Practical medicine and medical diagnosis / by Byrom Bramwell.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practical medicine and medical diagnosis / by Byrom Bramwell. 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.

    17/164 (page 9)
    Speaking generally, the facts observed by the ■physicuLn{oh]QC.i\\e. syinp- toms and physical signs), inasmuch as tliey do not depend upon the mere statement of the patient, are of more importance tlian the symptoms {i.e. the subjective symptoms or sensations experienced Ijy tlie patient). 1 )ue weight should, however, be given to the symptoms unless there is some obvious reason to the contrary. AVhen the ])atient is manifestly exaggerating, when he is labouring under some mental derangement, or when there is a motive to deceive, tlie diagnosis should be almost exclusively based upon tlie physical signs. Women are more apt jo exaggerate than men ; but this tendency is seen inlt^Tlillest extent in irie~condition called hypochondriasis, in which tli6 patient imagines tliat he is the victim of all sorts of dreadful complaints, magnifies the most trivial ailments in an extraordinary manner, and seriously believes that he is the subject of grave organic disease. In hospital practice it is no uncommon thing to meet with patients who feign disease. Tliese ‘ malingerers,’ or, ‘ hospital birds,’ as they are called, pass from one hos- ])ital to another, and keep a roof over their heads by their deceit. It often requires considerable acumen to detect them. Malingering is, as we all know, not uncommon amongst schoolboys; it is also frequently met with in soldiers, sailors, prisoners, tlie inmates of workhoirses, and the like. In railways cases, too, we sometimes meet with gross exaggeration and shamming. We find persons who have been in a rail- way collision, but who have received little or no injury, taking to bed, laying up for weeks or montlis, and feigning to be seriously ill in order to exact heav'y damages from the company. Hence it is tliat all railway cases are looked upon with more or less suspicion; a most un- fortunate circumstance for those persons who are really hurt, for in consequence of this feeling of suspicion, which is attached to all railway cases, the genuine ones are often inadequately recompensed. In other cases, on the contrary, patients who are the victims of .serious organic disease, make light of their complaints. In phthisis, for example, a patient will daily tell you that he feels much better, when it is manifest to the most casual obser\ er that he is rapidly getting- worse ; indeed, so frequent is this hopeful state of mind in pulmonary consumption, that a special name, the spes phthisica, has been given to it. Young doctors, whose experience has been limited to hospital prac- tice, and who start perhaps with an exaggerated notion of their powers of physical diagnosis, are apt to disregard symptoms. I know this from actual experience. The following, which I met with soon after commenc- ing practice, is a case in point:—A man presenting all the appearances of robust health, and who was obviously not exaggerating, consulted me on account of pain in the left cliest and back. Xot detectino- anv-