A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
For an exhaustive study of Etiology attention would now have to be
given to the modifying influences affecting the occurrence and
character of diseases in connection with age, sex, and temperament.
But, as neither of these is ever, per se, causative of any malady, and
they merely determine some modification of the action of morbid causes
when these occur, want of space must be our justification for leaving
them to be considered, in this work, in connection with the special
causation of the different {148} diseases which will be hereafter
described. A larger treatment of our present subject belongs rather to
hygiene than to practical medicine.
MEDICAL DIAGNOSIS.
For the purposes of the medical practitioner all professional studies
unite to the end of furnishing preparation for the diagnosis and
treatment of diseases. At the bedside the cardinal questions are, How
does the present condition of our patient differ from health? and,
What ought we to do to bring about his recovery?
Diagnosis involves three main directions of inquiry: 1, as to the
general bodily state of the patient; 2, morbid changes in particular
organs, tissues, or functions; 3, as to what name properly designates
the disorder, according to accepted nomenclature.
Pathology can never be out of view in connection with either the
theoretical or the practical study of diagnosis. But it is most
closely regarded when the last of these questions is before us, since
the names of diseases generally have a more or less distinct reference
to their pathological nature. Yet clinical observation always suggests
the early use of provisional terms for recognized groupings of morbid
phenomena; and sometimes these clinical designations remain for a long
time in use because of the imperfection of pathology.
We ascertain, in practice, the nature of a given case, first, by
considering its symptoms. These are those obvious evidences of
deviation from health which the patient himself is aware of, or which
the physician readily discerns or elicits by simple inquiry or
examination.
Secondly, taking the clue furnished by symptoms, a closer inspection
is made, with the intent of finding what is the actual state of
important organs, as the heart, lungs, liver, spleen, kidneys, and
alimentary canal.
Lastly, when these means fail to remove all obscurity, or when special
scientific investigation is practicable, instruments of precision are
employed, as the thermometer, sphygmograph, ophthalmoscope,
æsthesiometer, or aspirator; or by the microscope and chemical
analyses still more minute examination is made into the particulars of
the morbid processes present and their results.
We may subdivide diagnosis, then, into: 1, symptomatology; 2,
organoscopy or physical diagnosis; 3, instrumental diagnosis.
Symptomatology.
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