A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint.
- Austin Flint I
- Date:
- 1884
Licence: Public Domain Mark
Credit: A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
109/1212 page 99
![physician is exposed to error in consequence of inability on the part of the patient to describe them clearly. In young children this class of symptoms is not available. This is true, also, of idiots, the insane, and in the delirium incident to different diseases. As regards these symptoms, too, the physician is liable to be deceived by intentional misrepresentations on the part of patients ; and he is liable to be deceived, unintentionally, by a tendency, on the one hand, to exaggeration, and, on the other hand, to depreciation of morbid sensations or feelings. Owing to these sources of error, much tact is often requisite in placing a proper estimate on subjective symptoms. Objec- tive symptoms are not open to the same liabilities to error. The physician judges of these by the exercise of his ovi^n senses, and, if he fail to discover or place a proper estimate upon them, the fault consists in his own want of attention, judgment, or skill. Objective symptoms, thus, are much more reliable than subjective, in the investigation of cases of disease. The exaggeration of pain or suffering of any kind, and of morbid sensa- tions, is common, sometimes because patients are led to form an exaggerated idea of their subjective symptoms ; sometimes with a view to awaken interest or sympathy; sometimes for malingering purposes, and sometimes to secure greater attention on the part of the physician and more efficient treatment. Factitious and exaggerated ailments enter pretty largely into the cases which the practitioner is called upon to treat. A symptom, as already defined, is any manifest morbid phenomenon or event. Occurring concurrently with a disease, it may, or may not, have a ])athological connection with that disease. Its pathological connection with the disease may be such as to render it a pathognomonic symptom, or more or less diagnostic ; and, on the other hand, it may be present as a mere coin- cidence. If the latter be true, it has no pathological connection with the disease, and is devoid of diagnostic significance. This difference among symptoms has been expressed by calling them sfpis when they are either pathognomonic or more or less diagnostic. According to this distinction, a symptom becomes a sign whenever it denotes, in a greater or less degree, the existence of a particular disease. The term signs, however, has come con- ventionally to be used in a different sense. It is usual to apply this term to the phenomena obtained by certain methods of investigation distinguished as physical, namely, percussion, auscultation, etc. These phenomena are called physical signs, but for convenience, the word physical is often omitted, and is considered as understood when the term sign is alone used. In this sense of the term signs, it is used in contradistinction to symptoms, the latter em- bracing all other phenomena manifested in connection with disease. The phenomena thus included under the name signs, are, of course, objective, and will be found to be the most reliable of those by means of which the exist- ence, seat, and character of certain diseases are ascertained. Among the physical methods of examination introduced into modern medi- cine, the use of the thermometer holds an important place. For measuring the heat of the body, a thermometer adapted to this purpose is requisite. A self-registering thermometer is to be preferred. The bulb of the instrument is to be placed deep within the axilla, and the arm of the patient folded across the chest, the perspiration having been first wiped away. The instrument should remain in this situation for eight or ten minutes. It is a good practical rule to allow the thermometer to remain until a minute passes without any further rise of the mercury, the physician pressing the shoulder of the patient in order to secure close contact of the integument on all sides of the instru- ment. The normal temperature is from 98° to 99° Fahr. in the great majority of persons; exceptionally it may be half a degree, or even a little](https://iiif.wellcomecollection.org/image/b21198135_0109.jp2/full/800%2C/0/default.jpg)
