4. =Diagnosis.= After the pathologic changes have been fully studied,
the diagnosis should be formulated. If the pathologic changes found
can be correlated as factors in some specific conditions they should
not be considered separately, but the specific condition itself
would constitute the diagnosis. When the pathologic conditions
have no definite relation to each other they should be classified
separately. If a section of kidney shows cloudy swelling, congestion,
œdema, small-celled infiltration, hæmorrhage and casts, these
different conditions would all be included in the diagnosis of an
acute parenchymatous degenerative nephritis. If the general picture
corresponds to that of tuberculosis, syphilis, neoplasm, etc., the
various associated changes need not be considered alone, but the
broad and comprehensive diagnosis should be expressed in as concise
terms as possible.
Written descriptions of microscopic appearances should be so
full and clear that it is possible to make a diagnosis from the
word-picture. A full and adequate analysis of the preparation set
forth in concise and clear language is of more objective value
than the bare diagnosis. Reproductions by means of drawings are
also of great value in assisting the memory or in communicating
the results of the observation to others. A technique sufficient
for ordinary purposes may soon be obtained. Color work is usually
easiest, since the majority of sections are stained in color. The
camera lucida or Edinger’s drawing apparatus may be of great service
in the enlargement and placing of the various elements of the
section; with these instruments but little practice is necessary to
produce rapid and accurate representations. The close inspection
of the preparation during the drawing often reveals features that
previously had escaped attention. Many workers object to drawings
on the ground of subjectivity, but the same criticism applies even
more to word-descriptions. Especial attention must, however, be paid
to this danger, both in the case of drawings and word-descriptions.
In the case of scientific work the written description is best
backed up by photographs, rather than by drawings. Microphotography
has the very great advantage of being purely objective, although
dishonest photographs are possible. There are, however, certain
limitations to microphotography. Differential details are lost in
sections; all parts of the section cannot be fairly represented;
and focal and color limitations are great disadvantages. I believe,
however, that for pure scientific work word-descriptions should be
accompanied by objective microphotographs instead of drawings. The
microphotographic outfit of Zeiss has already been recommended as the
best. It is impossible to take up the subject of microphotographic
technique in this book. The reader is referred to the chapter on
“Microphotography” in Aschoff and Gaylord’s Atlas, and to the works
of Cresbie, Bagshaw, Kaiserling, Neuhauss, and others. (See article
Public-domain text, read in full here on John Shaqi.
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