A text-book of medical diagnosis / by James M. Anders and L. Napoleon Boston ; with 418 illustrations in the text and 25 plates, 17 of them in colors.

  • Anders, James M. (James Meschter), 1854-1936.
Date:
1911
Catalogue details

Licence: In copyright

Credit: A text-book of medical diagnosis / by James M. Anders and L. Napoleon Boston ; with 418 illustrations in the text and 25 plates, 17 of them in colors. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    in this manner need confirmation. It is safer, and it is here recommended, to defer the final conclusions until he has the completed fund of data for inductive purposes, except in those rare diseases in which a certain diag- nosis rests principally upon a pathognomonic feature. There are a number of infective diseases that usually do not recur during the life of the indi- vidual, e. g., typhoid fever, measles, whooping-cough, scarlatina, and variola. We should be guarded, therefore, in the matter of arriving at the diagnosis of second attacks of these diseases when the evidence of tlie occurrence of a primary attack in the past is convincing. Hasty generalizations from partial or defective investigations of disease too commonly lead the observer to hold untenable gi'ound in the field of diagnosis, and as certainly lead him to adopt disappointing lines of treat- ment. The scientific study of disease from the standpoint of diagnosis can never reach the high plane which its dignity and importance demand without receiving the continued impetus resulting from the combined application of all the known laboratory and clinical methods at our disposal. There is demanded a close examination of the particular parts—a process of thought in which the value of each symptom, sign, or laboratory finding, as the case may be, must be estimated deliberately and weighed against other features. A judicious balancing of the important diagnostics is then required preparatory to final induction by correct reasoning. After the examiner has gained a certain amomit of experience in the taking of an anamnesis he can, during the process of eliciting the facts pertaining thereto, discriminate the more essential phenomena and disregard those that are of least significance, in order that the details shall not become too massive for ready inference. On the other hand, the beginner should note all data, however insignificant, lest important clues to more or less obscure condi- tions present be overlooked. In not a few cases the most experienced clinician, after forming a provisional judgment from the anamnesis, is forced to abandon it for another after he has noted the pathologic physical signs and obtained all the available laboratory findings. The physician is thus competent to recognize a disease—to evolve a diagnosis—but not with certainty until, with the aid of morbid physiology, he has correlated the symptoms with the bacteriologic and pathologic causes to which they owe their origin. A diagnosis formulated and founded in the manner indicated above becomes the sure foundation of rational prognosis and effective therapeutics. It should be an invariable rule when the diagnosis is made to still con- sider the possibility of the existence of a combined condition or affection, so common are complications and associated diseases. Indeed, in many cases it is impossible for the physician to form a diagnostic judgment with- out making a study of the distinctions between a suspected or recognized disease and others that present points of striking similarity. Under these circumstances the pathognomonic diagnostics are golden, and should be searched for diligently. This phase of our subject, known as differential diagnosis, often occasions difficulty, and it is discussed at considerable length throughout the pages of this work in connection with individual affections. There are a few methods of investigating disease which should be con- sidered connectedly in this place; they are the Rontgen, cultural, chemical, and serum methods, and the opsonic index. The Rontgen method has become almost universally applicable, and