Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare.

  • Hare, H. A. (Hobart Amory), 1862-1931.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare. Source: Wellcome Collection.

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    Thup, in acute pleurisy the patient lies with the aflected side upper- most because it is too sore to permit him to touch it to the bed • whereas, if the stage of eifusion has arrived, he lies on the afiFected side in order to give the side which is healthy free play in compen- satory respiratory movements, and to remove the pressure of the effu- sion from the healthy lung. If the patient lying iu this posture is not suffering from pleurisy, his position may be assumed to be due to an effort to relieve the discomfort caused by an enlarged liver. The fact that the patient lies constantly on the back is also a characteristic of grave and advanced disease in some instances. Very ill persons almost never lie on the side, and the fact that a desperately ill case of yesterday is found lying on the side to-day is an encouraging sign. Persons with severe heart disease are rarely, if ever, able to lie prone in bed, and have to be more or less propped up with bed-rests and pillows. Large growths in the abdominal cavity producing pres- sure on the diaphragm also necessitate this semi-prone posture, and double pleural effusions, or pulmonary consolidation, or oedema, pro- duce the half-reclining attitude in order that the upper j)arts of the lung may be used to advantage. Again, if the patient wakes when spoken to, and then drops off to sleep at once, some form of poisoning may be present, as from opium, or the poison of advanced hepatic or renal cirrhosis may be present. (For the significance of picking at the bed-clothes, see chapter on Hand and Arm.) We can next pass to a consideration of the objects to be sought in questioning a patient as to the illness from which he is suffering. Often much information can be gained by a well-directed question, and a favorable impression can be made upon the patient by the manner in which it is put and the bearing which it has on his case. Thus, if a man is evidently much emaciated, and his clothes fit him loosely, a question in regard to his loss of flesh is very appropriate; but if he is manifestly too stout for comfort such a question will be most unfortunate. Or, again, if a young married woman comes complaining of constant sidiuess of the stomach and a fanciful appe- tite, and the physician directs all his questions to the condition of the stomach without an eye to a slight increase iu size about the waist or below it, his professional acumen is in grave danger of being libelled by that same woman, who knows, or soon finds out, that her discomfort is due to pregnancy. If the woman is unmarried and there is no evidence of gastric