SYMPTOMATOLOGY OF CHILDREN'S DISEASES two ways of presenting the relation between diseases and their symptoms. Either the symptoms peculiar to each disease may be enumerated, or the pathological conditions underlying the disease may be deduced from the several symptoms. The former method is commonly employed in the text books, while the latter, the semiotic system, is less often used.
The text book method is particularly serviceable for the study of the different types of disease and their character, while the semiotic method is more especially adapted to the needs of practical diagnosis. The physician when called to the sick bed observes or detects certain symptoms, and from these he arrives at his diagnosis, thus following a course directly opposite to that laid out in the text books. Herein lies the practical value of this method, which has been often adopted in monographs and essays but not in text books on the diseases of children. The "Symptomatology and Diagnosis of Children's Diseases" by Fila tow (of is an exception. This is an excellent work, but owing to the early death of the author it is 110W no longer in the first rank. I believe, therefore, that the following semiotic summary will meet an urgent practical need.
In many eases where an erroneous or negative diagnosis has been made, the mistake has been that the question as to the actual malady has not been considered. Certain symptoms have been detected at the time, which were perhaps purely accidental and did not call up the true picture of the disease. These symptoms, moreover, may mislead one and cause him to lose sight of the true state of affairs. The func tion of symptomatology is to check this tendency as far as possible.
What it cannot and must not do is to become a sort of automatic index to the diagnosis itself. It can never become a "key" to the diag nosis in any particular case. Such "keys" may be useful in recognizing objects of natural history, but they can never become the tools of the practising physician. The careful mental analysis in making a correct diagnosis can never be transformed into an automatic, subconscious process. Even the simplest mental picture of a disease can no more be resolved into the sum of several symptoms than can a portrait into the successive strokes of the artist's brush. The result in either case would
be a caricature.
It may seem unnecessary to emphasize the fact that a scientific diagnosis can be obtained only by a knowledge of the disease as a whole, including its various typical modifications of form and the character istics of its stages. To obtain this knowledge there is but one text book, the clinical, which must be studied in person at the bedside. Whoever hopes to diagnose correctly by means of symptomatology without hav ing carefully trained himself in the observation of children's diseases, will he speedily disillusioned.
A kindred danger lies in wait for the symptomatologist, and the following warning may place me beyond reproach: The value of single symptoms as such should never be exaggerated. The man who degen erates into a symptom monger will forfeit all capacity for wider views, and will stand helpless when the system he has carefully constructed leaves him in the lurch.
Everyone who constructs a practical symptomatology is unfort unately forced to frame some theory, and the high value of the method from a didactic point of view is all that reconciles inc to the inevitable evil of such theories. I have found in clinical teaching that moderate theoretical instruction in symptomatology, in connection with the clin ical course, increases the interest of the students and the success of the teaching. The clinical teacher should start from the obvious and more easily detected symptoms of the case in hand, to reach the diagnosis which he has in view. The students are more apt to feel the force of such an exposition than that of a theoretical discourse, which, more over, they imagine could be replaced by reading. For this reason, it has keen my practice to place my teaching and my case demonstrations almost wholly on a semiotic basis. The notes which I have accumulated for such purposes have furnished the ground-work for the present treat ise. ..‘s the experience of a single writer can seldom, if ever, be the exclusive source for such an exposition. I have been obliged to draw additional data freely from many text books and other medical litera ture. I fully realize the danger thus entailed, of producing it pedantic work unfitted for the practitioner.