Home >> Manual Of Medical Diagnosis >> Diseases Of Uncertain Or to Neuralgia >> General Examination of Regions_P1

General Examination of Regions and Organs

chest, particular, symptoms, examined, history, examine and disease

Page: 1 2

GENERAL EXAMINATION OF REGIONS AND ORGANS - we come now to the consideration of particular organs, and it will be found that many of' the more general indications sought for in the earlier part of the investigation have an especial bear ing upon the diseased states to which ea.ch organ is liable. These the student has,been advised to note as he proceeded in his in quiry, whether observed in the details of the history of the case, or in the general symptoms pertaining to the skin, the pulse, the tongue, the bowels and kidneys, or in the appearance and posi tion of the patient. He has also been advised not to attempt to form a judgment on the case before each indication has been fully investigated, and the seat of any complaint of pain or uneasiness has been thoroughly examined ; but he must be further warned that, although the history of the case, the general symptoms and the particular disorder, correspond to each other and make up one intelligible whole, he has not done his duty to himself or his patient unless a survey, however rapid, have been taken of the condition of each particular organ. This course is absolutely necessary, not only because the discovery of some obscure change may throw fresh light upon the totality of the symptoms, and ultimately lead to a different and more correct diagnosis ; but for the no less important end of ascertaining whether any distinct and superadded malady exist, which may most materially modify the treatment.

As already stated, the order in which it is proposed to examine these organs follows the usual division into regions—the head, the chest, the abdomen, and the extremities—taking the dependent structures connected with the principal organs situated in each of these regions as they successively come before us. We commence with those of innervation, the brain, spinal cord, and nerves. We then take those of respiration and circulation, the lungs, the heart, and the bloodvessels ; next, those connected with digestion, be isrinning with the mouth, the stomach, and intestines, with their investing membrane, followed by the liver, spleen, and kidneys ; and, lastly, the ovaiies and uterus. After these will be noticed, the skin, cellular tissue, bones, and muscles.

Throughout the inquiry, the importance of system in every step of the in vestigation has been pointed out, and I recommend to the student either to adopt the arrangement just mentioned, or to form for himself some other plan more consonant with the theory of disease which he has been taught: in every case which presents itself to him he ought to follow exactly the same course in examining the different organs, although occasionally h may find it ad vantageous first of all to examine thoroughly that organ which the history of the case or the prominent symptoms, whether objective or subjective, point out as the probable seat of disease, provided he have not, from general indi cations, come to the conclusion that the disease is one of those having no local site, which have formed the subject of the preceding pages. His next care, in either case, should always be to examine in a definite order the various organs, with their local phenomena, and to note in his case-book the negative as well as positive results which he obtains.

As a mere matter of detail, I would suggest that he should never enter in his notes such vague expressions as " chest healthy," but state explicitly the extent of his examination and its results, which need not, however, occupy much more space. Thus, to take the case of the chest, he may state simply that there is " no complaint of pain, palpitation, cough, or shortness of breath ing ;" and this would imply that the chest had not been examined by percus sion or auscultation. He may go further, and record that "nothing abnormal has been discovered by percussion or by auscultation," or he may limit him self to some particular portion, "breathing natural under the clavicles, at the back of the chest," Ac. ; in the one case he is understood to have examined the whole, in the other only a part. The chief use of all these suggestions is to establish habits of accuracy ; but if he should ever wish to refer to these cases in after years, if it should be his lot to publish reports of them for the information of others, then the value of definite statements will more clearly appear.

Page: 1 2