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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    It .should only be employed when the deduetive method seeims to fail. It is, too, an uncertain method, for, in using it, Ave must be quite certain that we have excluded all the possible conditions except one. If, for example, in the case I have supposed, there should be five instead ol four possible affections, and if we have omitted to think of and take into account the fifth, that one (the fifth) may be the affection, and our conclusion will of course be false. In other cases, again, we have recourse to therapeutics in order to clear up the case (we make a thenipeutic dicKjnosis). In a case of sup- ])osed abdominal tumour, for instance, if, after giving chloroform, we find that the tumour disappears, we at once conclude that it is not a tumour in the ordinary acceptation of the term, but a ‘ phantom growth.’ Or again, suppose the symptoms and physical .signs clearly point to the presence of an intra-thoracic tumour, but are insufficient to enable us to say whether it is an aneurism or a solid growth ; if after giving full doses of iodide of ])otassium combined with absolute rest, we find a marked improvement in the case, we should (.speaking generally) be justified in deciding in favour of aneurism, for the symptoms caused by aneurisms are, usually, materially benefited by this treatment, but those due to solid intra-thoracic growtlrs, which in the great majority of cases are malignant lympho-sarcomata, are not. Then again, in other cases, we have to fall back upon the theory of probabilities, i.e. the numerical chances in favour of one or other of two conditions. Suppose, for example, that a female ])atient came to u.s complaining of swelling of the abdomen, and that on examination we found that the cause of this distention was a large cyst; the numerical chances would be very strongly in favour of an ovarian tumour; and unless there were some strong reason to the contrary, the fact shoidd be allowed due weight. In the great majority of cases in which we followed the numerical chances and diagnosed an ovarian tumour, our conclusion would be correct. The following is a case in which it Avas Avrong:—A married Avoman, mt 33, Avas admitted to the XeAvcastle-on- Tyne Infirmary, under my care, on June 20th, 1877, suffering from great distention of the aljdonien. She stated that she had enjoyed excellent health until tAvo years previously, Avhen she began to sufl'er from pain in the abdomen, just above the right gi’oin, and noticed that the lower part of her belly Avas swollen. The SAvelling, Avhich Avas at first about the size of an orange, gradually got larger, and rapidly in- creased in size after the lurth of her last child, Avhich took place on April 1st, 1876. Of late her general health had deteriorated, and she had lost flesh. She had been married for thirteen years, and had had nine children. She had not menstruated since her last pregnancy.