Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    37/976 (page 17)
    ing degrees of accuracy, conveyed some theory into the pioce s diagnosis. Eememhering what was said with regard to m , _ disease, we shall find that, in this practical sense, diagnosis is sometimes the discovery of, and the calling of a disease by wha we conceive to he the most important structural change by which it is accompanied, such as pneumonia; at other times diagnosis stops short at the recognition of a pathognomonic symptom, such as hoopmg- couoh • again it may mean to express the starting-point or principal fact° in a°group of symptoms; or some general condition but im- perfectly understood, or some condition which is not understood at all. In all of these instances we notice two things, first that diagnosis looked at from its scientific side—is the step from particulars to particulars, from those which are observed to those which during life can only be inferred; the step from the one or the. one hundred to the whole; second, that diagnosis—regarded practically—is the giving of a name to the disease from which an individual suffers; the ticketing, and as it were placing of that malady in some niche with others that resemble it, so that it may be known and brought out when required. But let it be remembered that the principles upon which names are constructed are so various that no expression can be framed to convey their meaning, in so far forth as that it should carry further what is meant by diagnosis. Pathology.—When a patient presents himself for examination or for treatment, he tells us of certain things that he feels or sees, which are wrong, and which we call “symptoms ;” we ask him questions, and learn additional facts of a similar class; we observe him, and notice other facts which he can neither feel nor know by independent means, and these we call “ signs,” or “ objective symptoms.” Prom what we are informed, and from what we observe, we pass on to the inference of other facts : we believe, because we know that some three, four, or more changes from the healthy state are present, that other alterations exist; and this belief is more or less strong, and its character more or less definite according to the state of medical science, and our knowledge of it, at the time that the patient presents himself. We infer certain things, certain conditions which we cannot see, but which we may, in some measure classify, and therefore call by distinctive names. Thus heat of skin is a symptom from which we infer a number of ulterior conditions ; the reason for this heat of skin may—other symptoms being regarded—be conjectured by us to be an. altered blood-state, such as typhoid fever, tuberculosis, or the like: it may, on other symptomatic evidence, be referred to a change m some particular organ, such as inflammation of the lung or destruction of a portion of the spinal cord; and we may give names to the general conditions, part of which we have observed part of which we have inferred. This is what we call “ diagnosis ” in its practical sense; but that which makes diagnosis possible is the existence of a certain amount of information about the relations VUJj. I, 0