Practical medicine and medical diagnosis / by Byrom Bramwell.

  • Byrom Bramwell
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practical medicine and medical diagnosis / by Byrom Bramwell. 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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    G nuLst necessarily l)e in great part gained by listening to systematic lectures and reading systematic text-books, are very apt to ignore the ])ersonal element or ‘personal ec^uation’ as it has been fitly termed, and to regard their patients as so many cases of this or that disease (])neumonia, typhoid, mitral regurgitation, for example), rather than as separate individuals, each with his special tissue and constitutional peculiarities, to which, so to speak, the disease is engrafted or superadded. The fallacy of such a mode of looking at disease becomes obvious enough \vheii one gets into practice, and is, to some extent counterbalanced by clinical teaching, but it is necessary to emphasise it. The systematic lecturer and systematic writer niirst necessarily describe types of disease, rather than individual cases, and in order to be clear and intelligible, he must of necessity draw in his outlines sharply and clearly; a very little ])ractical experience will show you that the hard and fast lines of the ty])e pictures are being constantly departed from. Let me beg of you, then, to study the individual characteristics and peculiarities of your patients, and, while sparing no pains to make yourselves well accpiainted with the type pictures which systematic teachers and lec- turers describe, to study disease as it occurs in nature. It is only by the unwearied observation of disease at the bedside, and the study of the special features of each individiual case, by looking, in fact, not only at the lesion, but also at the individual affected by that lesion, that you can hope to acquire that broad and comprehensive grasp, without which no one can be a truly good practitioner. It may be impossible, owing to the very nature of the case, even for the most experienced and accom- plished physical! to make an ideal diagnosis, of the sort I have just indicated, in every case, but a minute and exact diagnosis should always be aimed at. In support of this proposition, I cannot do better than quote to you what Dr Gowers says in speaking of the diagnosis of the diseases of the spinal cord. He writes:—‘ A tendency is sometimes observed among many members of the profession to undervalue diag- nosis. Our business is to cure disease, as far as we are able, and a fear has been expressed lest our study of exactness in diagnosis should be at the exqjense of precision in treatment.’ ‘ It matters little,’ it has been said, ‘ whether your diagnosis of a diseased condition is minutely exact, if you are able to cure it.’ This is true, but a very superiicial study of practical medicine will show that much diagnosis, which is of no direct avail for treatment, is essential for the diagnosis wliich enables us to treat successfully. Of all organs there are some diseases for which we can do little, there are others for which we can do much ; but unless we are able accurately to distinguish the diseases of each class, we sliall be unable to apply our skill where it will be effective. Moreover, there