CHAPTER II.
EXAMINATION OF PATIE
Tire examination of the patient compri:
sl yeneral examination, which takes into aceount certain phe- nomena of disease which concern the organism as a whole, and are the expression of a pathological change of the whole organism.
A speetal examination, which inquires into the different regions and organs, the secretions and exeretions of the body. At the bed- side we generally proceed in such a way that, beginning at the head, Jually go downward, in order to facilitate the investigation by Bui in many cases it is better to group together or re funetionally related, no matter what their anatomical location may be, since we thus quickly obtain a compre- hensive view of the way in which the affected organs or systems are disturbed. Thus, in « s of the heart, the heart and bloodvessels, of the nervous system, the central and peripheral nervous ystems are examined together, Sometimes, as in the case of very weak or very unruly patients, as children, the examination of the ody must be very brief. Here the expertness of the physician espe- cially is put to the test to the utmost degree. of study if the division of the systems, and hence
we ¢
e
anining conti
in dixe
s
It will best a
yswer the purposes
subject throu etly conforms to the o1
the special part is divided into:
mination of the respiraté
apparatu ixamination of the circulatory apparatus,
JH. Examination of the digestive apparatus. IV. Examination of the urinary apparatus, including also in part the sexual apparatus, V. Examination of the nervous system, [Serr BY THE TRANSLATOR UPON KEEPING RECORDS OF CASES, AND A
FORM FOR RECORDING THE RESULTS OF A MEDICAL EXAMINATION,
at the bedside to go throngh any set form for ssent illness. The most direet
Ic is vot practica
conducting th ca
nquiry regarding the pl
EXAMINATION OF PATIENTS. a)
way of getting at it, and the one that will lead to the most satis factory replies to our interrogatories, is to ask the question, What is your complaint? How are you sick? or some such direct question as this, In this way we get at once at the disease we are called upon first to diagnose and then to treat. As we proceed we will «
ange the facts in our minds, and when we make the record, we shall place them in a natural and logical order, Having a regular form for keeping records of eases soon develops an order of procedure in accordance with it.
Case-tuking is a most valuable aid to the student in clinical study.
- Tle learns to make a systematic examination of the patients he sees, He forms the habit of bringing before his mind each factor in the case in orderly succession, There are two advantages from this. Fi He forms the habit of thoroughness in examining lis cases. Second. He can readily compare one case with another—having arranged the factors of each in like order. While it is not nee: in making the examination to have or to follow strictly a printed form, yet it is desirable to have some regular form for making the record, so that case y compared, One case may require going over only a few points, in another it wili he necessary to examine every organ in the body.
ary
s that are similar can be readi
The memory is greatly strengthened. Memory depends upon attention and repetition, Case-taking cultivates both of these in an eminent degree. Facts and symptoms that else would escape notice entirely, or be only slightly noted, are brought prominently before the mind for consideration. Their value or bearing is weighed, and so they are strongly impressed upon the mind.
The mind is developed by this habit of carefully reflecting upon every feature of a case. Thought is both stimulated and made easy.
Clearness and power of thought are increased. Independence of jadgment is cultivated. Both knowledge and intellectual cultivation are acquired. ‘‘By knowledge is understood the mere possession of truths; by intellectual cultivation, or intellectual development, the power, acquired by exereise of the higher faculties, of « more varied, vigorous and protracted uetivity.” (Sir William Hamilton.)
- Ease and habit of writing are almost unconsciously acquired. This is most valuable. The great majority of physicians keep no records of cases. Many never record or publish important ones,
ICAL DIAGNOSIS.
26 ME
heeause they have not the facility of writing whieh comes with prac- tice. Anything is easy to the practised hand. “Who can estimate how much we have lost, from the fact that generations of men gifted with powers of aente and shrewd observation, have passed away without leaving one record behind them? Think not that it is the hospital physi ance the progress of medicine. There is not a practitioner who could not aid this great work. But he can only add to it with elfficieney if he has faithfully recorded his observations, and does not trust to the general and vague sted memory. ‘Therefore, on all. grounds, per- sonal to yoursely nd general for medical science, so engrain this habit within you that it becomes a second nature.” (Coupland.)
or surgeon alone who
impressions of unas
Tie ANAMN
Personal and Previous History.
ne, Address, Birthplace, Age, Sex,
Family histor Father, Mother,
Brothers, Sisters, Other relatives.
Manner of life, habits, oecupation, residence, ete.,
character and results,
(Note each one tha effect upon the health or
was of such a character as to have any lasting ality.)
Preseut Illness, Duration, Possible exciting cause, Ifow hi mptoms, Course of the disease till the time of examination,
un—sudilenly or not. prodromal
{MINATION OF PATIE
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Examination of the Patient.
General examination : Appearance, Psychical condition, Position in bed, Steucture and nutrition, Skin and subcutaneous tissues, Temperature, Pulse.
This covers the general features of every case. Attention has been directed, by what has been learned thus far, to some one or more of the special organs or systems of the body. It is usually best first to examine that, and to make this examination very full and thorough. Then the remaining organs of the body can be examined with greater or less fulness, according as they are found to be affected by the principal disease, or as they are related to the one specially diseased. It is well to form the habit of following a certain order in examining each organ. One is much less apt to overlook any part; and, too, as has already been pointed out, the records will be more easily con- sulted and compared. For this purpose, it is well to take the order of the text-book, so as to become thoronglily fumiliar with each subject. It is not of so much importance that this or that one is adopted, pro- vided it is a good one. But we have here a notable illustration of the truth and value of the Spanish proverb: ‘+ Beware of the man of one book.”
Presuming that those who use this work will follow the order laid down in it, the form now given conforms with the order in which the systems are treated.
Spectra, EXAMINATION.
Examination of the respiratory apparatus: Nose, Mouth, Larynx.
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MEDICAL DIAGNOSIS.
Examination of the lungs:
Inspection of thorax, Palpation of thorax, Peren: Auscultation of lungs, Auseultation of veice. Measurement of thorax, Cough and expectoration.
ion of thorax,
Examination of circulatory apparatus:
Examination of the urinary
Exaui
Inspection and palpation of the region of the heart, Percussion of the heart, Apex-beat, Auscultation of heart,
Examination of the arteries and veins,
Examination of the blood. nation of the digestive appa Mouth, Stomach, Inte: Peritoneum,
Liver,
Spleen,
Pancreas,
Contents of the stomach and vomited matters, Feces.
autus t
mums, and pharynx,
ines,
apparatus : Kidneys,
Ureters and bladder.
ation of the urine:
Atmount in twenty-four hour Reaction, Ouor, Specific gravity,
vdimeut, Albumin, Blood. Bile,
Sus
Other constituents.
AMINATION OF PATIENTS,
Examination of the nervous system : Disturbances of sensibility, Location of, Superficial or deep, Motor disturbances, Disturbances of speech, Condition of the organs ot special sense.
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