126 DIAGNOSIS. 



of a disease, and of the ground whereby its treatment should 

 be directed, our first duty is to ascertain the vital state of our 

 patient. 



The extent to which it may be necessary to conduct the 

 examination will, in a great measure, depend upon the nature 

 of the case itself. In many chronic diseases, for example, a 

 more lengthy examination is required to arrive at a positive 

 knowledge of their precise nature and general relations, than 

 what is necessary to determine the essential nature of an acute 

 disease. 



In speaking thus, I would not have the reader understand 

 that every precaution is not necessary in both classes of disease ; 

 on the contrary, every case, whether simple or complicated — 

 whether acute or chronic, must receive the close attention of 

 the observer. In many chronic diseases, a number of symptoms 

 are occasionally present of a very obscure character (perhaps 

 two or more diseases maybe associated), to thoroughly unravel, 

 and clearly arrange which, may require the exercise of all the 

 care and tact of the medical attendant ; while in the generality 

 of acute diseases, the symptoms are of so objective a character 

 as to allow of the disease being at once recognised by an 

 observer of even moderate tact and experience. Consequently, 

 less difficulty is experienced with regard to acute than chronic 

 maladies; nevertheless, a thorough examination is required in 

 both ; the difierence of such examination being merely in the 

 extent to which each is necessary to be carried. 



In both classes of disease a similar method of examination 

 wiU necessarily have to be pursued ; the variation of that 

 method depending upon the nature and the seat of the malady. 



Causes of Disease. — Our first attention, in all cases, 

 should be directed to ascertain the cause of the disease, 



