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.

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    1() It“, then, M’c detect the ])resence of dulness we narrow tlie limits of the inquiry. 3. The natiu'c of the si/mjhoiiis.—Deep-seated pain in the back, for example, ocenrring in an adult, and not attended by any marked dis- turbance of the general health, would be very suggestive of an aneurism. 4. The mode of commencement of the attack, and the course of the ease, especially the acute or chronic nature of the affection.—This is a most important aid in arriving at the pathological diagnosis. ^Vhen, for example, we find consolidation over the base of the lung, and when rve know that it is of recent origin {i.e. acute), we can definitely exclude solid intra-thoracic growths. vSo, too, in a typical case of permanent hemiplegia, if the onset were sudden, we should conclude, as the result of experience, that the pathological process was in all probability either extravasation of blood into the brain substance (hsemorrhagic apoplexy), or plugging of a cerebi-al vessel.^ The exact mode of onset is also sometimes important. In a case of hemiplegia, if the paralysis followed an epileptic fit of tlie localised (Jacksonian) type, we should probal)ly be correct in concluding that it (the hemiplegia) would be of temporary duration, and further, that the pathological process at the root of the mischief would in all probability be a localised ‘ coarse ’ intracranial lesion (tumour or localised meningitis). When considered in conjunction with the exact anatomical diagnosis, the mode of onset is often quite conclusive. We know, for instance, that sudden paralysis of the lower extremities in a child, characterised by flaccidity, rapid atrophy of the muscles, and unattended by sensory derangements, depends upon an acute inflammatory process in the anterior cornua of the spinal cord. 5. The presence of associated diseased conditions.—In tlie case of a doubtful intra-thoracic growth, the presence of tumours in other organs or parts of the body, would show that the intra-thoracic disease was a malignant growth. So, too, in chronic Bright’s disease, the presence of a solid and uniform enlargement of the liver and spleen, would strongly point to the lesion being ‘waxy.’ Again, in a case of intracranial tumour, the presence of associated scrofulous disease of the glands, lungs, or joints, would indicate that the central lesion was of a similar patho- logical character. 6. The age of the patient.—Certain pathological processes are common at one period of life, but rare at others. In some cases this fact may help to decide the pathological diagnosis. Deep-seated pain in the back, for example, in a young subject, would probably be due to caries of the ' I say a typical case, foi’ in hysteria we sometimes meet with sudden hemiplegia (presenting certain peculiarities however) which may last for a long time.