THE SYMPTOMS OF DISEASE. x \vii 



which urc Billed the " special " hospitals, the patients are asked hardly any 

 questions, hut are examined straight oft*. For instance, a patient goes to 

 a throat hospital, it is taken for granted he has a bad throat, and that organ 

 is at once examined. In the same way, at a hospital for consumption the 

 physician wastes no time in asking the patient if he has a cough, but at onco 

 proceeds to sound the chest. If there is nothing wrong with the heart or lungs, 

 then comes the question, " What are you complaining of ] " And so it is with 

 skin diseases, the doctor looks at the rash, recognises its nature, perhaps asks one 

 or two simple questions respecting its duration, and prescribes the appropriate 

 remedy. In some instances the symptoms are purely subjective. A woman, for 

 example, is suffering from a bad attack of neuralgia or tic ; the agony may be intense, 

 and she may be able to describe her symptoms most graphically, but there is 

 nothing at all to be seen. Malingerers practically appreciate the difference between 

 these two kinds of symptoms. A prisoner who shams ill with the view of getting 

 off hard labour knows that if he says he has rheumatism, or lumbago, or sciatica, 

 he is pretty safe, and that it is very difficult to prove that he has not, whilst if 

 he were to pretend that he had a violent cough, an examination of his chest would 

 at once demonstrate the absence of disease, and lead to his detection. 



As a general rule, then, objective are much more valuable than subjective 

 symptoms, but the importance of the latter may sometimes far exceed anything 

 that the doctor can learn by direct observation. In the early stages of some 

 serious diseases of the heart or brain nothing wrong can be detected by the most 

 practised ear or eye, and yet the patient speaks of a deep unrest or sudden 

 horror, which, although it has no objective sign, may be the herald of a sudden or 

 lingering illness. In medicine, as in everything else, there are fashions, and the 

 prevailing tendency of the medicine of to-day is to underrate the importance of 

 subjective symptoms, and to pay but little attention to the account given by the 

 sufferer himself. 



For the detection of objective signs there are certain special modes of examination 

 which are resorted to by the physician. In examining the chest, for instance, he 

 sounds it, or, as he says, " percusses " it, that is, he strikes it lightly with the tips 

 of his fingers, with the view of detecting any difference in the note on the two 

 sides. Then he listens to it, or, as he says, " auscults " it, to see if the air enters 

 freely and equally all over. He may listen to the chest by placing his ear on it, or 

 he may use his stethoscope. Every physician carries one of these instruments 

 usually in his hat. They are generally made of some light wood, such as 

 cedar, and, being hollow, serve to convey and intensify the sound. 



The increased accuracy of late attained in the recognition of certain diseases has 

 been greatly assisted by the use of special instruments. Without the microscope 

 the existence of many forms of blood disease could not have been established, and to 

 its aid is due the knowledge of the parasitic nature of ringworm and thrush. The 

 detection of Bright's disease is materially aided by the information a microscopical 

 examination of the urine conveys. The thermometer to the practical physician 

 affords, as we shall presently see, information of the highest value, whether regard 

 be had to the detection of disease or its treatment. The laryngoscope, an instrument 



