Surgical diagnosis; a manual for students and practitioners / by Albert A. Berg ... illustrated with 215 engravings and 21 plates.

  • Berg, Albert A., 1872-1950.
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Surgical diagnosis; a manual for students and practitioners / by Albert A. Berg ... illustrated with 215 engravings and 21 plates. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Evidences of disease are detected by the senses of sight, smell, touch, and hearing. As the former two disturb the patient least, we should gain all the information we can through these channels before proceeding to palpate, per- cuss, or auscultate. It is surprising how much laiowledge can be gained by sight and smell. The short, rapid, forced respirations, with a flushed face, are strongly indicative of pulmonary disorder; the puffed eyelids, distended abdomen, protruding umbilicus, and oedema of the feet are pathog- nomonic signs of impaired general circulation; the facial expression shows actual pain, anxiety, etc.; thoracic respira- tion with immobility of the abdominal muscles are indica- tions of peritoneal inflammation; shortening of limbs, axial deviation, malposition or abnormal position thereof are evidences of fracture or dislocation, etc. The diagnosis can often be made by sight alone. The sense of smell likewise gives valuable information; thus the sweetish odor of the breath and perspiration which accompanies the septic state, and the odor of violets (acetone) in the urine and breath, that is sometimes present in diabetes, are important aids in making a diagnosis of these diseases.^ Palpation, percussion, and auscultation are proceeded with after a thorough inspection and smell of the patient. Here there is need of a light touch and a sharp ear. It is always a good rule to compare any abnormalities with the supposedly healthy side. The information obtained by these special sensory organs is supplemented by that which is elicited by the use of spe- cial apparatus—e. g., cystoscope, proctoscope, hsemocytom- eter, microscope, etc.—and finally by that which is obtained by bacteriological, chemical, and histological examination. It is to be remembered that the clinical evidences of disease are the most important; the laboratory results aid, elabo- rate, and substantiate the bedside findings; they never replace them. 1 The author knows of a patient admitted to the hospital iu comatose condition. No history could be obtained. The bladder was empty. A painstaking physical examination did not enable the attending physician to make an accurate diagnosis. The lay superintendent who had admitted the patient ventured the diagnosis of dia- betic coma from the smell of the patient's breath and perspiration. Subsequent examination of the urine proved him to be correct.