Clinical gynaecology : medical and surgical, for students and practitioners / by eminent American teachers ; edited by John M. Keating and by Henry C. Coe.
- Date:
- 1896
Licence: Public Domain Mark
Credit: Clinical gynaecology : medical and surgical, for students and practitioners / by eminent American teachers ; edited by John M. Keating and by Henry C. Coe. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
101/1062 (page 77)
![The pain, which is apt to be quite severe for a few hours at least, may be controlled by morphine, and it is, of course, absolutely necessary that the patient should remain in bed during the whole time that the tents are in position. GENERAL OUTLINES OF DIFFERENTIAL DIAGNOSIS. In diseases of women more than in most branches of medicine the- diagnosis is dependent upon the physical examination. The principal symptoms of which women complain are common to too many different affections to enable us to draw correct inferences from them as to the particular trouble which causes them ; therefore our history must in the majority of cases be supplemented by an examination. While the importance of the physical examination is thus emphasized, it is not for a moment intended to minimize the value of the information to be gained by a careful questioning of the patient and an attentive hearing of her nun statement. The subjective symptoms can only be ascertained in this way, and the digital and instrumental examination serves the double purpose of interpreting and correcting the facts thus given and adding such information as the employment of the different senses furnishes. The successful diagnostician in this department of medicine will be the man who recognizes the value of the patient's account of herself, both its exaggerations and its limitations, and who has so trained his senses that he is able to employ them to the best advantage in the physical examination. He must possess a good knowledge of human nature, especially important in dealing with women, keen judgment as regards the value of evidence, an accurate sense of touch, and skill in the use of instruments. Having in this general way indicated the two methods of examination and shown their mutual interdependence, it is now our purpose to go a little more into detail, and indicate the value of the various symptoms of which the patient complains and of the conditions which our physical examina- tion reveals. There are two classes of symptoms, subjective and objective: subjective, those of which the patient is conscious; objective, those which the physician can appreciate by his senses. The subjective symptoms may be direct, affecting the organ or organs which are the seat of the disease, or reflex, affecting other organs of the body at a distance. These distinctions cannot, of course, always be closely maintained. Thus, the symptom leueorrlxea is both subjective—the patient being conscious of :i feeling of moisture—and objective when the discharge escapes from the vagina and is seen. Still, it may in a general way serve as a basis for their consideration. Pain.—Of the purely subjective symptoms the most common is pain. It is usually the first to attract the woman's attention and lead her to con- sult a physician, and is often the most obstinate to treat and the last to disappear; at the same time it is of comparatively little value as an aid to a differentia] diagnosis. There are comparatively few kinds of pain,](https://iiif.wellcomecollection.org/image/b21018145_0101.jp2/full/800%2C/0/default.jpg)
