Medical examination

“ DISEASE HAS CERTAIN UNMISTAKABLE SIGNS,
or symptoms, and, by reason of this fact, we have been enabled to originate and perfect a system of determining with the greatest accuracy the nature of chronic diseases without seeing and personally examining our patients. In recognizing diseases without a personal examination of the patient, we claim to possess no miraculous powers. We obtain our knowledge of the patient's disease by the practical application of well-established principles of modern science to the practice of medicine. ”

“ It is immaterial that another person employs the physician to examine the patient, and to report to the employer, and that the person examined does not appear to desire any knowledge as to his condition; if the examination is made as a professional act, the relation of physician and patient is established between the physician and the person examined, even though it be the only interview. ”

“ With the abundant information, the well argued deductions and the carefully drawn up statement here placed before us it may be claimed that we are now in a position to make diagnoses that not long ago were quite beyond our reach, whilst a thorough training of our younger medical men in the methods of blood examination must result in the accumulation of new facts of prime importance both to the pathologist and to the physician. ”

“ Another of the duties of the Department of Health was to examine every person that applied to practice medicine and surgery or to engage in any professional calling. The law required a medical examination to be made of the person, who was granted a license every year, so as to keep the professions up to a high standard. ”

“ It involves a continuance of the mischievous ideal of medical practice of the past, a conception still held by a large portion of the public to its own detriment, that a hasty inquiry, a perfunctory examination, and a bottle of medicine, represent the best that scientific medicine can offer a patient. ”

“ Thus clinical experience is opposed to what is learnt from laboratory research or theoretical considerations. The substantive “clinic” is technically employed for a medical school or class where instruction is given in practical work as illustrated by the examination and treatment of actual cases of disease. ”

“ Certainly, on some occasions, the examination to which the patient was subjected, in order to ascertain if he were truly a leper or not, seems to have been of the most searching and scrutinising nature. I have already alluded to the strict rules of examination that have been preserved for us in the works of different authors,98 and quoted the method recommended by Guy de Chauliac to be followed by physicians before they remitted suspected patients with medical certificates to the magistrates (cum literis medicorum ad rectores) . ”

“ The preliminary examination in general subjects is taken before admission to the medical school. After this, the first year at the medical school is spent in scientific study, such as Biology, Inorganic Chemistry, etc. Having passed her first scientific examination, the student proceeds to the study of the human individual, and deals for the next two years with Anatomy, which includes dissection, Physiology, the study of drugs in Materia Medica and Pharmacology, and Organic Chemistry. ”

“ Various States have made obligatory a preliminary examination of those intending to pursue medical studies, and three additional States have passed acts requiring, as a condition of practice, evidence of graduation at a medical college in good standing, or, a satisfactory examination by an authorized board. ”

“ Three physicians give their sole attention to diseases peculiar to women and three to those of the nasal organs, throat and chest, embracing all chronic diseases of the respiratory organs. Thus we have a full council of three and four physicians in these several specialties. In several other divisions we have two specialists. No case is slighted either in the examination or in the treatment. All doubtful, obscure or difficult cases are submitted to a council composed of several physicians and surgeons. Skilled pharmaceutists are employed to compound the medicines prescribed. ”

“ Dissection consists in minutely tracing out all the important structures of the limbs, body, and vital organs, and thus it takes several weeks’ hard work to get through a whole subject; while a post-mortem examination is the labour of an hour or two, and consists in examining and noting the pathological conditions of the internal organs, with a view merely to discovering the cause of death. An adult subject is worth about £5 when properly prepared for research. ”

“ Examination of the Living.—With regard to the identification of the living, the presence of a medical man is seldom required, but there are many occasions when his opinion may be sought. Thus, under the Factory Acts, he may have to examine children about whose age doubts may have arisen. ”

“ All persons coming from any recognized college outside of Her Majesty’s possessions desirous of obtaining a license from the College of Physicians and Surgeons of the province must previously pass a preliminary examination before the examiners appointed by the board or establish to the satisfaction of the board that they have already passed equivalent examinations, and they must moreover follow in one of the schools of medicine in the province a complete course (for six months) of lectures, and such other course or courses as shall be necessary to complete the curriculum required by the board. ”

“ In the past seventy-five years medicine has progressed from an art to a science. The doctor today has diagnostic aids which would have seemed fabulous to the physician of a hundred years ago. Exact laboratory tests and the X ray enable the physician to base his treatment on definite knowledge. These are as available to the surgeon and doctor aboard ship as to the man working in the most modern and extensive medical center. ”

“ 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 ”

“ 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. ”

“ While the practice of medicine is so vast and extensive a field, that it has been found necessary to subdivide it amongst physicians, surgeons, accoucheurs, apothecaries, oculists, aurists, dentists, men for the gout and men for the gravel, one for the belly and another for the brain, these reformers seem to regard medical knowledge and medical practice as in a nutshell,—as already perfect and complete. ”

“ ADVANTAGES OF SPECIALTIES.
By thorough organization and a perfect system of subdividing the practice of medicine and surgery in this institution, every invalid consulting us is treated by a specialist—one who devotes his undivided attention to the particular class of diseases to which his or her case belongs. The advantage of this arrangement must be obvious. Medical science offers a vast field for investigation, and no physician can, within the limit of a single life-time, achieve the highest degree of success in the treatment of every malady incident to humanity. ”

“ Qualification.—It is the duty of the board of examiners to examine thoroughly every applicant, upon the production of a medical diploma from a recognized college, upon anatomy, physiology, surgery, gynæcology, therapeutics, obstetrics, and chemistry, but no preference is given to any school of medicine ”

“ Qualification.—Every person practising medicine, surgery, or obstetrics, in any of their departments, if a graduate in medicine, must present his diploma to the State board of examiners for verification as to its genuineness. ”

“ 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. ”

“ How weak appears the reasoning of many great physicians, when we examine it, not in their works, but on the dead body. Medicine was for a long time excluded from the circle of the exact sciences; it will have a right to be associated with them, at least in the diagnostics of diseases, when we shall every where unite to accurate observation, an examination of the changes our organs undergo. ”

“ The more nearly the treatment of diseases can be brought throughout to this degree of accuracy, the more scientific will the art of physic become, and the tendency of all medical observation and of all medical writing, should be to advance in this direction. ”

“ No competent physician will treat patients from a distance. Neither will he write out a prescription without making a physical examination of the patient. The questioning of the patient and the physical examination always go together, some questions being asked before an examination is made to give an approximate idea of what is wrong and some during the examination to aid the doctor in making an accurate diagnosis. ”

“ 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. ”

“ Yet we regard clinical medicine as illustrating art, and didactic medicine as representing science. What figure, think you, would the hospital professor make who should come before you with a patient, and be unable to determine with what disease the person was suffering, the organs affected by it, the nature of their functional disturbance, why some functions rather than others were disordered, how these various elements affect the issue of the attack, what that issue will probably be, and finally, what means should be taken to render it favorable? ”

“ The external symptoms visible to the clinical eye of a physician worthy of the name, vastly outweigh in important significance, all the objectionable detailed examination of parts and organs which from long use has become the habit of the old-school practitioner. ”

“ Electricity, massage, baths of all kinds, thorough examination of the blood and the various excretions, the use of the sphygmograph and ophthalmoscope, together with a very thorough physical examination would easily and most profitably keep employed the number of physicians assigned to the acute cases. ”

“ Each of the doctors makes a complete examination, and each sends in his written findings to the head physician without any opportunity whatsoever to consult with any of the other examining physicians. ”

“ The students in turn were permitted first to question the patient about his ailment and then afterward to make whatever physical examination appeared to be necessary; next, each one of them stated briefly what he believed to be the nature of the malady, and also gave his views as to the prognosis, symptoms and treatment; after which the professor commented on these different reports, pointing out both the correct and the incorrect features in each case. ”

“ In a discussion of professional service, however brief, no thoughtful medical man could forbear some comment on the present general status of clinical medicine and its developments within the last few years. ”

“ It can hardly be but that the modes of investigating disease ordinarily followed, labour under some radical errors or defects, else the researches of ages, pursued, as they have been, with exemplary diligence, and, in many splendid instances, by minds of the first order of intellect, must, ere this, have rendered our knowledge of the nature and treatment of disease more certain and more complete. ”

“ Medical observation is ever incomplete, unless it take cognizance of all the functions, the aggregate adequateness of which, respectively ascertained, constitutes and is essential to health. The state of each should be accurately examined, however unconnected it may appear to be with the prominent derangement. Diligent scrutiny will often detect a morbid condition where it was unsuspected; and a negative should never rest on surmise wherever direct evidence is attainable. ”

“ The advances in general medical science and practice have also necessitated great elaboration of the resources for the study and treatment of the physical condition of the patients. Instruments of precision, laboratories, x-ray departments, dental and surgical operating rooms, massage and hydrotherapy departments, facilities for eye, throat, nose, and ear examinations and treatment, and all the other means of determining disease processes and applying proper treatment have been supplied and the methods and standards of modern clinical medicine and surgery are utilized. ”

“ Sitting down by the patient, after some inquiries, he produces out of his medicine box a pebble, or a boar's tusk, or some other charm, and gently strokes the body with it. If there be several medicine men called in, the leader undertakes the preliminary examination, the rest giving their assent. ”

“ The value of an examination depends, of course, entirely on its thoroughness and on the experience of the physician who makes it. It is only too easy to overlook one of the faint grayish patches in the mouth or a trifling pimple on the genitals. The time and special apparatus for a microscopic examination are not always available. ”