A concise manual of specific symptomatology can be allowed only a small space in a work like this, and I fear that. that space has been exceeded. For this reason, I have been obliged in writing to employ a style as compressed and uninteresting as that of a lapidarist. I regard it solely as a means of reference, and to facilitate its use as such I call particular attention to the Index at the end of the section. This will be helpful in finding the different symptoms and divisions. It has been impossible in enumerating the diseases which give rise to numerous symptoms even to attempt such a degree of completeness as the consul tation of all the latest treatises \vould insure. mid such a mass of de tails the general outline would he lost, and \Ve could not see the forest for the trees. This consideration awl the effort to omit nothing of real value, have placed me in many a painful dilemma. How nearly I have struck the golden mean must be determined by my younger colleagues in active practice, to whom this chapter is dedicated. With this idea_ in view, I feel myself entitled to deny the competence of any other tribunal, and above all that of the official theorists in this department, who will assuredly find much or all of my work inadequate. For example, the very grouping in the different divisions is in the highest degree unscientific. This must indeed be so, since this grouping can take account only of the purely external characteristics of a disease, such as a physician would easily detect, and not of those which lie deep in the inmost nature.
The possibility of such a misapprehension of my design as a whole, and of the detection of many other deficiencies of which I am not uncon scious, cause me to look forward with a certain dread to the verdict of those of my own specialty. In this verdict due allowance must be made for the utter absence of modern models in my undertaking.
The arrangement of the Symptomatolqy is as follows: The title of each division, when it denotes a symptom or a syndrome is followed, when necessary by: 1. An elucidation of the wording and of the idea.
2. A brief description of the symptom, if it is evident, or directions for discovering and distinguishing it, if it is not apparent.
3. Data concerning the respective physiological conditions at different ages.
4. Predispositions in certain cases, whereby a symptom may he simulated.
5. An enumeration of the pathological conditions which may, but do not necessarily, accompany or produce the symptom under consid eration. If, for example, under "Diaz() Reaction in the Urine" croup ous pneumonia is mentioned among the conditions, it must not be assumed that croupous pneumonia is always accompanied by diazo reaction; but only that in case a positive diazo reaction is present, pneumonia must be considered in the differential diagnosis. single pathognomonic symptoms are practically unknown, but the few essen tial symptoms from whose absence definite conclusions might be drawn are so designated.
The pathological conditions in company with which the symptom named in the heading appears, are not in every case its actual cause; indeed, the connection may be simply coordinate, or even some rela tionship not yet understood.
To many of the diseases enumerated I have added, briefly: 1. Some other indications, whose presence may serve effectually to distinguish the respective diseases from other conditions mentioned close by.
2. Some etiological references, but only such as appear valuable for diagnosis.
Rare diseases which are the occasional cause of the symptoms named in the headings are put in brackets.
Roman figures after the names of disease (e.g., meningitis tuber culosa I) indicate the stage of the disease.
Certain infectious diseases (such as the plague, typhus fever, Asiatic cholera, yellow fever, etc.) which seldom or never appear in our country, have been entirely omitted. This also is true of ailments which usually require the services of specialists, in the narrow sense of the term. I refer to certain surgical, orthopfedical, otological, laryngolog ical, psychiatrical, and dermatological diseases. Many details which have little practical value are omitted, such as the determination of the different types of congenital chorea, local devices of the neurologists, etc. There is no discussion of symptoms which can be used only within narrow limits in children, or which do not differ materially from those in adults (e.g., pneumothorax, pulmonary cavities). Symptoms having little value on account of their great frequency, such as "restlessness" and "fever," are not considered. Symptoms which demand special skill and require expensive bacteriological or chemical apparatus are not included.