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Dentist’s Guide to Medical Conditions, Medications & Complications K anchan G anda , M.D. Dentist’sGuidetoMedical Conditions,Medications, andComplications Dentist’sGuideto MedicalConditions, Medications,and Complications SecondEdition KanchanM.Ganda,M.D.
Thiseditionfirstpublished2013 C 2013byJohnWiley&Sons,Inc. Firsteditionpublished2008.
Wiley-BlackwellisanimprintofJohnWiley&Sons,formedbythemergerofWiley’sglobalScientific, TechnicalandMedicalbusinesswithBlackwellPublishing.
Editorialoffices: 2121StateAvenue,Ames,Iowa50014-8300,USA TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 9600GarsingtonRoad,Oxford,OX42DQ,UK
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LimitofLiability/DisclaimerofWarranty:Whilethepublisherandauthor(s)haveusedtheirbest effortsinpreparingthisbook,theymakenorepresentationsorwarrantieswithrespecttotheaccuracy orcompletenessofthecontentsofthisbookandspecificallydisclaimanyimpliedwarrantiesof merchantabilityorfitnessforaparticularpurpose.Itissoldontheunderstandingthatthepublisheris notengagedinrenderingprofessionalservicesandneitherthepublishernortheauthorshallbeliable fordamagesarisingherefrom.Ifprofessionaladviceorotherexpertassistanceisrequired,theservices ofacompetentprofessionalshouldbesought.
LibraryofCongressCataloging-in-PublicationData
Ganda,KanchanM.,author.
[Dentist’sguidetomedicalconditionsandcomplications]
Dentist’sguidetomedicalconditions,medications,andcomplications/ KanchanM.Ganda.–Secondedition.
p.;cm.
Revisededitionof:Dentist’sguidetomedicalconditionsandcomplications/ KanchanM.Ganda.2008.
Includesbibliographicalreferencesandindex. ISBN978-1-118-31389-3(softback:alk.paper)–ISBN978-1-118-31390-9(epdf)–ISBN978-1-118-31391-6(epub)–ISBN978-1-118-31392-3(emobi)
I.Title.
[DNLM:1.StomatognathicDiseases–complications.2.DentalCareforChronicallyIll. 3.MedicalHistoryTaking.4.PharmaceuticalPreparations,Dental–administration&dosage. 5.PharmaceuticalPreparations,Dental–contraindications.6.StomatognathicDiseases–drug therapy.WU140]
RK55.S53
617.6 026–dc23
2013003815
AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmay notbeavailableinelectronicbooks.
Coverimage: C webphotographeer CoverdesignbyMaggieVoss
Setin9.5/12ptPalatinobyAptara R Inc.,NewDelhi,India
12013
Dedication Thisbookisdedicatedtoallmystudents,pastandpresent;tomylateparents,Amrit DeviandRoopKrishanDewan;andtomyfamily,foralltheirencouragementandlovingsupport.
Acknowledgmentsxii Introduction:IntegrationofMedicineinDentistryxiv
SectionI:PatientAssessment1
1.RoutineHistory-TakingandPhysicalExamination3
2.HistoryandPhysicalAssessmentoftheMedicallyComplex DentalPatient24
SectionII:Pharmacology33
3.EssentialsinPharmacology:DrugMetabolism,CytochromeP450 EnzymeSystem,andPrescriptionWriting35
4.LocalAnestheticsCommonlyUsedinDentistry:Assessment, Analysis,andAssociatedDentalManagementGuidelines54
5.PainPhysiology,Analgesics,OpioidDependencyMaintenance Therapies,MultimodalAnalgesia,andPainManagement Algorithms67
6.OdontogenicInfections,Antibiotics,andInfectionManagement Protocols110
7.AntifungalsCommonlyUsedinDentistry:Assessment,Analysis, andAssociatedDentalManagementGuidelines150
8.AntiviralsCommonlyUsedinDentistry:Assessment,Analysis, andAssociatedDentalManagementGuidelines155
SectionIII:AcuteCareandStressManagement159
9.ManagementofMedicalEmergencies:Assessment,Analysis,and AssociatedDentalManagementGuidelines161
10.OralandParenteralConsciousSedationforDentistry:Assessment, Analysis,andAssociatedDentalManagementGuidelines183
SectionIV:HematopoieticSystem199
11.CompleteBloodCount:Assessment,Analysis,andAssociated DentalManagementGuidelines201
12.RedBloodCellsAssociatedDisorder:Anemia:Assessment, Analysis,andAssociatedDentalManagementGuidelines209
13.RedBloodCellsAssociatedDisorder:Polycythemia:Assessment, Analysis,andAssociatedDentalManagementGuidelines222
14.RedBloodCellsAssociatedDisorder:Hemochromatosis: Assessment,Analysis,andAssociatedDentalManagement Guidelines225
SectionV:HemostasisandAssociatedBleedingDisorders229
15.PrimaryandSecondaryHemostasis:NormalMechanisms,Disease States,andCoagulationTests:Assessment,Analysis,and AssociatedDentalManagementGuidelines231
16.PlateletDisorders:Thrombocytopenia,PlateletDysfunction,and Thrombocytosis:Assessment,Analysis,andAssociatedDental ManagementGuidelines243
17.VonWillebrand’sDisease:Assessment,Analysis,andAssociated DentalManagementGuidelines250
18.CoagulationDisorders:CommonClottingFactorDeficiency DiseaseStates,AssociatedSystemicand/orLocalHemostasis Adjuncts,andDentalManagementGuidelines254
19.Anticoagulants:Assessment,Analysis,andAssociatedDental ManagementGuidelines262
SectionVI:CardiologyandRenalDisease273
20.RheumaticFever:Assessment,Analysis,andAssociatedDental ManagementGuidelines275
21.InfectiveEndocarditisandCurrentPremedicationProphylaxis Guidelines279
22.HypertensionandTargetOrganDiseaseStates:Assessment, Analysis,andAssociatedDentalManagementGuidelines288
23.CerebralCirculationDiseasesTIAsandCVAs:Assessment, Analysis,andAssociatedDentalManagementGuidelines300
24.CoronaryCirculationDiseases,ClassicAngina,andMyocardial Infarction:Assessment,Analysis,andAssociatedDental ManagementGuidelines302
25.CongestiveHeartFailure:Assessment,Analysis,andAssociated DentalManagementGuidelines311
26.CardiacArrhythmias:Assessment,Analysis,andAssociated DentalManagementGuidelines315
27.PeripheralCirculationDisease318
28.RenalFunctionTests,RenalDisease,andDialysis:Assessment, Analysis,andAssociatedDentalManagementGuidelines319
SectionVII:PulmonaryDiseases331 29.PulmonaryFunctionTestsandSedationwithPulmonaryDiseases: Assessment,Analysis,andAssociatedDentalManagement Guidelines333
30.UpperAirwayDisease:AllergicRhinitis,Sinusitis,and StreptococcalPharyngitis:Assessment,Analysis,andAssociated DentalManagementGuidelines337
31.AsthmaandAirwayEmergencies:Assessment,Analysis,and AssociatedDentalManagementGuidelines341
32.ChronicBronchitisandSmokingCessation348
33.Emphysema:Assessment,Analysis,andAssociatedDental ManagementGuidelines356
34.ChronicObstructivePulmonaryDisease:Assessment,Analysis, andAssociatedDentalManagementGuidelines358
35.ObstructiveSleepApnea:Assessment,Analysis,andAssociated DentalManagementGuidelines365
36.Tuberculosis:Assessment,Analysis,andAssociatedDental ManagementGuidelines367
SectionVIII:ClinicalPharmacology375 37.PrescribedandNonprescribedMedications:Assessment,Analysis, andAssociatedDentalManagementGuidelines377
SectionIX:Endocrinology383
38.IntroductiontoEndocrinologyandDiabetes:Assessment, Analysis,andAssociatedDentalManagementGuidelines385
39.ThyroidGlandDysfunctions:Assessment,Analysis,and AssociatedDentalManagementGuidelines403
40.AdrenalGlandDiseaseStates:Assessment,Analysis,and AssociatedDentalManagementGuidelines408
41.ParathyroidDysfunctionDiseaseStates:Assessment,Analysis, andAssociatedDentalManagementGuidelines417
42.GrowthHormoneDysfunctionandEndocrineTissuesofthe ReproductiveSystem433
SectionX:SeizureDisorders437
43.ClassicSeizures:Assessment,Analysis,andAssociatedDental ManagementGuidelines439
SectionXI:GastrointestinalConditionsandDiseases447
44.GastrointestinalDiseaseStatesandAssociatedOralCavity Lesions:Assessment,Analysis,andAssociatedDental ManagementGuidelines449
SectionXII:Hepatology465
45.LiverFunctionTests,Hepatitis,andCirrhosis:Assessment, Analysis,andAssociatedDentalManagementGuidelines467
SectionXIII:PostexposurePreventionandProphylaxis493
46.Needle-StickExposureProtocolandCDCRecommendationsfor DentalHealth-CareProvidersInfectedwiththeHepatitisBVirus495
SectionXIV:InfectiousDiseases503
47.HumanImmunodeficiencyVirus,HerpesSimplexandZoster, LymeDisease,MRSAInfection,andSexuallyTransmittedDiseases505
SectionXV:OralLesionsandDentistry539
48.TherapeuticManagementofOralLesionsinthe Immune-CompetentandtheImmune-CompromisedPatientinthe DentalSetting541
SectionXVI:TheFemalePatient:Pregnancy,Lactation,and Contraception565
49.Pregnancy,Lactation,andContraception:Assessmentand AssociatedDentalManagementGuidelines567
SectionXVII:Rheumatology:DiseasesoftheJoints,Bones, andMuscles587
50.ClassicRheumaticDiseases:AssessmentandAssociatedDental ManagementGuidelines589
SectionXVIII:Oncology:HeadandNeckCancers,Leukemias, Lymphomas,andMultipleMyeloma625
51.HeadandNeckCancersandAssociatedDentalManagement Guidelines627
SectionXIX:Psychiatry661
52.PsychiatricConditions:AssessmentofDiseaseStatesand AssociatedDentalManagementGuidelines663
SectionXX:Transplants683
53.OrganTransplants,ImmunosuppressiveDrugs,andAssociated DentalManagementGuidelines685
SectionXXI:CommonLaboratoryTests695
54ComprehensiveMetabolicPanelandCommonHematological Tests697
Appendix:SuggestedReading699 Index743
Acknowledgments IwishtosincerelythankBruceJ.Baum,D.M.D.,Ph.D.,ChiefoftheGeneTherapy andTherapeuticsBranchattheNationalInstituteofDentalandCraniofacialResearch inBethesda,Maryland.Hewasinstrumentalinmentoringmeandmotivatingmeto publishmywork,whichisnowinitssecondedition.Dr.Baum’svisionfordentistry andhisconfidencethatmyworkwouldmakeadifferencehasbeenandcontinuesto beveryhumbling.
ThankstomyformerdeansatTuftsUniversitySchoolofDentalMedicine—Lonnie Norris,D.M.D,M.P.H.,andDeanofCurriculum,NancyArbree,D.D.S.,M.S.—formakingmyvisionofintegratingmedicineintothedentalcurriculumareality.Iwasgiven theflexibilitytocreateamedicinecurriculumforourstudentsandintegratethiseducationthroughallthefouryearsofdentalcurriculum.
MyverysincerethankstoHuwF.Thomas,B.D.S.,M.S.,Ph.D.,ourcurrentdeanatTuftsUniversitySchoolofDentalMedicine,andtoMarkNehring, M.Ed.,D.M.D.,M.P.H.,thechairoftheDepartmentofPublicHealthandCommunityServicesatTuftsUniversitySchoolofDentalMedicine(myformerchair), fortheirtremendoussupportinensuringarapidlyprocessedsabbatical,soI couldcompletethesecondeditionofmybook.Additionally,IamverygratefultomycolleaguesDianaEsshaki,D.M.D.,M.S.,andPatrickMcGarry,D.M.D., fortheirunconditionalsupportinefficientlyexecutingallresponsibilitieswhileI wasaway.
Toallthepastandpresentmedicinecoursespeakersandrotationdirectors,specialistsintheirrespectivefieldsofmedicine,thisuniquedentaleducationwouldhave beenincompletewithoutyouractiveparticipation,dedication,andsupport.Iwishto acknowledgeandthankyouallforyoureffortsandendlesssupport.
IalsowouldliketothankmyD’14studentMs.JaskarenK.Randhawaforherunflaggingsupportandhelpwiththeproofingofthematerial.
I’dliketothankmydaughterKiran,forpatientlyprovidingmewitharound-theclocktechnicalsupport.Also,sincerethankstomydaughterAnjaliandmyhusband, Om,bothofwhomarephysicians,forenthusiasticallyparticipatinginournumerous discussionsduringwhichtheyofferedtheirinsightsaboutpatientcare.
Thisfinestqualitysecondeditionwouldnothavebeenpossiblewithouttheassistanceofmyverytalentedprojectmanager,Ms.ShikhaSharmaofAptara,Inc., xii
NewDelhi,India.Herprofessionalism,veryfriendlypersonality,expertise,attentionto detailmadeitaverypleasurableexperienceindeed;sheissomeonewhowentabove andbeyondeverystepoftheway.Iamdelightedtohavebeenlinkedwithsucha talentedandknowledgeableindividualandIamsoextremelysatisfiedwiththefinal productshecreated!
Lastbutnotleast,Iwishtothankallmystudents,whohavebeenmyconstantsource ofinspiration.Inevercouldhaveexperiencedthejoyofteachingwithouttheiractive participationandenduranceinthelearningofmedicine!
KanchanGanda,M.D.
Introduction:Integrationof MedicineinDentistry Dentalcaretodayholdsmanychallengesforthedentalpractitioner.Patientsareliving longer,oftenretainingtheirowndentition,haveoneormoremedicalconditions,and routinelytakeseveralmedications.
Alongwithexcellenceindentistry,thepracticingdentisthasthedualtaskofstaying updatedwiththecurrentconceptsofmedicineandpharmacology.Theyshouldrightfullybecalledthe“PhysicianoftheOralCavity.”
Theintegrationofmedicineinthedentalcurriculumhasbecomeanecessity,and thisintegrationmustbeginwiththefreshmanclass,sothestudentscangainmaximum benefitandthechancetogaincredibility.Theintegrationofmedicineisbestachieved whendoneinacase-basedorproblem-basedformatandcorrelatedwiththebasicsciences,pharmacology,generalpathology,oralpathology,anddentistry.Thereneedsto beatruecommitmentand constant reinforcementoftheintegrationin all thedidactic andclinicalcourses.
Theintegrationofmedicine,pharmacology,andmedicallycomplexpatientcareis bestachievedwhendoneinapyramidalprocess,throughthefouryearsofdentaleducation.
Thefoundationshouldinstillabasicknowledgeof:
1.Standardandmedicallycomplexpatienthistory-takingandphysicalexamination.
2.Symptomsandsignsofhighest-priorityillnesses,alongwiththecommonlaboratorytestsevaluatingthosediseasestates.
3.Anesthetics,analgesics,antibiotics,antivirals,andantifungalsusedindentistry.
4.Prescriptionwriting.
“Normal”patientassessment,whenstressedinthefirstyear,preparesstudentsto betterunderstandthechangespromptedbydiseasestatesduringthesecondyearof theireducation,whendidacticandclinicalknowledgeofhighest-priorityillnesses,associateddiagnosticlaboratorytests,andthevastpharmacopeiausedforthecareofthose diseasesisincluded.Case-basedscenariosshouldbeusedtosolidifythisinformation.
Theprogressivelearninguptotheendofthesecondyearpreparesthestudentto “care”forthepatient“onpaper.”Withthestartoftheclinicalyears,thestudentispreparedtoapplythisknowledgetoward“actual”patientcare,whichoccurstypicallyduringthethirdandfourthyearsofeducation.
Duringthethirdyear,thestudentshouldparticipateinmedicalandsurgicalclinical rotationsinahospitalizedsettingandcompleteaHospitalClerkshipProgramwhere thestudentisexposedtohead-and-neckcancercare,emergencymedicine,criticalcare, anesthesia,hematology,oncology,transplants,cardiothoracicsurgery,andsoon.This exposurewillwidenthestudent’sknowledge,broadenclinicalperception,andfurther enhancethelinkbetweenmedicineanddentistry.
Duringtheclinicalyears,thestudentsshouldcompletefaculty-reviewedmedical consultsfor all theirmedicallycompromisedpatients, prior todentistry.Thispatientby-patienthealthstatusreviewwillhelpcorrectlytranslatetheirdidacticpatient-care knowledgeintheclinicalsetting.
Thetextisacompilationofmaterialsneededfortheintegrationofmedicineindentistry.Itisabookalldentalstudents and dentalpractitionerswillappreciatebothasa readandchair-side.
Thistextprovidesinformationonepidemiology,physiology,pathophysiology,laboratorytestsevaluation,associatedpharmacology,dentalalerts,andsuggesteddeviationsintheuseofanesthetics,analgesics,antibiotics,antivirals,andantifungalsforeach diseasestatediscussed.
Thestudentwillgreatlybenefitfromthesectionsdetailinghistory-takingandphysicalexamination;highlyexpandedclinicalandappliedpharmacologyofdentalanesthetics,analgesics,antibiotics,antivirals,andantifungals;stressmanagement;andmanagementofmedicalemergenciesinthedentalsetting.
I PatientAssessment GENERALOVERVIEW PatientInterviewIntroduction 1 RoutineHistory-Takingand PhysicalExamination Theprimaryjobofthedentalstudentstartingclinicalworkistolearntoconducta patientworkupthoroughlyandefficiently.Theheartofeverypatientworkupisaset patterndoneinasequentialorderofdatacollectionandanalysis.
PatientWorkupSequentialPattern Thesequentialpatternofpatientworkupconsistsofthefollowing:
1.Historyandphysicalexamination.
2.Laboratorydatacollectionandanalysis.
3.Diagnosticandtherapeuticplanformulation.
Thefirststep,thepatientinterview,orthehistory,isprobablythesinglemostimportanttaskinthediagnosticpatientworkupbecauseofitsimportanceindiagnosisandin thedevelopmentofagooddoctor-patientrelationship.Theprovidershoulddemonstrateaprofessionalmannerthatwillputthepatientatease.Duringtheinterview, alwayslistencarefullytothepatient.Useinterrogationsparingly,oruseitlatertoaida communicatingpatient,ortorestricttherarepatientwhohasatendencytoramble!
PatientInterviewPracticalPoints Keepyourappearanceneatandclean.Thiswillhelpgainyourpatient’strust.Always introduceyourselfwhenmeetingapatientandrefertothepatientas“Mr.JohnDoe” or“MissJaneDoe.”Donotusefirstnamesduringtheinitialencounter.Exchangeafew briefpleasantriesbecausemovingforward,thiswillhelpbothyouandthepatientfeel comfortableandateasewithoneanother.
Dentist’sGuidetoMedicalConditions,Medications,andComplications,SecondEdition.KanchanM.Ganda. C 2013JohnWiley&Sons,Inc.Published2013byJohnWiley&Sons,Inc.
Alwayshaveafriendlyandsincereinterestinyourpatient’sproblem(s).Alwaysbe courteous,respectful,andconfidentialandshowacontinuedinterestwhileyouarewith thepatient.
PhysicalExaminationPracticalPoints Priortothestartofthephysicalexaminationletthepatientknowthatyouaregoingto takethepulseandbloodpressureandexaminetheheadandneckarea.Thisheads-up willenablethepatienttounderstandthatyouwillbetouchinghimorher.Yourattentive andrespectfulwayswillenhanceagooddoctor-patientrelationship.
Thephysicalexaminationisanartthatislearnedbyconstantrepetition.Thereare manystylesandmethodsforconductingthegeneralexamination,andeveryclinician willultimatelychooseoneexaminationsequencetogoby.Mostclinicians,however, preferthehead-to-footorder.Whenexamininganyareaofthebody,itisusuallybestto followanorderlysequenceofinspection,palpation,percussion,andauscultation.This sequentialroutineensuresthoroughness.
Thephysicalexaminationshouldalwaysbeconductedandassessedinthecontextof thepatient’sdentalandmedicalhistory.Therangeof“normal”variesfrompatientto patient.
Thestudentneedstobecomefamiliarwiththeuseofthestethoscopeandtheblood pressurecuff.Fumblingwithyourequipmentorthetechniqueduringpatientexaminationwillcauseyouembarrassment.Thestudentalsoneedstopracticethehead-andneckexamtechniquesoftenonfriendsorfamilymemberstogetagoodsenseofthe normal.
History-TakingandPhysicalExamination:BroadConclusions Afterthehistoryandphysicalexaminationiscompleted,youshould,inmostcases,be abletoanswerthefollowingquestions:
Thediseasestatesthatexistinthepatientandwhetherthepatient’sproblemsare acuteorchronic.
Theorgansystemsthatmaybeinvolved.
Thedifferentialdiagnosisofthepatient’sproblems.
Thelaboratoryteststhatwillbeneededfortheevaluationofthediseasestates.
Confirmationorexclusionofadiagnosisand/orwhethertofollowthecourseofa diseasestate.
HISTORY-TAKINGDETAILS Thepurposeofmedicalhistoryandphysicalexaminationistocollectinformationfrom thepatient,toexaminethepatient,andtounderstandthepatient’sproblems.Traditionalhistory-takinghasseveralparts,eachwithaspecificpurpose.Inordertoachieve maximumsuccess,themedicalhistorymustbeaccurate,concise,andsystematic.
Thefollowingisastandardoutlineinsequentialorderofthedifferentcomponents ofhistory-taking.Theintroductorymaterialsinthehealthhistoryconsistofcollecting severaltypesofinformationfromthepatient.
DataCollection Thefollowinginformationisobtainedinallpatientstogainabasicunderstandingof thepatient:
Dateofthevisit:Recordnumber:
Name: (last)(first)(middle)
Homeaddress:Homephone:
Businessaddress:Businessphone:Cellphone:
Occupation:Dateofbirth:
Sex:M/F/Transgender/Other
Maritalstatus:S/M/D/W/Partnership
Height:
Weight:
Referredby:
ChiefComplaint Thechiefcomplaintstatesinthepatient’sownwordsthereasonforthevisit,forexample,“Ihaveatoothache”or“Ineedarootcanal.”
PresentHistory Presenthistorylists,inclear,chronologicalorder,thedetailsoftheproblemorproblems forwhichthepatientisseekingcare.Youwilldeterminebyinterrogationatimelineof thefollowing:
1.Whendidthepatient’sproblem(s)begin?
2.Wheredidtheproblem(s)begin?
3.Whatkindsofsymptomsdidthepatientexperience?
4.Hasthepatienthadanytreatmentfortheproblem(s)?
5.Hasthetreatmenthadanypositiveornegativeeffectonthepatient’scondition?
6.Hasthepatient’slifestylebeenaffectedbytheproblem(s)?
PastHistory Thepasthistorygivesyouaninsightaboutthehealthstatusofthepatientuntilnow. Checkwiththepatientforthepresenceorabsenceofdiseasesbyelicitingthe symptoms andsigns associatedwiththediseasestates.Itisbesttoaccessthediseasestateswith thepatientin alphabetical ordertoensureyouaddresseachdiseasestateanddonot missanything.Useinterrogationtocheckforthefollowingdiseasestates:
Anemia Determinethepresenceorabsenceofthenutritional,congenital,andacquiredorchronic disease-associatedanemias.
BleedingDisorders
Determinethepresenceorabsenceofthecongenitalandacquiredtypesofbleeding disorders.
CardiorespiratoryDisorders
Determinewhetherthepatienthasahistoryofangina,myocardialinfarction,transientischemicattacks(TIAs),cerebrovascularattacks(CVAs/strokes),hypertension, rheumaticheartdisease,asthma,tuberculosis,bronchitis,sinusitis,andchronicobstructivepulmonarydisease(COPD).
Drugs/Medications
Determinethepatient’scurrentmedications.Checkforprescribed,herbal,andoverthe-counter(OTC)medications.Determinewhetherthepatientiscurrentlyoncorticosteroidsorhasbeenonthem,bymouthorbyinjection,fortwoweeksorlongerwithinthe pasttwoyears.Checkifthepatienthasknownallergiestoanydrugs,suchasNSAIDS, aspirin,codeine,morphine,penicillin,sulphaantimicrobials,bisulfites,metabisulfites, orlocalanesthetics.
EndocrineDisorders
Checkfordiabetes,hyperthyroidism,hypothyroidism,parathyroiddisorders,andpituitaryandadrenaldisorders(Addison’sdiseaseorCushing’ssyndrome).
FitsorFaints
Checkforthepresenceofdifferentkindsofseizures:grandmalepilepsy,petitmal epilepsy,temporallobeorpsychomotorepilepsy,orlocalizedmotorseizures.
GastrointestinalDisorders
Checkfororalulcerations,esophagitis,gastritis,pepticulcerations,Crohn’sdisease, celiacdisease,ulcerativecolitis,diverticulitis,polyps,andhemorrhoids.
HospitalAdmissions
Determinethecauseorcausesforadmissionandalsocheckifthepatienthadanyhistoryofaccidentsorinjuries.Determinewhetherthepatientwasgivenanyanesthesia, eitherlocalorgeneral,duringthehospitaladmission.Furthermore,determinewhether therewereanycomplicationsduringthehospitaladmissionduetotheanesthesiaor duetothemedical/surgicalconditionforwhichthepatientwasadmitted.Determine whetherthepatientwasgivenabloodtransfusionduringhospitalization.
ImmunologicalDiseases
Checkforlupus,Sjogrenssyndrome,rheumatoidarthritis,andpolyarthritisnodosa.
InfectiousDiseases Checkforinfectiousdiseasesofchildhood:measles,mumps,chickenpox,streptococcuspharyngitis,rheumaticfever,orscarletfever.Alsocheckforinfectiousdiseasesof adulthood:sexuallytransmitteddiseases(STDs),hepatitis,HIVinfection,MethicillinResistantStaphylococcusAureus(MRSA)infection,andinfectiousmononucleosis.
JaundiceorLiverDisease
Ifthepatientisjaundicedorhashadjaundice,determinethecause.Isitduetoviral hepatitis,alcoholichepatitis,orgallstones?Determinewhetherthereisanyhistoryof gallbladderdysfunction.Checkwhetherthereisanyindicationofimproperliverfunction.
KidneyDisorders
Determinewhetherthereisanyindicationofkidneydysfunction,renalstones,urinary tractinfections,renaldisease,renalfailure,orrenaltransplant.
LikelihoodofPregnancy Determinethedateofthepatient’slastmenstrualperiod(LMP)andwhetherthepatient ispregnant.Alwaysletthepatientknowthatpriortodentalradiographs,youneedto knowifthepatientispregnant.Youneedtoalsoknowthepregnancystatus,asthere arecertainanesthetics,analgesics,andantibioticsthatarecontraindicatedduringpregnancy.
MusculoskeletalDisorders
Checkforosteoporosisandothercausesofimpairedbonemetabolism,Paget’sdisease,osteoarthritis,rheumatoidarthritis,psoriaticarthritis,gout,musculardystrophy, polymyositis,andmyastheniagravis.
NeurologicalDisorders Checkforcranialnervedisorders,headaches,facialpains,migraine,multiplesclerosis,motorneurondisease,transientischemicattacks(TIAs),orcerebrovascularaccidents(CVAs)associatedneurologicaldeficits,Parkinson’sdisease,andperipheralneuropathies.
ObstetricandGynecologicalDisorders Checkforconditionsordiseasesthatcanleadtospontaneousabortions,miscarriages, bleeding,oranemia.Alsocheckforanytumorsneedingchemotherapyorradiotherapy.
PsychiatricDisease Checkforpersonalitydisorders,neuroses,anxiety,phobias,hysteria,psychoses,schizophrenia,dementia,Alzheimer’sdisease,andposttraumaticstressdisorder(PTSD).
RadiationTherapy
CheckforanyradiationtotheheadandneckregionandtheRADSorGyofradiation received.
SkinDisorders
Lichenplanus,phemphigus,herpessimplex,herpeszoster,eczema,unhealedskin lesions,andurticaria(itchingoftheskin)areconditionsthatshouldbecheckedfor.
Tetanus
Determinethepatient’simmunizationstatusfortetanus,hepatitis,influenza,andpneumonia.
Violence
Checkfordomesticviolence,intimatepartnerviolence(IPV),andelderorchildabuse.
Wounds
Determinethepatient’swound-healingcapacity.
PersonalHistory Inthispartofthehistory,wetrytogetaninsightintothepatient’slifestyle,occupation, andhabits.Inthelifestylecomponent,anattemptismadetounderstandwhatconstitutesatypicaldayforthepatient.Whatdoesthepatientdoforrecreation,relaxation, andsoon?Whatisthepatient’sjoblike?Arethereanyjob-relatedtoxicexposures?Is thereanyhistoryofalcohol,coffee,orteaintake?Howmuchofthesedoesthepatient consume?Isthereanyhistoryofdiarrheaorvomiting?
Isthereanyhistoryofsmokingcigarettesorusing“recreational”drugssuchasmarijuana,cocaine,oramphetamines?Hasthepatienteverusedintravenous(IV)drugsor swappedneedles?Hasthepatientbeenexposedtoanyinfectiousdiseasesorsexually transmitteddiseases(STDs)?Doesthepatientuseanyherbalmedicationsorover-thecountermedications?
Doesthepatientusedietpills,birthcontrolpills,laxatives,analgesics(aspirin, acetaminophen,NSAIDS,andotherpainmedications),orcough/coldmedications?
FamilyHistory Oncethepatient’smedicalhistoryhasbeencompleted,itisimportanttoassessthe healthstatusoftheimmediatefamilymembers.Determinewhethercertaincommon
diseasesruninthefamilyorifafamilialdiseasepatternexists.Determinetheageand healthofthepatient’sparents,siblings,andchildren.Ifanymemberisdeceased,the causeofdeathandageatdeathshouldalwaysbeestablished.
Presenceofdiseaseswithastronghereditarycomponentortendencyforfamilial clusteringshouldbedetermined.Thesediseasesarecoronaryarterydisease(CAD), heartdisease,diabetesmellitus(DM),hypertension(Htn),stroke(CVA),asthma,allergies,arthritis,anemia,cancer,kidneydisease,orpsychiatricillness.
ReviewofSystems:OverviewandComponents Reviewofsystems(ROS)isafinalmethodicalinquirypriortophysicalexamination. Allorgansystemsnotdiscussedduringtheinterviewaresystematicallyreviewedhere. Itprovidesathoroughsearchforfurther,asyetunestablished,diseaseprocessesinthe patient.Ifthepatienthasfailedtomentioncertainsymptoms,theprocessofROShelps remindthepatient.Also,ifyouhaveunknowinglyomittedquestioningthepatient aboutcertainaspectsofhisorherhealth,nowisthetimetoincludetheseaspects.
ReviewofSystems:AssessmentComponents Constitutional Determinewhetherthereisanyhistoryofrecentweightchange,anorexia(lossof appetite),weakness,fatigue,fever,chills,insomnia,irritability,ornightsweats.
Skin
Isthereanyhistoryofallergicskinrashes,itchingoftheskin,unhealedlesions(probably duetodiabetes,poordiet,steroids,HIV/AIDS,ansoon)?Istherashacuteorchronic? Istherashunilateralorbilateral?Doesthepatienthaveanyhistoryofbruisingor bleeding?
Head Isthereanyhistoryofheadachesorlossofconsciousness(LOC)?LOCmaybedueto cardiovascular,neurologic,ormetaboliccauses;oritmaybeduetoanxiety.
Isthereanyhistoryofseizures?Aretheseizuresgeneralized(withorwithoutlossof consciousness)orfocal?Arethereanymotormovements?Isthereanyhistoryofhead injury?
Eyes
Checkforacuityofvision,historyofglaucoma(cancauseeyepain),redness,irritation, halos(seeingawhiteringaroundalightsource),orblurredvision.Isthereanyirritation oftheeyesorexcessivetearing?Thesesymptomscouldalsobeallergy-associated.
Ears Checkforrecentchangesinhearing,earpain,discharge,vertigo(dizziness),orringing intheears(tinnitus).
LymphGlands
Checkforlymphglandularenlargementintheneckorelsewhere.Arethenodestenderorpainless,oraretheyhotorcoldtotouch?Whendidthepatientfirstnoticeany changesinthenodes?Arethenodesfreelymobile,oraretheyanchoredtotheunderlyingtissues?
RespiratorySystem
Askifthereisanyhistoryoffrequentsinusinfection,postnasaldrip,nosebleed,sore throat,orshortnessofbreath(SOB)onexertion,oratrest.SOBcanbeduetorespiratory, cardiac,ormetabolicdiseases.
Checkforwheezing(maybeduetoasthma,allergies,andsoon)andhemoptysis orbloodinthesputum(maybeduetodentalcausesorduetolungcausessuchas bronchitisortuberculosis).Checkifthecoughwithexpectorationisblood-tingedoris therefrankbloodinthesputum.Isthereanyhistoryofbronchitis,asthma,pneumonia, oremphysema?
CardiovascularSystem Isthereanyhistoryofchestpainordiscomfortorpalpitations?Havethepalpitations beenassociatedwithsyncope(lossofconsciousness)?Isthereanyhistoryofeither hypertensionorhypotension?Doesthepatientexperienceanyparoxysmalnocturnal dyspnea(shortnessofbreathexperiencedinthemiddleofthenight)?Isthereanyshortnessofbreath(SOB)withexerciseorexertion?
Isthereanyhistoryoforthopnea(SOBwhenlyingflatinbed)?Doesthepatientuse morethanonepillowtosleep?Hasthisalwaysbeenthecase,orhasthepatientrecently startedusingmorepillows?
Isthereanyhistoryofedemaofthelegs,face,andsoon?Doesthepatientexperience anyhistoryoflegpainsorcramps?Arethecrampsrelievedbyrest?Ifso,thisissuggestiveofintermittentclaudication.Ifthecrampingorlegpainsareunremitting,itismore likelytobemuscularinorigin.
Isthereanyhistoryofmurmur(s),rheumaticfever,orvaricoseveins?Isthereany historyofhypercholesterolemia,gout,orexcessivesmokingthatcanleadtoorworsen heartdisease?
GastrointestinalSystem Checkforahistoryofbleedinggums,oralulcers,orsores.Isthereanyhistoryofdysphagia(difficultyswallowing)?Canthepatientpointoutanddescribewherethedifficulty swallowingexists?Isthereanyhistoryofheartburn,indigestion,bloating,belching,or flatulence?Isthereanyhistoryofnausea?Isitrelatedtofood?Determinethefollowing:
Vomiting: Isthereanyassociatedweightloss?Aretherepsychosocialfactorsor medicationscausingit?
Hematemesis(vomitingblood): Askforassociatedulcerhistory,foodintolerance, abdominalpain,ordiscomfort.
Jaundice: Isthejaundiceduetoaviralcauseorgallstones?
Isthereahistoryofdiarrhea/constipationoranychangeincolorofstools?
GenitourinarySystem Isthereahistoryofpolyuria(excessiveurination)duetodiabetes,renaldisease,oran unknowncause?Isitarecentchange?Isthereanyhistoryofnocturia(gettingupat nighttogotothebathroom)?Isthisarecentchange?Isthereanyhistoryofdysuria (painfulurination)?Ifdysuriaisbecauseofurinarytractinfection(UTI),frequencyand urgencywillalsobeexperienced.STDswillalsobeassociatedwithsimilarsymptoms. WithapositivehistoryofSTD,alwayschecktoseeiftreatmentforSTDwascompleted. Checkforrenalstones,painintheloins,andfrequentUTIs.
MenstrualHistory Determinethedateofthelastmenstrualperiod.Neverforgettoparaphrasethisquestion,asdiscussedpreviously.Checkforanyhistoryofmenorrhagia(heavyperiods). Checkwhetherthepatientusesbirthcontrolororalcontraceptivepillsanddetailsof thetypeofcontraception.Letthepatientknowthatitisfirmlyestablishednowthatoral antibioticscanonlydecreasethepotencyofcombinedoralcontraceptivespills(COCPs) orprogesterone-onlycontraceptivepillswhenantibioticscause severepersistent diarrheaorvomiting,thusessentially“washingout”thepills.Itisonlythenthatthepatient willhavetouseextrabarrierprotectionuntiltheendofthenextcycletopreventpregnancy.ItiswelldocumentednowthatcertainmedicationslikeRifampinorantiseizure medicationsorazoleantifungalsthat induce cytochromeP450enzymesystem doaffect thepotencyof justtheCOCPs containingestrogenandprogesterone,asthesemedicationsnegativelyaffectthemetabolismofjustestrogenandnotprogesterone.Sowhileon theseenzyme-inducermedicationsincombinationwithCOCPs,thepatientwillhaveto usebarrierprotectiontopreventpregnancy.Antibioticsprescribedinthedentalsetting arenotCYP450enzymeinducers.Alwaysenteracasenoteintherecordstatingthatthe patienthasbeensoinformed.
MusculoskeletalSystem Checkforahistoryofjointpainsandwhatjointsareaffected.Isthepainacuteorchronic, unilateralorbilateral,andisitinthemorningorintheevening?Arethereanysystemic symptoms?Isthereahistoryofrheumatoidarthritis,osteoarthritis,orgout?
EndocrineSystem Checkforsymptomsassociatedwithdiabetes:polyuria(excessiveurination),polydypsia(excessivethirst),polyphagia(excessivehunger),orweightchange;thyroid: heat/coldintolerance,increased/decreasedheartrateorgoiter,andadrenals:weight change,easybruising,hypertension,andsoon.
NervousSystem Checkforahistoryofstroke,cerebrovascularaccident/stroke(CVA),ortransient ischemicattack(TIA).Checkforahistoryofmuscleweakness,involuntarymovements duetotremors,seizures,oranxiety.Checkforhistoryofsensorylossofanykind,anesthesia(nosensation),parasthesias(alteredsensationcommonlyexperiencedaspinsand needles),orhyperesthesias(increasedsensations).Checkifthereisanychangeinmemory,especiallyarecentchange.
History-TakingConclusion Itisimportantatthispointtocollecttherelevantdataorallpositivefindingsaboutthe patientandthenconstructalogicalframeworkofthecase.Youarenowabletodecide whichorganorbodyareaisaffectedandwheretofocusonduringphysicalexamination.
PHYSICALEXAMINATION:DETAILEDDISCUSSION StructureandOverview
Thehistoryservestofocusonandprovidesemphasistothephysicalexaminationinthe sequenceofpatientworkup.Thepatientisexaminedfromheadtotoe,thusensuring thoroughnessandscreeningforabnormalities.Anyspecificphysicalfindingssuggested becauseofthehistoryfindingsaresought.
PHYSICALEXAMINATION:ASSESSMENTCOMPONENTS Thefollowingarecomponentsofthephysicalexaminationinsequentialorder.
GeneralAppearance
Notethepatient’smentalstatus,abilitytointeract,speechpattern,neatness,andsoon.
VitalSigns:Pulse,RespirationRate,BloodPressure,Height,and Weight
Pulse
Notetherate,rhythm,volume,andregularityofthepulse.Countthepulserate/minute. Ifthepulserhythmisirregular,determinewhethertheirregularrhythmisregularor irregular.Anirregularity,morethan5beats/min,ispathologicalandshouldprompta consultwiththepatient’sMD(normalpulse:65–85beats/min).
RespirationRate
Notethebreathingpatternandtherespiratoryrate(RR)/min whiletaking thepulse, sothepatientisunawareandanxietydoesnotalterthebreathing(normalRR:12–16 breaths/min).
BloodPressureOverview
Takethebloodpressure(BP)inbotharmsduringthepatient’sfirstvisit.Alwaysobtain twobloodpressurereadings,takenfiveminutesapart,duringthepatient’sfirstvisit.If thebloodpressureishigh,confirmtheelevatedreadinginotherarmandthentaketwo morereadingsatthenextvisit.Anaverageofthreetofourreadingswilldeterminethe meanbloodpressureforthepatient.
Alwaysensurethatthepatienthasrestedsufficientlyinthechairpriortomonitoring theBP.Certainphysiologicalstatescanerroneouslyraisethebloodpressure.Stress,caffeine,heavymealconsumption,improperpositioningofthearm,orimpropercuffsize
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“Is some one ill?” she asked again.
“No; some one—some one is very well!” I managed to reply, lifting my eyes again to her wan face. The spectacle of its drawn lines and pallor all at once assailed my wearied and overtaxed nerves with crushing weight. I felt myself beginning to whimper, and rushing tears scalded my eyes. Something inside my breast seemed to be dragging me down through the stoop.
I have now only the recollection of Miss Stratford’s kneeling by my side, with a supporting arm around me, and of her thus unrolling and reading the proof-paper I had in my hand. We were in the hall now, instead of on the stoop, and there was a long silence. Then she put her head on my shoulder and wept. I could hear and feel her sobs as if they were my own.
“I—I didn’t think you’d cry—that you’d be so sorry,” I heard myself saying, at last, in despondent self-defence.
Miss Stratford lifted her head and, still kneeling as she was, put a finger under my chin to make me look her in her face. Lo! the eyes were laughing through their tears; the whole countenance was radiant once more with the light of happy youth and with that other glory which youth knows only once.
“Why, Andrew, boy,” she said, trembling, smiling, sobbing, beaming all at once, “didn’t you know that people cry for very joy sometimes?”
And as I shook my head she bent down and kissed me.
BIBLIOGRAPHICAL NOTE [Since any list approaching a complete bibliography would be unduly long, these suggestions are merely for the convenience of those who, without special research, wish to read further and compare. They remain after rejection of many essays that seem hardly to advance the discussion.]
Cairns, William B., On the Development of American Literature from 1815 to 1833, with especial reference to periodicals; Bulletin of the University of Wisconsin, Philology and Literature Series, volume i, no. 1, pages 1–87.
Canby, Henry Seidel, The Short Story; Yale Studies in English, xii (revised as introduction to The Book of the ShortStory, edited by Alexander Jessup and Henry Seidel Canby).
Chassang, A., Histoire du Roman ... dans l’Antiquité GrecqueetLatine; Paris (2d ed.), 1862.
Gilbert, E., LeRomanenFrancependantlexixe Siècle; Paris (2d ed.), 1896.
Hart, Walter Morris, The Evolution of the Short Story; address delivered before the Alumni Association of Haverford College, June 12, 1901.
Matthews, Brander, The Philosophy of the Short Story; New York, 1901. (This, the standard essay on the subject, is now published separately, with notes and a few striking references.)
Moland et d’Héricault, Nouvelles Françoises en Prose du xiiime Siècle; Paris, 1856 (l’Empereur Constant, Amis et Amile, le Roi Flore et la Belle Jehane, la Comtesse de Ponthieu, Aucassin et Nicolette; introduction, notes).
Morris, William, OldFrenchRomancesdoneintoEnglishby William Morris, with introduction by Joseph Jacobs; London, 1896 (translation of the same tales as in the preceding, except Aucassin and Nicolette).
Peck, Harry Thurston, Trimalchio’s Dinner by Petronius Arbiter, translated from the original Latin, with an introduction and bibliographical appendix; New York, 1898. (The introduction discusses prose fiction in Greece and Rome.)
Perry, Bliss, AStudyofProseFiction; Boston, 1902.
FOOTNOTES 1 Donald G. Mitchell, AmericanLandsandLetters.
2 LiteraryPapersofWilliamAustin, Boston, 1890, page 43.
3 See Prof. William B. Cairns, On the Development of American Literature from 1815 to 1833, with especial reference to periodicals; Bulletin of the University of Wisconsin, Philology and Literature Series, volume i, No. 1.
4 For a pungent characterisation of the annuals, see Prof. Henry A. Beers’s life of N. P. Willis (American Men of Letters), pages 77 and following.
5 Fromentin (Un ÉtédansleSahara, page 59; Une Annéedans leSahel, pages 215 and following) lays this down for painting.
6 Bret Harte, The Rise of the Short Story, Cornhill Magazine, July, 1899.
7 See Cairns, as above, page 64. The influence of the Spectator form in France appears strikingly in L’Hermite de la Chaussée d’Antin, ou observations sur les mœurs et les usages français au commencement du xixme siècle, par M. de Jouy, Paris (collective volumes), 1813.
8 Cross, DevelopmentoftheEnglishNovel, pages 24, 25.
9 For Irving’s own view of his tales, see a quotation from his letters at page xix of Professor Brander Matthews’s edition of
the TalesofaTraveller.
10 “A rivulet of story meandering through a broad meadow of episode—a book of episodes with occasional digressions into the plot.” Kennedy’s preface to SwallowBarn.
11 This is the character of the tales of Mme. de Genlis, of which a volume was published in New York, 1825: New Moral Tales, selectedandtranslatedfromtheFrenchofMme.deGenlis,by anAmerican.
12 Nodier adopts the same setting for the same purpose (cf. Les Quatre Talismans, 1838); but the habit is at least as old as Voltaire.
13 So Godfrey Wallace’s Esmeralda, Atlantic Souvenir for 1829.
14 Miss Sedgwick’s Chivalric Sailor (1835) is essentially like our current historical romances. A typical instance is Dana’s Paul Felton(1822).
15 This tendency was confirmed, of course, by the predominance of Scott.
16 Brander Matthews, The Philosophy of the Short-Story, page 15.
17 Poetics, chapter x.
18 Poe’s review of Hawthorne’s tales (1842) begins by remarking that they are not all tales (Stedman and Woodberry edition of Poe, vol. vii, page 28).
19 Poe’s tales were translated into French, German, Italian, and Spanish. He was reviewed in the RevuedesDeuxMondes, Oct. 15, 1846 (new series, vol. xvi, page 341).
20 See Aristotle’s Poetics, chapters vii and viii. The “classical” French drama deduced from Aristotle’s general principle of
unity of action a strict system of practice. Of Poe’s adherence to this system a good instance is TheCaskofAmontillado.
21 In a review of Mrs. Sigourney, Southern Literary Messenger, volume ii, page 113 (January, 1836); quoted in Woodberry’s Life of Poe, page 94.
22 In a review of Hawthorne, Graham’s Magazine, May, 1842; Stedman and Woodberry’s edition of Poe, volume vii, page 30; quoted in the appendix to Brander Matthews’s Philosophy of theShort-Story.
23 A collection ascribed to Antonius Diogenes, compiled by Aristides of Miletus, was translated into Latin by Cornelius Sisenna (119–67 B.C.). The translation is lost.
24 The Cena of Petronius has more consistency, is in form more like the longer tales of antiquity.
25 The object of Lucian is always satire. This, not any purely narrative end, determines his method. But it is worth observing that The Ass is picaresque. For the rest, no single adventure of the string is more than anecdote.
26 The Greek title is ποιμενικά.
27 E.g., the fifteenth idyl of Theocritus, and the opening of the seventh oration of Dio Chrysostom. The latter, though brought in as anecdote, has extraordinary ingenuity and finish of form.
28 See the introduction by Joseph Jacobs to Old French RomancesdoneintoEnglishbyWilliamMorris.
29 This, perhaps, is typically the novella; but Boccaccio will not fix the term: “intendo di raccontare cento novelle, o favole o parabole o istorie, che dire le vogliamo ... nelle quali novelle....”—PrefacetoDecameron.
30
For reference in more detailed study of mediæval forms, this tentative classification of the Decameron may be tabulated as follows:
anecdote
(a) simpleanecdote 34
I, all but nov. 4; III, nov. 4; V, nov. 4; VI, entire; VIII, all but nov. 7 & 8; IX, nov. 1 & 7–10.
(b) anecdotemoreartisticallyelaborated 21
III, nov. 1, 2, 3, 5, 6; V, nov. 10; VII, entire; VIII, nov. 7; IX, nov. 2–5. scenarioorsummaryromance
55
40
II, nov. 3–10; III, nov. 7–10; IV, entire; V, all but nov. 4 & 10; X, entire. approachingshortstory 3
I, nov. 4; II, nov. 1; VIII, nov. 8. shortstory 2
II, nov. 2; IX, nov. 6.
100
31 E. Gilbert, LeromanenFrancependantlexixe siècle, page 65; A. France, Lavielittéraire, Ire série, page 47.
32 Brander Matthews, The Philosophy of the Short-Story, page 65.
33 Colombahas one hundred and fifty pages.
34 See an essay on The Literary Influence of Sterne in France, Publications of the Modern Language Association of America, volume xvii, pages 221–236.
35 It would be interesting, for instance, to determine whether Mérimée learned anything in form from Poushkin.
36 Vide the excellent discourse of G. C. Verplanck, Esq., before the New York Historical Society.
37 Not in the first edition.
38 In New Hampshire.
39 In the original publication the name is Patience.
40 [“In place of this clause the first edition has: “Her figure, her air, her features,—all, in their very minutest development were those—were identically (I can use no other sufficient term) were identically those of the Roderick Usher who sat beside me. A feeling of stupor,” etc.]
41 Watson, Dr. Percival, Spallanzani, and especially the Bishop of Llandaff. See Chemical Essays, vol. v.
42 The season of peach-blossoms was the only season of marriage in ancient China.
43 The most common decorations of rooms, halls, and temples, in China, are ornamental scrolls or labels of colored paper or wood, painted and gilded, and hung over doors or windows, and inscribed with a line or couplet conveying some allusion to the circumstances of the inhabitant, or some pious or philosophical axiom. For instance, a poetical one recorded by Dr. Morrison:
“From the pine forest the azure dragon ascends to the milky way,” typical of the prosperous man arising to wealth and honors.
INDEX [Titles ofbooks andperiodicals are inquotation marks; titles ofseparate stories, in italics]
Addison, a model for Irving, 6
Aldrich, Thomas Bailey, 34
AliceDoane’sAppeal(Hawthorne), 13
Allegory, 10, 14, 23, 230
AmbitiousGuest,The(Hawthorne), 14
American literature, brevity of, 1; wherein American, 1–4, 8, 35; American life in, 3–6, 11, 12
“American Monthly Magazine, The,” 113
AmisandAmile, 25
Anecdote, 10, 24, 26, 27, 29
Annuals, American, 2, 4, 5, 9–12, 18
Antonius Diogenes, 24
“Appleton’s Journal,” 245
Apuleius, 30
Aristides of Miletus, 24
Aristotle, “Poetics,” 13, 19, 20
ArsèneGuillot(Mérimée), 31
Artificiality in short story, 20, 32
“Ass, The,” of Lucian, 24
“Atlantic Monthly, The,” 247
“Atlantic Souvenir, The,” 2, 4, 5, 11
AucassinandNicolette, 25, 27, 31
Austin, William, 1, 10, 12, 59–95; biographical and critical sketch, 59; JosephNatterstrom, 1, 10; PeterRugg, 10, 12, 60–95
Bacon, Delia, 11
Balzac, Honoré de, 32–33; Elverdugo, Lesproscrits, Lamessedel’athée, Z.Marcas, 32; form in, 32–33
Bandello, 29
Beckwith, Hiram W., 97
Bee-Tree,The(Kirkland), 195–210
Beers, Henry A., 2, 177
BenHadar(Paulding), 10
Berenice(Poe), 2, 3, 16, 18, 21, 22, 33
Blackwell, Robert, 97
Boccaccio, “The Decameron,” 26–28, 30
“Boston Book, The,” 61
Brunetière, Ferdinand, 26
BuckthorneandHisFriends(Irving), 8
Bunner, Henry Cuyler, 289–301; biographical and critical note, 289; TheThirdFigureoftheCotillion, 289; TheLoveLettersofSmith, 291–301
Burton’s “Gentleman’s Magazine,” 154
Cable, George W., 5, 34; PossonJone, 34
Cairns, William B., 2, 6, 325
Canby, Henry Seidel, 325
