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.

    15/164 (page 7)
    are examples of the same form of disease, in some of which the diagnosis is easy, in others most difficult. The diagnostic knowledge which is superHuous in one case, is essential in another.'^ The Basis of a correct Diag-nosis.—1 hope I have now impresse yon with the idea, that you should in all cases do your Lest to make full and exact diagnosis. Now,in order to attain this end it is necessary— 1. To have a sufficiency of facts. 2. To have the facts correctly observed and noted. 3. To give due weight to the individual facts, and to the manner in which they aregrouped, and to draw the logical conclusion therefrom. The facts of the case include— (1) Cevtfim preliminary particulars, viz., the age, sex, occupation, etc., of the jjatient. (2) Tlie previous history— (a) Of the present attack. (&) Of the patient's former health. (c) As to his social surrounding, habits, etc. {cl) As to his hereditary tendencies (the family history). (3) The symptoms^ i.e., the morbid sen sations experienced by the patient. (4) The facts ohserved ly the johysicicm, including the objective symp- toms and the physical signs. The correct observation of the facts of the case.—In my next lecture I shall speak in detail of the manner in which the facts of the case are to be elicited (case-taking), but I may mention here, that the particulars on which the diagnosis is founded are derived partly, from the statements of the patient (the oral examination, as I am in the habit of terming it); and partly, from the direct observation of the pliysician himself (the physical examination). Both methods are diffi- cult to learn, and it is only after considerable practice and experience that you can hope to observe and note the facts correctly. ' ' The Diagnosis of Diseases of the Spinal Conl,' p 1 ^ Symptoms are usually divided into subjective and objective. SnhjecHre symptoms are those abnorma sensat.ons, such as pain and numbness, which are e.xperienced by he patient, but which cannot be appreciated by the physician. Under the term obJ- U e symptoms, are included such obvious abnormal conditions as jaundice, sweUing of ^ J^^^^J^ perceived by the physician, but which do not require any ^fhy sicai examination, properly so called, for their detection. The physical siam -J-,in are such facts as dulness on percussion, which the physician ellcftX^ lyS oxtm nation It is preferable, I think, to include the ob ective symptoms ami X loal s'^s eef and' fr^'S™ the pkysician. 'jLndice, swelfi g of f B.C.U signs as i.iles or murmurs, winch may sometimes be observed by the unaided ear.