Licence: Public Domain Mark
Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
31/974 (page 13)
![presents. Deficiency of resonance is discovered only by percussion ; but short-breathing is a sensation of which the patient complains, as well as a phenomenon which may be appreciated and measured by the physician ; and, in like manner wasting of a limb may make itself at once evident to the observer, whereas paralysis is a condition which the patient may assume. The really valuable element of distinction between these two classes of phenomena is therefore that which exists between objective and subjective symptoms; meaning, by the former word, all those elements of disease which can be appreciated by the senses of the observer, and by the latter, those which can only be known through the statements of the patient. Whatever of disease comes to us only through the mind or feelings of the patient, as expressed by language, either of gesture, or words, is a subjective symptom. Its form and its degree of intensity are subjected to the conditions of the machinery —mental, emotional, and sensational—through which it passes, and it is liable therefore to be changed, either in character or degree. What- ever of disease comes to us through our own senses alone escapes this danger of addition, alteration, or subtraction, and is pro tanto of higher value. In one class the patient gives his version of his case ; the symptoms are such as we can only get at through his mind, and they are termed subjective: in the other, we make our own observations—the feelings or ideas of the sufferer have nothing to do with them—simply, physical facts are the objects we recognise, and such symptoms are called objective. As a general rule the objective are much more valuable than the subjective symptoms ; but let it be remembered that the importance of the latter is very widely variable, and that sometimes it may far exceed anything that can be derived from direct observation. In the early stages of some serious diseases of the heart, or brain, nothing may be presented to the practised ear or eye ; and yet the patient tells us of a deep unrest, or sudden horror, which, although it has no objective sign, may be the herald of a sudden or lingering disease; as true and as important—although to others the mind seems clear, and the heart's beat healthy—as any murmur we might hear with the stethoscope, or any palsy we might measure by the hand. We have to deal with man as a whole; and to ignore or undervalue what he tells us of his ideas, emotions, or sensations, because they may be termed subjective symptoms, and be held to be therefore, unreliable, would be to shut out from ourselves that which—egotistic and fearful, prejudiced and ignorant as man may be—yet forms an integral part of his life, and therefore of his disease. We must be careful to give to both groups of symptoms their true value, and our danger in the present day is to under-rate the importance of those which, a few years ago, constituted almost the total symptomatology of disease. The distinction between general and local symptoms need not detai]! us, since the terms are obvious in their meaning, and the difference between them is gradually dying out by the recognition of](https://iiif.wellcomecollection.org/image/b2198010x_0001_0031.jp2/full/800%2C/0/default.jpg)
