Diagnosis

“ A diagnosis is an examination or analysis to determine the identity of a disease and to reveal its cause and characteristics. A reputable medical man will not undertake the treatment of any malady without having first made a searching examination and a thorough diagnosis of the trouble.
In the case of the stammerer or stutterer, expert diagnosis is very important and should be undertaken only by a diagnostician who has had previous training and experience of sufficient duration to enable him to be classed as an expert on the subject. ”

“ Every malady is accompanied by its characteristic indications, some of which are diagnostic, i.e., they particularize the affection and distinguish it from all others.
Medical diagnosis is both a science and an art; a science when the causes and symptoms of a disease are understood, and an art when this knowledge can be applied to determine its location and exact nature. Science presents the general principles of practice; art detects among the characteristic symptoms the differential signs, and applies the remedy. ”

“ The final diagnosis is with respect to the nature of the lesion. While the second diagnosis may be said to possess the greater scientific interest, this one must be admitted to possess paramount practical importance, as from it we derive the indications for rational treatment and the data of prognosis. The third diagnosis is to be made by the application of the observer's knowledge of general pathology and etiology; hence it is in this field that the best-trained physician succeeds—where the experienced practitioner may sometimes eclipse the brilliant specialist. ”

“ With him the first step in every case of disease is diagnosis, without which prescribing is simply drawing a bow at a venture, with small probability of penetrating a joint of the harness; and he insists that neither the apothecary nor the patient is qualified to make a diagnosis. The determination of the character of a disease is not a simple matter, often baffling the profoundest learning and the broadest experience, and, in most cases, requiring special knowledge and discriminating judgment. The most obtrusive symptoms are by no means necessarily the most characteristic ”

“ What is it to him that you can localize and name by some uncouth term the disease which you could not prevent and which you cannot cure? An old woman who knows how to make a poultice and how to put it on, and does it tuto, eito, jucunde, just when and where it is wanted, is better,—a thousand times better in many cases,—than a staring pathologist, who explores and thumps and doubts and guesses, and tells his patient he will be better tomorrow, and so goes home to tumble his books over and make out a diagnosis. ”

“ Every physician will admit that by the correct diagnosis of a malady more than half the fight against it is won; also, that if a correct diagnosis has not been made, all skill and all care and attention will be of little avail. ”

“ As to all the higher questions which determine the starting-point of a diagnosis—as to the philosophy of medical evidence—any glimmering of these can only come from a scientific culture of which country practitioners have usually no more notion than the man in the moon. ”

“ The best medical diagnoses, those made after death, contain from thirteen to seventeen items on the average. One of my chief tasks during the last fifteen years has been to study diagnoses made after death and compare them with those made in life. The real diagnosis as it is revealed at autopsy contains on the average thirteen to seventeen items. The diagnosis made during life contains often but two or three items. ”

“ Besides, it is often very difficult, if not impossible, to determine the true character of a disease by its early symptoms; so that much skill and experience are often required to make a correct diagnosis. But when the case is fully made out, no good physician thinks of treating it with one or more specifics. Such remedies are improper for physicians, and always dangerous in the hands of the common people, as many sad examples prove. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ Of several physicians, all but one are mistaken in the diagnosis of a case. Why do they differ? Every disease is characterized by a multitude of{150} symptoms. Some of them are obvious, so that no one can fail to notice them: the complaints of the patient. Others are more hidden, but no less important. The physician must search for them. Each symptom, for example, fever, lack of appetite, dizziness, megalomania, may appear in very different diseases. A definite group of symptoms in definite degrees of intensity is characteristic of a particular disease. ”

“ Not only in everyday practice in certain lines is a knowledge of this technique necessary for diagnostic purposes, but the true physician should so hold himself toward every problem of diagnosis which presents itself to him, that with every opportunity, he will, through excision, curettage or autopsy, make use of his technical skill to further his knowledge of disease, and to aid his science toward a solution of its great problems. ”

“ The very notion of Diagnosis in our modern sense of the word depends upon Morbid Anatomy. The older physicians seldom attempted to determine the seat of an ailment. [8] Disease was looked upon not as a condition depending upon disordered physiological functions, but as something external, attacking a previously healthy person, disturbing, and, if not expelled by art, finally destroying him; while any structural changes which were found after death were regarded rather as the effects than the causes of the symptoms during life. ”

“ It is to be distinguished from “diagnosis” (Gr. διάγνωσις, διαγιγνώσκειν to distinguish) , the determination or identification of a disease in a particular case from an investigation of its history and symptoms. ”

“ SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC. Every medical practitioner must have met with a certain class of cases which has set at defiance every effort at diagnosis, baffled every treatment, and belied every prognosis. ”

“ The old mode of determining the diagnosis of disease is made up of opinions of diseased persons, in their right mind and out of it, all mixed up together, and set down accompanied by a certain state of pulse. In this dark chaos of error [the doctors] come to certain results like this: If you see a man going towards the water, he is going in swimming; for people go in swimming. But if he is running with his hat and coat off, he is either going to drown himself, or some one is drowning, and soon. ”

“ Nowadays, all this is past, in medical science. As to the causes of disease, we know that they are facts of nature,—various, but distinguishable by diagnosis and research, and more or less capable of prevention or control or counter-action. ”

“ It is true that medicine has ticketed and shelved all symptoms, and that it is its plan to await development of indications before diagnosis. But medicine devotes its attention entirely to the suppression of the manifestation to the neglect of its cause, and a classification thus made finds items overlapping each other in such manner as to make distinction difficult if not impossible. ”

“ Treatment without diagnosis, besides its inefficiency, brings us for the time unpleasantly near to the charlatan who, whatever title he may assume, is always therapeutical and never pathological. Rational, bold, and effectual treatment, whether preventive or curative, must always depend upon accurate diagnosis and sound pathology, and the power of diagnosis depends upon that systematic inspection of the bodies of diseased persons which was recommended and practised by Harvey. ”

“ At the same time we must admit the possibility of mixed forms, where the functional element is linked with primary or secondary organic disease, and perhaps their occurrence is more general than is ordinarily imagined. We repeat, however, that rigorous and lengthy investigation alike of the psychical and the somatic phases of the condition, embracing the state of the reflexes, will usually furnish sufficient information to facilitate the question of diagnosis and justify a positive statement. ”

“ The ordinary practitioner, examining bodily symptoms, telling the patient that he is sick, and treating the case according to his physical diagnosis, would naturally Metaphysics challenges physics induce the very disease he is trying to cure, even if it were not already determined by mortal mind. ”

“ Hence it is that the diagnosis of injury and disease in the extremes oflife is beset by especial difficulties, since the entire body is as silent as are the brain, the pericardium, the mediastinum, and other symptomless areas. For the same reason, when a patient who is seriously ill with a painful disease turns upon the physician a glowing eye and an eager face, and remarks how comfortable he feels, then the end is near. ”

“ We do not hesitate to reveal the main points of our system of diagnosis, which is much broader than the old system of scholastic medicine,—the performance with auscultation, percussion, X rays and the rest. ”

“ In order to make a differential diagnosis, however, it is not only necessary to know the structure and functions of the organs in health, but to adopt a rigid system of details of examination, without which successful results can not be reached. ”

“ Not ours is the task of analyzing special methods of neurological and mental differential diagnosis such as are used in the psychiatric clinic and in the office of the nerve specialist. There the family history with reference to nervous and other diseases, the history of the patient himself, the infectious diseases which he has passed through, his habits and anomalies, his use of alcohol and of drugs, his experiences in social life, the demands of his profession, his recent troubles and their first origin are to be recorded carefully. ”

“ The basis of a positive diagnosis is the exclusion, by the absence of their physical signs, of inflammatory affections and lesions of structure.
The physician who undertakes to diagnosticate functional disorders of the heart by symptoms alone—that is, without physical exploration—must often be in doubt, and if not prudently distrustful of his ability as a diagnostician, he is liable to commit errors which are sometimes extremely unfortunate. I was requested to see a young woman who was represented as suffering from a disease of the heart from which she might die at any moment. ”

“ Every case that terminates fatally is examined after death, and an account of the morbid appearances is entered in a book kept for the purpose. In this manner, in the progress of years a mass of facts accumulates relating to the statistics, the types, the symptoms, the causes, the diagnosis, the pathology and the treatment of the disease, whether successful or unsuccessful, which both on account of the fullness and accuracy of the record and of the extent of the period it embraces, cannot but be of great value. ”

“ Pathologic material is examined in the fresh state when it is desired to make a diagnosis in the shortest time possible, or when the processes of fixation and hardening produce such alterations in the morphology and chemic constitution of the cells that these features can be recognized only in the unfixed, fresh state. ”

“ Yet there are signs that we are entering on a new phase, and that a realisation of the importance of early diagnosis is slowly permeating through the medical profession. In America we see an increasing insistence on the use of detailed and specialised laboratory methods for exact diagnosis ”

“ The doctor greets a patient courteously and always waits for him to tell what his symptoms are. He then examines the patient, asking questions based on what the patient tells him, to bring out certain points which will help in making an accurate diagnosis. Very often such questioning will enable the doctor to determine just what the nature of the illness is. ”

“ It is imperative to create an environment or a culture that reduces stress for the physician, to always use differential diagnoses even when the diagnosis seems obvious, and to train humble physicians who are willing to listen to patients and other team members so that they can revisit the evidence when they are questioned about their diagnosis or management of patients. ”

“ Troubles which would lead the patient to go to the specialist primarily, without consulting his family physician, should receive little attention.
Two other classes of lesions in such organs as are usually handed over to specialists should receive attention in the undergraduate course—those which are apt to cause remote or reflex disturbances, and those which are definitely symptomatic of central lesions. The first should, in my judgment, be dwelt upon only to such an extent as to enable the student to know causative relation and method of diagnosis. ”

“ Specially Arranged for Diagnosis by M. von V. The object of this little work is to meet a need often keenly felt by the busy, physician, namely, the need of some quick and reliable method of com- municating intelligibly with patients of those nationalites and languages unfa- miliar to the practitioner. The plan of the book is a systematic arrangement of questions upon the various branches of Practical Medicine, and each question is so worded that the only answer required of the patient is merely Yes or No. ”

“ As the inclusion of the word 'diagnosis' came before the Senate for consideration, a controversy developed on the floor, aimed more at the word 'devices,' which was not then before the Senate, than at the word 'diagnosis.' 79 Cong.Rec. ”

“ The recognition, the diagnosis, and the preservation of psychopathic individuals account for the apparent increase of neurotics in civilized communities. ”

“ The practical bearings of a science, it will be granted, are simply, as it were, the summation of its facts, with the legitimate conclusions from them, the natural application of the data ascertained, and have not necessarily any direct relationship to its pursuit. It is when studied on these hues that pathology finds its proper place as a department of biology. Disease as an entity—as something to which all living matter is subject—is what the pathologist has to recognize and to investigate, and the practical application of the knowledge thus acquired follows as a natural consequence. ”