Text-book of nervous diseases : being a compendium for the use of students and practitioners of medicine / by Charles L. Dana.

  • Dana, Charles L. (Charles Loomis), 1852-1935.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of nervous diseases : being a compendium for the use of students and practitioners of medicine / by Charles L. Dana. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    59/654 (page 39)
    CHAPTER V. DIAGNOSIS AND METHODS OF EXAMINATION. The diagnosis of a nervous disease may be simply a clinical one -t that is to say, one may recognize it as belonging to a certain known and definite group of symptoms. Thus in recognizing the phenom- ena of epilepsy, one makes a clinical diagnosis. In other cases, and especially in all organic nervous diseases, the physician must make in addition a local, and then a pathological diagnosis. That is, we must determine the seat and nature of the disease. A diagnosis is made by first getting all the obtainable facts in the patient's past history, then by learning from him all his subjec- tive symptoms, and finally by making an examination according to the technical methods to be here described. In examining a patient, it is imperative that a careful search for diseases outside the nervous system first be undertaken. Then the morbid nervous phenomena should be investigated. The physician should make it an invariable rule to make this examination in a certain fixed and systematic manner. The best method is first to get the family and personal history, and then to go over the mental, cerebral, and special ner- vous functions serially in the way indicated under the description of general symptoms, thus: Examine— 1. Physiognomy, general condition of nutrition, complexion, physical defects (stigmata of degeneration), gait, station, posture, speech. 2. Mental and cerebral symptoms. 3. Motor and muscular symptoms, including muscular and joint atrophies, electrical reactions, and the reflexes. 4. Sensory symptoms, general and special. 5. Vasomotor, trophic, and secretory. 6. Visceral centres. In investigating the family history, it is often necessary to make very direct and probing inquiries, for patients are, as a rule, inclined to forget or ignore the existence of nervous and mental disease among relatives. The existence of consumption and inebriety, epi- lepsy and s}philis, in the direct line are very important facts; so also are those concerning birth. The patient should be questioned closely as to his previous diseases, especially syphilis; also as to his