Licence: Public Domain Mark
Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![tend to lead the observer away from the true seat of the malady, inasmueh as not nnfrequently disease of eentral organs first makes itself known by symptoms in remote parts. Against this there can he no safeguard but a thorough knowledge of the relations subsisting between morbid states and the possible phenomena which may attend upon them. Again, symjitoms of importance may be forgotten, and circumstances which must greatly influence our opinion on the case may have been omitted, and these points must be inquired into. Tlie same knowledge of the associations of morbid states and their jihenomcna leads ns to ask such ques- tions as may determine evhether the symptoms detailed have been caused by one condition or another (e. (]., whether pain has been caused by inflammation from the knowledge whether fever has been present or not). Out of this further inquiry arises one of the greatest and most common sources of fallacy; and it is great in proportion as the history and sensations of the patient become the sources of infor- mation, and the alterations in structure or function of which we can take cognizance are few and indistinct. It springs from the • necessity of framing an hypothesis of the disease from the general outline already given of the case, and the anticipation arising out of this hypothesis, that certain phenomena ought to be present; in consequence of this persuasion, interrogatories assume the form, more or less, of leading questions, unconsciously to the inquirer himself; and this cannot fail to bias the mind of the person to whom they are addressed. Tliis preliminary investigation leads to the associa- tion of symptoms according to their order of sequence, and we must he careful, by observing them from another point of view, to correct any false impression to which it may have given rise. While, therefore, we follow the patient telling his own case in his owui way, it is quite essential that we should make a subsequent and independent investigation of existing symptoms according to some systematic course, which shall have - the effect of ranging them in such scientific groups as i may most readily and naturally lead to the detection of the cause wliich best accounts for their origin, J and most fully satisfies all the requirements of the case. In seeking for such an arrangement, we find that there are two great classes of indications, the general and the local; eacli of these comprehending two divi- sions, the subjective and the objective, the sensations](https://iiif.wellcomecollection.org/image/b24989812_0040.jp2/full/800%2C/0/default.jpg)
