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.

    142/164 (page 134)
    APPENDIX I, physical signs (those which result from the physical condition of tlie organ in different states of disease); and iUrdly, with the chief functional derangements and symptoms which result from its more striking and important lesions. It is only after he has acquired a considerable amount of knowledge, and has made himself more or less familiar with the different symptoms and physical signs, that the student is capable of deriving full benefit from out-patient practice. With so much work to do, it is, as I have already pointed out, essential to economise time as much as possible; to avoid asking any unnecessary questions; and to see that every question has its point. Now it is only the student, who has some knowledge of disease, who can see and appreciate the object of questions which are put in this way, and who can understand the mental analysis of the facts of the case which I am carrying on—as revealed by the questions which I ask—and can follow up my train of thought. It is only tlie advanced student who can thoroughly appreciate the physiognomy of disease, as it is exhibited in many different cases coming rapidly one after the other. Again, it is quite impossible with the limited time at our disposal,—even if it were desirable, which I do not admit—to explain the significance of elementary facts which are elicited in the course of the physical examination. In a case, for example, in which a double, blowing, endocardial murmur is audible over the course of the aorta and down the sternum, I do not stop to tell you that the murmur is indicative, and why it is indicative of aortic regurgitation— as I might think it advisable to do if I were teaching a class of be- ginners—I take it for granted that you know the significance of cardiac murmurs, and I proceed at once to direct attention to any special features whicli the case may present, and to the facts and circumstances by which we endeavour to determine whether the lesion has resulted from disease beginning at the root of the aorta or in the endocardium; and whether the aortic regurgitation is free or not—in other words, whether in the special case under observation, the lesion is serious or not. Do not, however, let it be supposed that I wish to discourage the attendance of junior students altogether. All I want to point out is, that the special plan of examination and instruction, which I adopt, is better fitted for seniors than for juniors. There is always a good deal which the beginner can understand; and, although he can- not get the full benefit which a senior student can, yet a certain amount of time passed here will not be mis-spent; if he were to acquire no- thing else, he cannot fail to get many valuable hints as to the methods of eliciting information, examining, managing, and dealing with patients.