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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    live e.Kaiii])les of tho same luriii of disease, in some of which the diagnosis is easy, in others most ilitlicnlt. The diagnostic knowledge which is superfluous in one case, is essential in another.’^ The Basis of a correct Diag’nosis.—I hope I have now imjjiessed yon with the idea, that you should in all cases do your best to make a full and e.xact diagnosis. Now,in order to attain this end it is necessary 1. T’o have a sutticiency of facts. 2. To have the facts ctwrectly observed and noted. 3. To give due weight to the individual facts, and U> the manner in which they aregrouped,and to draw the logicalconclusion therefrom. The fads uf the case include— (1) Certain preliminari/ partieiilars, vi/.., the age, se.v, occujtation, etc., of the patient. (2) 'The prerioas histur//— («) Of the ])i'esent attack. (/>) Uf the ]>atient’s former health. (c) ^Vs to his social surruuiuling, habits, etc. ((/) As to his hereilitary tendencies (the family history). (3) Thesy//<^^/owv/.r.,themorbidsensationse.\perienceil bythe])atient. (4) 'The faets ohservet/ hi/ the phi/sieian, including the objective syni])- toms and the j)hysical signs. The correct observation of the facts of the case.—In my ne.xt lecture I shall speak in detail of the manner in which the facts of the case are to be elicited (case-taking), but 1 may mention here, that the particulars on which the diagnosis is founded are derived l>artly, from the statements of the ])atient (the oral examination, as 1 am in the habit of terming it); and ]»artly, from the direct observation of the physician himself {{\ai physieal examination). ISoth methods are diffi- cult to learn, and it is only after considerable ])ractice and exjterience that you can hope, to observe and note the facts correctly. ' ‘ The Diagnosis of Diseases of tlie Spinal Cord,’ p. I. ^ Symptoms are usually divided into subjective and objective. Suhjtctire symptoms are those abnormal sens;itions, such as pain and numbness, which are experienced by tlie patient, but which cannot be appreciated by the physician. Under the term ohjec- tire symptoms, are included such obvious abnormal conditions as jaundice, swelling of the feet, etc., which are perceived by the physician, but which do not recpiire any phy- sical examination, properly so called, for their detection. The ]>hy.<iral dyiis, again, are such facts as ilulness on percussion, which tlie physician elicits by physical exam- ination. It is preferable, I think, to include the objective symptoms and physical signs under the common term of J(irh< ob>>erreil hi/ (he /ihi/xiriiui. .Jaundice, swelling of the feet, and other conditions which are detected l>y the aid of sight, are just as much phy- sical .signs as rales or murmurs, which may sometimes be observed by the unaideil ear.