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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    vertebme (Pott’s disease). Pain in tlie same situation, during active manhood, might result from the presence of an aneuri.sm ; in an old person, from malignant disease of the spine.^ In addition to the points I have already mentioned (1, 2, 3, 4, 5, and G), the following circumstances are sometimes helpful in deciding the pathological diagnosis:— 7. The occu'pation of the 'patient.—A rapid attack of ill-developed pneumonia with fever, ending in death, in a icoolsorter, would suggest anthrax. Headache, convulsions, and double optic neuritis, a combina- tion of symptoms which is usually indicative of an intra-cranial growth, would, in a v:hite-leadworker, suggest plumbism. 8. The abode of the patient.—A cystic tumour of the kidney, if it occurred in Iceland, would probably be diagnosed as an hydatid, for hydatid disease is very prevalent in that country ; neuralgic affections occurring in places where ague is endemic, are very often due to tlie malarial poison ; and so on. Errors in Diagnosis.—Before concluding these remarks, it may perhaps he useful to point out the chief sources of error in arriving at a full and correct diagnosis. In the first place, then, a diagnosis may fail through insufficiency of facts. The facts may he actually wanting. In the earlier stages of a febrile attack, for instance, it may he impos- sible to come to a definite conclusion; under such circumstances we must he content to make a provisional diaynosis, and to wait for the appearance of additional facts. Again, the facts may lie insufficient owing to the information supplied by the patient being defective; some patients wilfully conceal facts; others cannot furnish the necessary facts owing to their being children, foreigners, speechle.ss, comatose, or affected with some mental derangement. In such cases we have to fall hack upon the friends for many j^articulars, and if, as it may happen, there are no friends, we must rely on the physical examination alone. In cases of this description, the gi’ounds for forming an accurate opinion may he insufficient. This is one of the sources of difficulty of diagnos- ing simple affections in lunatics. In the second place, a diagnosis may fail fhronyh the incorrect or erroneous observation of facts. The patient may wilfully deceive you, or your own observation may he at fault. Defective or incomplete observation on the part of the physician, is a fertile source of error, especially in young practitioners. In a case of dropsy, for instance, the urine is found to he albuminous, and it is ' This does not of course imply tliat malignant disease of the vertebra^ does not occur in young persons, or tliat old people do not sufler from aneurism or caries. P.