Practical medicine and medical diagnosis / by Byrom Bramwell.

  • Byrom Bramwell
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practical medicine and medical diagnosis / by Byrom Bramwell. Source: Wellcome Collection.

    13/164 (page 5)
    A diagnosis is not a mere guess, but is a logical conclusion based upon the facts of the case. In making a diagnosis, our aim should be, not merely to give a name to the disease, but to take into account the special features wliich it presents in the individual case under observation, to ascertain, if possible, the exact character and extent of the lesion—for it is only after we have got this information that we are in a position to treat the affection satisfactorily and to judge of its probable duration and course. The mere naming of the disease is, as a rule, an easy matter. Some- times, however, even that is impossible, owing to the facts that in some cases the grounds for forming an opinion are insufficient (the symptoms and physical signs are imperfectly developed); and that there are pro- bably some diseases whose clinical features are as yet unknown. I can give you no better illustration of the fact that the mere naming of the disease is not a diagnosis, than by referring to the term ' heart disease,' which is so frequently used both by the laity and also by the profession. Under this name are grouped many different conditions, and many different desrrees of the same affection. Some forms of ' heart disease' are of the gravest possible significance; others may continue for years, but are apt to terminate in sudden death; others, again (and in this class we meet with cases in-which the heart's action may be markedly deranged, and in which the sounds may be replaced by murmurs), are of comparatively trivial importance, some of them having no tendency to cause sudden death or to materially shorten life, and others being readily amenable to treatment. To include all these different conditions under a common term, which to both the lay and to the professional mind is of very serious significance, and to diagnose them all as ' heart disease,' is obviously highly unscientific and improper. In making a diagnosis in such cases, the physician endeavoiirs to determine whether the cardiac derangement is organic or functional; and if it be organic, the exact character and extent of the lesion. To correctly appreciate the special features of any given case, and to gauge the extent and tendencies of the morbid process, is much more difficult, and demands the highest skill of the experienced practitioner. In order to arrive at a correct conclusion on this point, it is necessary to be well acquainted with tlie characters which the disease usually presents, and to take into account not only the special features which are mani- fested in the individual case under observation, but also the constitu- tional peculiarities, and the pathological tendencies of the patient. It is impossible to insist too strongly \ipon the importance of studying the individual characteristics and peculiarities of each and every patient who comes under observation. Students, whose knowledge of disease