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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