A practical treatise on medical diagnosis for students and physicians

Front matter

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UNITED STATES OF AMERICA.

Preface

Modern methods of medical education demand that the student should be taught the expressions of morbid action , or, in other words, the phenomena of disease. He must be brought into contact with them in the hospital ward and the out-patient room, which are the medical laboratories where all the data are collected, analyzed, and used in discriminating the various disorders.

The object of this volume is to aid the student in the pursuit of such laboratory studies, and at the same time to furnish the practitioner with a reliable practical guide to diagnosis for use in his daily work. It has been thought best to combine in these pages the study of the objective phenomena or signs of disease, the subjective phenomena or symptoms, and the methods employed for their determination. Special attention has been paid to research for objective phenomena appearing in physical, chemical, and biological changes in the tissues and secretions. The necessity for elaborate descriptions or extended lists of minutiae as guides to differentiation is being rapidly displaced by the use of instruments of precision. Formerly, for instance, extensive tables were displayed to indicate the differential diagnostic features of anaemia and chlorosis ; now a few moments' examination of the blood decides the nature of the affection and whether iron or arsenic is to be given for its cure.

The following pages bear evidence that the author does not undervalue the direct and collateral data obtained by inquiry. Without them an examination carefully conducted according to all other methods may go for naught in the distinction of disease.

The association of morbid processes with their phenomena is a practice of the utmost importance to students, and a chapter has therefore been inserted upon the Symptomatology of Morbid Processes. Bacteriological Diagnosis has become an established method vi

PREFACE.

by which various disorders are recognized, and it is essential that the procedures in this new means of research should be fully outlined. The chapter on this subject is included not merely as a guide and reference for the trained student, but it is hoped that it will also emphasize the possibilities of bacteriological studies and inspire those who are themselves without facilities for prosecuting laboratory work to have examinations made for diagnostic purposes by experts with laboratories at their command.

My best thanks are due to my associate in private and hospital work and teaching, Dr. H. B. Allyn, for assistance without which this book could not have been written ; to Dr. H. Toulmin for aid in the collaboration of the sections devoted to the examination of Sputum and Faeces ; to Dr. Charles Burr, of the Infirmary for Nervous Diseases, for the articles on Cerebral and Spinal Localization and on Electrical Diagnosis, and to Drs. Joseph Sailer, W. H. Fenn, and J. E. Talley, for valuable assistance.

Fortieth and Locust Streets, Philadelphia, February, 1894.