Metabolic,and Nutritional Disturbances 406
Connective Tissue Diseases 410
Congenital Defects 413
ILLUSTRATIVE CASES 414
Ⅰ．Rheumatic Mitral and Tricuspid Disease;Pedunculated Thrombus in the Left Auricle 414
Ⅱ．Pancreatic Adenoma 419
Ⅲ．Pheochromocytoma;Resolving Pneumonia 426
Ⅳ．Multiple Myeloma 431
Ⅴ．Diabetes Insipidus;Eosinophilic Granuloma 436
Ⅵ．Lymphosarcoma 443
Ⅶ．Lymphosarcoma 448
Ⅷ．Infected Abortion 455
Ⅸ．Chronic Calcareous Pancreatitis 459
Ⅹ．Appendicitis with Rupture and Local Abscess Formation 464
Ⅺ．Amebic Dysentery with Intestinal Ulceration;Liver Abscesses;Encapsulated Empyema 469
Ⅻ．Vertebral Tuberculosis with Compression of the Spinal Cord 473
ⅩⅢ．Actinomycosis 480
ⅩⅣ．Pulmonary and Generalized Miliary Tuberculosis 485
ⅩⅤ．Acute Pneumococcal Endocarditis 490
ⅩⅥ．Acute Bacterial Endocarditis,Right Side of Heart 494
ⅩⅦ．Hyperthyroidism 499
ⅩⅧ．Intestinal Lipodystrophy 503
ⅩⅨ．Addisons Disease Due to Adrenal Tuberculosis 509
ⅩⅩ．Primary Amyloidosis 515
ⅩⅪ．Tuberculous Enteritis with Jejunal Stricture 521
ⅩⅫ．Inadvertent Gastroileostomy 526
ⅩⅩⅢ．Necrosis of Anterior Hypophysis Due to Multiple Abscesses 532
ⅩⅩⅣ．Systemic Lupus Erythematosus 539
ⅩⅩⅤ．Systemic Lupus Erythematosus;Glomerulonephritis;Rheumatic Valvulitis 544
ⅩⅩⅥ．Periarteritis Nodosa 549
ⅩⅩⅦ．Bronchiectasis;Allergic Reaction to Sulfonamide 556
REFERENCES 562
Chapter 14 UNKNOWN CASES FOR STUDY 567
CASE HISTORIES 568
Ⅰ．Aortic Insufficiency 568
Ⅱ．Partial Intestinal Obstruction 570
Ⅲ．Fever,Purpura and Anemia 571
Ⅳ．Skeletal Pain and Hypercalcemia 573
Ⅴ．Hypertension and Renal Failure 575
Ⅵ．Scleroderma and Encephalopathy 577
Ⅶ．Dyspnea,Cyanosis and Clubbing of Digits 580
Ⅷ．Massive Gastrointestinal Hemorrhage 582
Ⅸ．Heart Failure and Sudden Death 583
Ⅹ．Renal Failure without Hypertension 585
Ⅺ．Skeletal Pain and Hyperglobulinemia 587
DISCUSSIONS AND ANATOMICAL FINDINGS OF FOREGOING CASES 590
Ⅰ． 590
Ⅱ． 593
Ⅲ． 596
Ⅳ． 600
Ⅴ． 603
Ⅵ． 609
Ⅶ． 614
Ⅷ． 617
Ⅸ． 620
Ⅹ． 623
Ⅺ． 626
LABORATORY VALUES OF CLINICAL IMPORTANCE(ADULT) 631
SPECIAL INDEX OF SYMPTOMS,SIGNS,AND LABORATORY FINDINGS 635
GENERAL INDEX 641