The student will do well to commit to writing the results of his inquiries. There is no means nearly so successful in giving system and correctness to his investigation; in no other way can he acquire the habit of observing all the phenomena of any given case, or tracing their bearing on each other; and nothing will so effectually teach him to mark correctly, and estimate justly, each successive fact elicited by his own inquiries, or volunteered by the patient. From the whole evidence thus faithfully committed to writing can he alone hope to form a correct diagnosis. His written description ought to be a full and accurate account of all that he sees, hears, feels, or even smells, and must never embody any conclusions he has formed from them until the whole inquiry has terminated. Thus, to take a prominent example—in examining the lungs, however distinct he may fancy the evidence of a cavity to be, he ought never to put down in his notes "cavernous riles," or "cavernous breathing," but what he actually hears—gurgling sounds, loud or very loud, blowing, expira tory breath-sound, &c.; everything, in fact, just as it is heard ; as he proceeds, it is quite possible that other signs or symptoms may be observed so incon sistent with the hypothesis, that it would be quite unwarrantable to assume the existence of a cavity—a conclusion which ought only to be formed from the coincidence of several other phenomena.
The following plan has seemed to me the best adapted for obtaining the information required, and is that which is adhered to in the following pages, but admits of modification according to the previous course of study or habits of the individual. It is merely offered as one which has been found practically most ser viceable in making available notes of a large number of cases.
It may be divided into four principal sections. After a pre liminary inquiry into the age, occupation, and habits of the pa tient, and also ascertaining if there have been any previous similar attacks or any important illness, we proceed 1. To inquire when the first deviation from health occurred, how it was manifested, and what was the order of sequence among the phenomena.
2. To examine into the general state of the patient at the time of observation, as manifested both by objective and subjective phenomena.
3. To make a rapid survey of all the organs, especially with reference to his sensations.
4. While doing so, to examine more particularly any organ to which the history of the case, the general indications, or the sensa tions of the patient especially point, and now to investigate the objective as well as the subjective phenomena of the particular organ.
In short, we first get all the information we can of what has happened, we next feel his pulse, look at his tongue, &c., then ask,
with reference to each of the larger divisions of the trunk, whether he has anything to complain of; stopping in our progress to make more minute investigations whenever it seems necessary.
In endeavoring to point out to the student the probable devia tions from health he may meet with in various parts of the body, in the order in which they present themselves according to this arrangement, it will necessarily happen that the diseases of which they are the indications should be discussed in a similar order; and as it is not my wish to create for diagnosis a distinct place in the science of medicine, but to make it subservient to practice, it seems desirable to adapt it as much as possible to a scientific and practically useful classification. For this purpose, that has been selected which is in use at St. George's Hospital, which, it is hoped, will be intelligible to all, as it is most familiar to myself; but it is not put forward here as possessing any claims to perfection. Its principle I. To throw into a large group at the commencement all those diseases which, while perhaps manifesting themselves in particular organs, are more or less proved to have their origin in general conditions of system.
This is again subdivided into twenty-one heads, grouped in the following order: 1. Those which are believed to have a specific origin; of which the febrile diseases are placed first, including many of the so-called " zymotics." Next come rheumatism and gout, followed by such as are wholly adventitious, the poisons, entozoa, &o.
2. Diseases of uncertain or variable seat, dropsies and hemor rhages, which, pathologically, might be regarded as merely indi cations of deeper-seated lesion, but which, from the consistency of their signs and symptoms among themselves, and their dependence on a variety of causes, also demand separate investigation.
8. The chronic blood ailments—purpura, scurvy, anaemia, &c.
4. The constitutional ailments of solid parts; scrofula, tubercle, and morbid growth.
5. The quasi-nervous diseases; • the symptoms of which are principally derived from functional derangements of the nervous system, in the ultimate distribution of its filaments, and in relation to muscular fibre : they thus stand in juxtaposition to diseases of the brain and nerves immediately following.
II. To take in detail the diseases of special regions, or systems of organs.
In this class'we commence with the brain and nerves, and de scend regularly to the thoracic and abdominal viscera, which are ranged in several groups, and we conclude with the bones, joints, muscles, and skin. In each subdivision the acute take precedence of the chronic diseases.