92 Symptomatology; Diagnosis. 



A purely symptomatic diagnosis is illustrated by such examples as 

 the determination of varieties of convulsions, of palpitations, coughs ; a 

 symptomatic and anatomical diagnosis, by the recognition of a relation 

 existing between jaundice and some hepatic affection; an ^etiological diag- 

 nosis, by the conclusion that a jaundice depends upon the presence of 

 some microorganisms in the liver and blood. [Very frequently diagnoses 

 are classified as topographical, when indicating the location and extent of 

 lesions, and as nosological, when indicating the nature of the process. 

 No diagnosis can be regarded as complete unless embodying the recogni- 

 tion of both location and nature of an affection, as well as of its aetiology, 

 in so far as is possible. Incomplete, purely topographical diagnoses, as 

 the declaration of "lung disease," "kidney disease," etc., are often made 

 to serve the nonce, or by the careless as final ; in the same way an incomplete, 

 merely nosological diagnosis is often met with where it is said that an 

 individual is the subject of "inflammation," "congestion," "dropsy," "fever," 

 "tuberculosis." The full diagnosis should declare that the subject has 

 an inflammation of the pericardium, if possible indicating the cause of 

 the pericarditis ; "tuberculous caseation of the lungs" would embody all 

 the desirable points of view.] 



Symptoms immediately referring to changes in a given part, 

 as abnormality of color, increased size, hardness, softness or un- 

 evenness of outline, are spoken of as direct symptoms; those 

 which do not depend upon the diseased organ entirely, but which 

 perhaps may be appreciable in the products of such an organ or 

 become manifest in other organs in relation with the diseased 

 part, are known as indirect symptoms. Thus a direct symptom 

 of a lesion of one of the cardiac valves would be a cardiac mur- 

 mur ; an indirect symptom of pericarditis would be an oedema 

 of the dewlap. There are certain symptoms called pathognomonic 

 sympfouis, whicli definitely indicate the existence of some particu- 

 lar disease, as the rusty nasal discharge in pneumonia, locking of 

 the jaws in tetanus, crepitus at the site of a fracture of bone; 

 however, as a rule a single symptom does not suffice for a diag- 

 nosis, but must be considered in its relations with a wider group 

 of recognized features. Study of disease phenomena constitutes 

 a large part of clinical pathology and pathological anatomy; tho 

 ability to recognize and to determine the im.portance of symptoms 

 is one of the essentials of the medical art. and depends on the 

 skill, experience, general knowledge and power of judgment of 

 the individual conducting the examination of the subject. The 

 majority of symptoms can be realized only by special methods 

 of examination. He who has not acquired such methods cannot 

 have a clear understanding about the morbid condition extant 

 in the body of his patient, and is really groping about in the dark- 



