A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt.

  • Vierordt, Oswald, 1856-1906.
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    25/642 (page 19)
    ANAMNESIS. What is it necessary for the physician to know, beyond what his examination reveals, in order to recognize a given disease in itself and to form a critical judgment regarding the patient in a larger sense? It is difficult to define this. Facts which appear insignificant in them- selves, in experience often exercise a decided influence upon the special diagnosis, and especially in forming a judgment regarding the consti- tution of the patient or upon the timely recognition of a secondary dis- ease. From having at hand clear knowledge of the symptoms of the different diseases, both of their remote or predisposing and of their directly exciting causes, a physician of experience is able in a short time to select what is essential from the past, and so to avoid too great prolixity. But it is always well for the beginner to secure as complete an anamnesis, or prior history, as possible, in order that he may allow nothing of importance to escape his attention. The anamnesis generally begins with and involves the question as to whether the disease is acute or chronic, what organs are affected or are inclined to be diseased. This determines the examination to fol- low, in that certain organs are examined with greater exactitude than others. But the examiner must guard himself from too great influence or prejudice from the result of the anamnesis : the objectivity of the objective examination must be kept in view; and this, in turn, may give occasion for supplementing the anamnesis by propounding addi- tional inquiries regarding certain occurrences and appearances, and thus a conclusion is finally reached. It is advisable for the student, under all circumstances, with all the patients he examines, and for the physician at least with his more important cases, to note down in regular order the results both of the anamnesis and of his examination. [See Translator's note, page 24 et scq7[ For the purpose of clinical instruction it is frequently of advantage to note the present state of the patient before making the anamnesis. We are thus better able to see the real facts and to preserve the objec- tivity of our judgment; but it cannot be expected that a physician will long continue to observe this rule in ordinary practice. Mode of Taking the Anamnesis.—First, we always note the name, occupation, age, residence of the patient. Then we conduct, as simply as possible, a dialogue with the patient, or, in the case of a child or of a person who is insensible, unconscious, or mentally dis- turbed, with his neighbors or relatives. How much we may allow the person simply to tell, how much we must learn by asking ques- tions, must depend upon the cultivation and intelligence of the one giving the information. We must particularly guard against asking the patient leading questions—that is, influencing the reply by the manner in which we put the questions. To the question : Have you, then, really never had any pain in the bowels ? or, Did you never have any pain in the bowels ? we shall almost certainly receive an affirma- tive answer, either from indifference, or from a desire to make his com- plaints as interesting as possible and to enlarge upon them, or, lastly, because he is of a very impressionable nature, and the question of pain suggests to him what in reality he has not had.