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
Not nearly every case will correspond with such an
average in all respects. Moreover, so great is the possible variety of
alterations among the different organs of the body that the chances of
two instances of disease being precisely alike in every particular are
hardly greater than those in favor of every move being the same in two
games of chess with the same opening.
In an essay like the present it is not easy to decide upon the best
manner of treating the subject before us. Too much or too little may
be said. With advanced readers the whole history of symptoms and
physical signs might be left to the special discussions occurring in
articles upon different diseases. But it may be taken for granted that
those who consult the present work will do so either at a
comparatively early stage of their studies or when time has made
desirable a renewal of what may have been once known and then
forgotten. Since, then, it is impossible {150} to anticipate what may
be the exact needs of either class, a somewhat elementary statement of
main facts appears justifiable here.
Following the natural method, we may suppose a call to visit a
patient. Arriving in his presence, the first question (mostly left out
of view and rarely expressed) may be, Is it a case of real or only
imaginary indisposition? Army medical officers, more than most others,
can appreciate the possibility of this inquiry sometimes disposing of
the whole case.
Supposing it to be real, is it an illness or an accident or other
injury? Is it severe or of trifling account? Acute or chronic? We
observe the position of the patient, lying quietly in bed, sitting up,
or walking restlessly about the room. Then the countenance is
observed--pale or flushed, tranquil or excited in expression. We feel
the forehead, touch the cheek and hand. Is the skin hot or cold, dry
or moist? The pulse is felt; the breathing also is counted.
Of the patient himself or of another (in serious acute cases better of
his care-taker, in another apartment) we ask questions whose answers
give us the general history of the case. When not before known these
should include his antecedent personal history, even extending to that
of the family, as far as can be learned. What tendencies have they, or
has he or she, shown by previous attacks and their results?
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