Medical diagnosis : with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis : with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    29/1004 (page 25)
    between affections of the heart and affections of tlae kidney ! Here it is easy to arrive at a conckision, since we have the means of judging accurately of the condition of both organs. But there are instances in which it is very difficult, especially when a part contiguous to one chronically affected is attacked with acute dis- ease. A person applies for relief, presenting all the symptoms of a severe local peritonitis. The inflammation spreads; death re- sults. The exciting cause of the inflammation is discovered to be a structural alteration of one of the abdominal viscera, the signs of which were completely merged in the more marked signs of the recent inflammation. And this disguisement is effected not only by the supervention of another and more acute complaint, but also sometimes by the prominence of those remote sympa- thetic derangements which an affection of any viscus may produce. Thus, the disturbed action of the heart in dyspeptic persons throws at times the symptoms of the gastric malady into the shade. Yet it must be admitted that errors of diagnosis from this soorce are not apt to occur to the careful practitioner. A thorough exami- nation of the case is a safeguard against them. These, then, are the various causes which render a diao-nosis uncertain, or wholly unattainable. Let us add to them one that does so temporarily. There are disorders the early manifestations of which are so much alike that it is next to impossible to tell with which of several we have to deal. In fevers this often happens. Here, however, a few days, or even less time, will almost always solve the difficulty. But not so in other diseases. It is only after a mucli longer period, and by careful watching of the patient, that the appearance or disappearance of a striking symptom, or the greater prominence a liitherto indistinct sign assumes, inclines the scales toward one or the other of the affections between which judgment has been kept in suspense. In some such instances, the treatment becomes the touchstone of the diagnosis. Now it may be asked, Does this demonstrate that the diagnosis of a case is not necessary for its treatment? Not at all. It simply proves that we are sometimes obliged to aim at removing sym])toms without understanding their source. But it does not prove that if we understood their source we sliould not be better able to remove the symptoms. The physician who undertakes to relieve disease simply by attempting to allay its