A manual of general pathology : for the use of students and practitioners of medicine / by Ernst Wagner ... Tr. from the 6th German ed. by John Van Duyn ... and E.C. Seguin.

Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: A manual of general pathology : for the use of students and practitioners of medicine / by Ernst Wagner ... Tr. from the 6th German ed. by John Van Duyn ... and E.C. Seguin. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    meet a stranger, we conclude from physiognomy, the expression of his eyes, his gestures, his deportment, from the first impression we have of the development of certain parts of his body, to his inner psychical life, his character, his education, occupation, his ruling ideas and pursuits. In the same way the expert can, from the color of the face, from the facial expres- sion, the posture, mode of lying, the walk of the patient, from his manner of breathing, of speaking, etc., often draw apposite conclusions as to the nature of the disease. The second wav to form a diagnosis constitutes diagnosis from the anamnesis, that is, from the story which the patient tells of his illness. This account usually consists only of a recital of sensations of the most varied kind, intermingled with conjectures upon the origin of the disease. If the patient be competent to give a chronological account of the course of his ailment, it is sometimes possible to draw some conclusions from the often confused story as to the condition of the patient’s body. It is necessary to understand popular expressions in order to be able to translate their vague import into medical language. The physician is sometimes obliged to give advice to and treat patients at a distance upon such sources of information transmitted by letter. It is well always to do this with the greatest caution, for it is natural that incomplete observation should lead our judg- ment into error. The third and surest diagnostic process is the objective investiga- tion. We in this way seek to convince ourselves by actual sensorial observation of the anomalies presented bv the diseased organism. In order to arrive at the most positive and comprehensive judgment of the condition, it is not sufficient to investigate that part of which the patient complains, but we must inquire into the state of every part of the body, and the con- dition of every function. This last rule is essential if one means to proceed in a well-grounded and certain manner. The physician's art consists mainly in the thoroughness of his examination. Without this, in spite of thorough scientitic acquirements, he remains practically a useless man. The examination of patients consists of two parts. The first is devoted to the obtaining of the anamnesis (or history of the case). The conversation is most properly begun by a general inquiry, What tlo you complain of, where is your trouble? Then the patient may be allowed to talk uninterruptedly for awhile, but, as soon as he wanders otl to irrelevant matters, as he commonly soon does, then it is necessary to ask special questions. In order to reach a conclusion in as short a time as possible, and to demonstrate our interest in the patient’s condition, we first investigate the organ or function which he believes to be in a morbid state. For example, if the patient complain of chest symptoms, we are to pro- ceed at once in this direction. The important points in this connection are : Cough, how much, at what time of the day ; if chronic, whether it bo actually present, or at times altogether wanting;—Expectoration, its loose- ness, quantity, and color;—Dyspnoea, whether when at rest, or excited by movement;—Pain, dull or sharp; its seat, whether in the centre or side of chest;—the mode of lying, whether upon the right or left side, or if pos- sible on both sides. And fur the larynx, hoarseness, etc. ; for the nose, hi reding, etc. In an analogous way the physician should investigate the condition of the digestive organs, the urinary apparatus, etc., and inquire into altera- tions of nutrition, into the presence or absence of fever. if we wish to make a more special inquiry, it becomes necessary to ascer- tain exactly the duration and course of each individual symptom, and, espe-