CHAPTER IV. GENERAL DISEASES OF CONSTITUTIONAL TYPE. THE diseases enumerated in the nomenclature of disease, under the second section or division of General Diseases, are distinguished from those of the first division by their longer persistence, their possible recurrence in the same person, and their constitutional and hereditary character. These types of disease are defined in the nomenclature of the Royal College as : "Diseases for the most part which are apt to invade different parts of the same body simultaneously or in succession. They are sometimes spoken of as constitutional diseases, and they often manifest a tendency to transmission by inheritance." The diseases may be described in the following order. ACUTE RHEUMATISM. A specific disease, attended with fever and characterized by inflammation of the fibrous tissues surrounding the joints, but without tendency to the formation of matter. Many joints may be affected in the course of an attack at the same time or in succession. Acute rheumatism is attended with a free secretion of acid fluid from the skin, the acid being of the kind known as lactic. In my experimental researches I have shown that this acid has the power of producing the symptoms of the disease. Rheumatic disease of the heart is a common result of acute rheumatic fever. The affection is hereditary. Varieties of Rheumatism. Subacute Rheumatism.-A less acute form of the disease, but attended usually with some fever and much pain. Gonorrheal Rheumatism.-A specific form of acute rheuma tism, often very severe, and attended with severe febrile disturbance and with pain and swelling in the joints. A disease connected with and probably dependent on the specific disease which precedes its occurrence. Synovial Rheumatism.-Rheumatism of the joints with accumulation of serous or watery fluid in the synovial sacs or investing membranous pouches of the joints in which the lubricating synovial fluid is secreted. The disease is attended with much local swelling of the joints and pain, but with less inflammation and fever than occurs in acute rheumatism. Muscular Rheumatism.-A form of rheumatism affecting the sheaths, or fibrous coverings of muscles, and giving rise to pain, increased greatly by motion, throughout the muscular structures. There are two sub-varieties of muscular rheumatism : Lumbago, or rheumatism of the muscles of the back. Stiff neck, or rheumatism of the muscles of the neck. Chronic Rheumatism.-Rheumatism in which the pain is continued chiefly in joints, and attended with "stiffness and swelling of the various affected joints," and with little or no fever. GOUT. ACUTE GOUT. "A specific febrile disorder, characterized by inflammation without suppuration "-in other words, without the formation in the part affected of matter or pus-" but with considerable redness of the affected joints, chiefly of the hands and feet, and especially of the great toe. The disease is attended with excess of uric acid in the blood." Varieties of Gout. Chronic Gout.-A disease marked by a persistent gouty condition, with the joints often permanently enlarged from deposit of the urate of soda. Gouty Synovitis.-Gout attacking the synovial, or lining membrane of the joints. Chronic Rheumatic Arthritis.-"An affection characterized by pain, stiffness, and deformity of one or more of the joints, as- . sociated with deposition of new bone around them." This affection is sometimes confounded with pure chronic gouty disease. CANCER. MALIGNANT DISEASE. "A deposit or growth that tends to spread indefinitely into the surrounding structures, and in the course of the lymphatics in the part of the body affected, and to reproduce itself in remote parts of the body." Varieties of Cancer. Schirrus.-Hard cancer. A cancerous swelling, hard at first and then ulcerating. Schirrus often affects the breast in the female. Medullary.-Soft cancer. A cancerous tumor, frequently of rapid growth. It often becomes fungoid and easily bleeds. Epithelial. Cancroid.-Surface cancer. A cancer occurring superficially, and ulcerating over a large surface from the point where it commences. Melanotic Cancer. Melanosis.-Dark cancer. A cancerous growth with deposition in it of black pigment. Osteoid Cancer commencing in bone, and followed, as a rule, by similar development in other organs of the body. Villous.-Cancer of mucous membrane covered by villi or fine projecting mucous filaments. COLLOID. "A new growth, a great part of which is formed of transparent gelatinous substance," often attaining a large size. Colloid is doubtfully ranked as malignant. TUMORS. SIMPLE TUMORS OR SWELLINGS. The term tumor or simple tumor is applied to a swelling caused by a growth which is not cancerous or malignant. Such growth is sometimes called "benign," or non-malignant. Varieties of Tumors. Fibrous tumor.-A circumscribed growth of fibrous tissue, usually firm and of slow development. Fibro-cellular.-A circumscribed growth of mixed fibrous and cellular tissue. Fibro-nucleated.-A growth of fibrous tissue containing elongated nuclei. Fibro-plastic.-A rapidly-growing nucleated cellular growth, the cells being fusiform, spindle shaped. Myeloid. A growth of red tint, containing many nucleated cells, and commencing, generally, in the ends of bones. Fatty. Sometimes called Lipoma.-A growth composed of adipose or fatty tissue. Osseous. A growth of bone called sometimes exostosis, and presenting several sub-varieties, as ivory, or hard and smooth ;cancellated or porous; and diffused or spreading. Cartilaginous, sometimes called Enchondroma.-A growth affecting cartilage or cartilaginous structure. Fibro-cartilaginous.-A growth composed of fibrous and cartilaginous elements. Glandular. A growth occurring near to a gland and, to some extent, resembling a gland in structure. Sometimes called Adenocele. Vascular.-A growth composed largely of blood-vessels, but increasing slowly. Novus.-A vascular growth developing upon or below the skin, and when upon the skin assuming a round or strawberrylike character. Diffused over a considerable surface of the skin, a nævus is called, vulgarly, "port-wine mark" or "mother's mark." Sebaceous. A growth containing a fatty suet-like material, and often called a wen. Cholesteatoma.-A growth containing a fatty substance resembling cholesterine. Molluscum.-A firm dermoid growth connected with the hair follicles and resembling somewhat the bodies of molluscs. The growths attain sometimes a large size and have a pedicle or stalk. Warts. The hard, rough, vegetative-like structures occurring on the skin. Cheloid. A hard growth on the skin. Is often developed on a cicatrix or healed wound or sore. Moles.-Irregular raised spots on the skin containing black pigment. CYSTS. Cysts, often also called wens,-are hollow growths, more or less firm, containing some substance within them. The contained substance varies, and so gives rise to modifications of cysts. Scrous cysts contain watery or serous fluid. Synovial cysts, situated near joints, contain synovial fluid. Burse are the little swellings which occur near to joints, as at the back of the wrist. In addition to these there are also mucous cysts; suppurating cysts; sanguineous cysts,-called by the vulgar blood-warts ;—hemorrhagic; aneurismal; oily; gelatinous; compound or proliferous; complex; cretaceous or dermoid; and dentigerous cysts. LUPUS. NOLI ME TANGERE. "A spreading tuberculous inflammation of the skin, usually of the face, tending to destructive ulceration." There are two varieties: Chronic lupus; fixed, or not spreading. Lupus excedens; extending or spreading lupus. RODENT ULCER. A gnawing ulcer, or destructive ulceration going very deeply into the tissues without previous hardness, ulceration, or constitutional affection. The appearance is as if the tissues had been bitten or nibbled out from the surface. LEPROSY. The Elephantiasis of the Greeks. A disease of the skin, consisting of dark-red swellings or tubercles, with a rough and raised state of the skin generally. The affection is attended with hoarseness of the voice; with a fœtid discharge from the nose; and with ulcerations on the surface of the body. SCROFULA. A common constitutional disease, showing itself, generally, in symptoms of physical weakness of the body, with external swellings of the glands which often end in suppuration,-formation of matter. In some instances there is a deposit of tuberculous matter in different structures or organs of the body, especially in the lungs and in the mesenteric glands. To this condition or tendency of the body, the term scrofulous diathesis has been applied. There are two varieties of scrofula. Scrofula with tubercle. |