Excerpt from The Medical News, Vol. 34
Thus, pain referred to the knee frequently depends upon disease of the hip, and pain in the loins from supposed kidney-disease, upon stricture of the urethra. The eye will take in many of the leading features of a case at a glance, such as the general aspect of the patient, his mode of walking or standing, etc.; and, when the affected part is exposed to view, it will in many cases, if sufficiently practised, complete the diagnosis. Let me warn you, however, against "jumping to conclusions" too rapidly; for those who are foolish enough to pride themselves on rapidity in diagnosis not unfrequently make mistakes which a little more time would have enabled them to correct. You can no more afford to leave out steps when tracing the nature of a case by progressive induction, than you can venture to omit one or more tests when examining a complicated fluid in the chemical laboratory. Lastly comes the hand, which may require to be fitted with various instruments for special purposes; but which, in its simplicity, is the surgeon's most powerful ally if properly educated. The much-talked-of tactus eruditus is to be acquired by all who will take the trouble to practise their fingers in the manipulation of healthy and diseased subjects, and will at the same time use their mental powers. For, of course, no amount of examination of a patient will tell you what is the matter with him, unless you elaborate the facts thus ascertained in a mind which has been trained by previous study to comprehend the importance of the several symptoms; and this is the reason why, at first, beginners must be at a disadvantage, lacking the experience necessary for a clear appreciation of symptoms. You will find, however, that with a little help from the surgeon, you will soon begin to see the "why" and the "wherefore" of diagnosis and treatment; and let me beg of you not to be afraid of asking questions - so long, at least, as the questions ore put for the purpose of increasing, and not of displaying, your own amount of information. One pitfall I must just allude to; and that is the tendency to over-elaboration of a diagnosis which besets some men, and seems to stick to them through life. They never can take the plain obvious facts of a case, and from them draw a conclusion; but must dig and delve so deeply that they sometimes get, so to speak, "out of their own depth," and never come up again so far as any utility to the patient in question is concerned. Superficial carelessness is bad; but too great profundity is not much better.
And now I bring before you a man with no special deformity or ailment, in order that I may be able to show yon a few noteworthy points which you can readily appreciate at a little distance, and which will assist you in studying disease and injury in the wards. With his back towards us, you have the opportunity of examining a healthy spine; and you may notice that, while the spinous processes are readily visible in the dorsal region (and particularly when the arms are folded), they are not so visible in the lumbar, and still less so in the cervical, region, where they are covered by muscles and ligaments, the seventh, or vertebra prominens, being the only one really seen or felt. Here, in a healthy adult, we have the average anterior and posterior curves in the lumbar and dorsal regions; but you must remember that, in young children, the spine is nearly straight, while in disease we may have great exaggeration of either curve. Thus, in the back, we find cyphosis, or angular curvature, the result of caries of the vertebr?; while in the loins we have lordosis, an exaggeration of the healthy curve, and generally connected with old hip-disease. Of the latter, I now place an example before you; and, of the former, there is an instance in No.1 Ward, in a man whose foot I removed last week.
The model is now standing at "attention," with his knees straight; consequently the two sid. Это и многое другое вы найдете в книге The Medical News, Vol. 34 (Classic Reprint)