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.
42/642 (page 18)
![i bearing on the general conditiou of the system, and also in its relation to lesions of j)articular organs. When the student is introduced to the bedside of the patient, it is of great importance that he should carry in his mind a certain definite course of inquiry, according to which he should endeavour to trace out a faithful history of the case, so that withoiit any guide but his own investigation, he may be able to frame a history which will leave him in little doubt as to the department in the theory of disease to which it ought to be referred. We are at present only engaged in inquiring into the uses of such an investigation, in so far as it leads to a correct diagnosis ; hut every one of the separate features in the picture may be of im- portance in deteraiining the treatment. Even when a correct diagnosis is formed, various remedies will suggest themselves to • the mind of the practitioner as equally applicable, and their judi- cious selection very often depends upon a due consideration of the antecedents and peculiarities, much more than upon the name given to the disease, or the place it may hold in a scientific classifica- tion. 1 The student will do well to commit to writing the results of 1 his inquiries. There is no means nearly so successl'ul in giving ] system and correctness to his investigation ; in no other way can he acquire the habit of observing all the phenomena of any given case, or tracing their bearing on each otlier ; and nothing will so i effectually teach him to mark correctly, and estimate justly, each successive fact elicited by his own inquiries, or volunteered by the ■ Itatient. From the wdiole evidence thus faithfully committed to writing can he alone hope to form a coarect diagnosis, liis written description ought to be a full and accurate account of all that ho sees, hears, feels, or even smells, and must never embody any conclusions he has formed from (hem until the whole inquiry has terminated. Thus, to take a prominent example,—in examining the lungs, however distinct he may fancy the evidence of a cavity to be, he ought never to put down in his notes ‘ cavernous rales,’ or ‘cavernous breathing,’ but what he actually hears—gurgling sounds, loud or very loud, blowing, expiratory breath-sound, &c.; everything, in fact, just as it is heard; as he proceeds, it is quite possible that other signs or symptoms may be observed so incon- sistent with the hy])othesis, that it would be quite unwarrantable to iissume the existence of a cavity^—^a conclusion which ought only to be formed from the coincidence of several other phe- nornena. llie following plan lias seouied to me the best](https://iiif.wellcomecollection.org/image/b24989812_0042.jp2/full/800%2C/0/default.jpg)
