A system of clinical medicine, dealing with the diagnosis, prognosis, and treatment of disease / 2nd edition.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1909
Catalogue details

Licence: In copyright

Credit: A system of clinical medicine, dealing with the diagnosis, prognosis, and treatment of disease / 2nd edition. 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.

    34/1012 (page 2)
    suffering. Submammary pain, for instance, in the first might indicate aneurysm ; in the second, hysteria. General (or constitutional) symptoms are those which relate to the whole body, such as debility or pyrexia. By some writers the term is used solely to indicate pyrexia and its concomitant symptoms, such as headache and general malaise. A latent disease is one which is unattended by any very obvious symptoms. Thus, we speak of latent pulmonary tuberculosis when a patient suffering from tuberculosis of the lung has none of the more usual and constant symptoms of that disorder, such as cough, dyspnoea, haemoptysis, and dulness on percussion. Physical signs are not neces- sarily absent in latent disease, but they are often difficult to detect. Some writers speak of a malady as being latent when the pain, which is usually a prominent feature of the disease, is absent. Thus, peri- carditis is ordinarily attended by a good deal of pain, but this is absent in the latent form of pericarditis which frequently complicates rheu- matic fever, and in the latent peritonitis which complicates enteric fever. A 'paroxysmal disorder is one which comes on in the form of attacks separated by intervals of comparative health. Each attack or paroxysm consists of a stage of invasion (usually more or less sudden), leading to an acme, and followed by a gradual decline in the severity of the symptoms. As instances of paroxysmal disorders may be mentioned Paroxysmal Tachycardia, Angina Pectoris, Epilepsy, Nervous Faints and Flush Storms, and Paroxysmal Hsemoglobinuria. The clinical features which all paroxysmal disorders present, and a close study of those features which admit of a pathological explanation, point to the sym- pathetic system, and especially the vaso motor portion of it, as being probably at fault in such cases. The student will often meet with the termination -itis, and it is well to remember that it signifies “ inflammation of.” § 2. Case-Taking.—In clinical investigation, or case-taking, our object is, first, to elicit all the data of the case; and, secondly, by reasoning based on those data to arrive at its Diagnosis, Prognosis, and Treatment. It will be found in actual practice that everything turns on the diag- nosis ; that is our first and principal object; the prognosis and treat- ment follow from this. The investigation of a case consists of two parts : (A) The Interroga- tion of the Patient, and (B) the Physical Examination. Students should always accustom themselves to learn all that is possible bj^ inter- rogation before proceeding to the physical examination. A. By Interrogation of the Patient we learn— (a) What is his chief or dominant symptom ; (b) The facts concerning the present illness ; (c) The patient’s previous history ; and (d) His family history.