CHAPTER II.
SURGICAL “ HISTORY’? AND HOW IT SHOULD BE TAKEN.
UNDER the term “history” is included all the informa- tion that is obtained from the patient or his-friends up to the time when the case comes under the notice of the surgeon. This naturally falls into three more or less distinct groups.
The history of the disease, illness, or injury from which the patient is at present suffering.
The past history, relating to any disease, illness, or injury antecedent to the commencement of the present trouble.
The family history, relating to diseases whether of a similar kind or not, that may have occurred in other members of the patient’s family.
Each of these may be discussed separately. The
first is usually by far the most important.
History of the present disease, illness or injury.—The surgeon has to ascertain and to arrange, as far as possible, in chronological order, all the symptoms and physical signs of which the patient has been the subject up to the present time.
SURGICAL “ HISTORY.” 13
The first question which should be put is, ‘‘ What is the matter with you ?”’ or, ‘‘ What is your complaint ?’’ The next question should usually be, ‘“‘ How long have you had this trouble P”? (or these symptoms).
The duration, and consequently the rate of progress, of the disease being often a matter of great importance, the surgeon should first direct attention to the date of the beginning of the illness, and ascertain how the latter began. He should endeavour to get the patient to tell him what were the symptoms that he first noticed. Then, successively, the various steps in the progress of the disease should be ascertained, until he arrives at the present condition of the patient.
The surgeon should avoid asking leading questions, except when absolutely necessary. The patient should be induced, as far as possible, to tell his story in his own way, the surgeon merely directing his questions to the elicitation of particular points which may seem to have an important bearing upon the case.
Some patients are, however, very tiresome in the way they describe their symptoms. They often lay far too much stress upon unimportant details and envelop the really important facts in an irrelevant mass of verbal surplusage. This may arise from incompetence, from lack of intelligence or general education, from want of intelligent observation, and even sometimes from wilful misrepresentation.
Much care and attention may be required on the part of the surgeon to sift the grain from the chaff, to separate the really important points of the history from those which are trivial or irrelevant.
The state of the patient, again, may be such as to
14 SURGICAL DIAGNOSIS.
prevent him from giving any intelligible account of his symptoms. Information must then be sought from the patient’s relations or friends, or others who have had — opportunities of observing his symptoms. Especial attention should be paid to information communicated by a skilled observer, say a doctor or a nurse. The in- formation communicated by unskilled observers should be received with a certain amount of caution. More attention should naturally be paid to facts observed by them than to any opinions that they may express.
The surgeon should also be on his guard against accepting too readily any diagnosis that may already have been made by other observers, whether skilled or not. It is well to receive with a certain amount of dis- trust any diagnosis which the patient himself may have made.
It should be remembered that the patient, especially if he belong to the better educated class, may have been reading about the disease from which he supposes him- self to be suffering, and may perhaps glibly relate along train of symptoms which have little or no real existence save in his own imagination. It is very easy for an excitable and nervous patient to believe that he (or she) really has the symptoms that he thinks he ought to have.
And this may occur without any idea or intention of wilful deception on the part of the patient.
The cautious and well-trained surgeon will endeavour to estimate from observation of the character of his informant the relative value of the statements made by him. Statements which appear to be wholly at variance with the facts observed by himself should be received with much caution. The history obtained from others