THE PHYSIOLOGICAL FACTOR IN DIAGNOSIS. THE FAMILY HISTORY. CHAPTER I. THE HISTORY OF THE INDIVIDUAL. WHEN a patient presents himself or herself before the medical man, that patient is commonly a stranger. Everything then has to be learned about him, as well as about the malady for which the medical man is consulted. How, then, must the young practitioner commence his examination? Some fly at the patient with a stethoscope, or call in the aid of divers instruments of precision. These latter are not to be ignored, certainly; but there is much to be done besides resorting to these valuable aids. Instruments of precision come in more fittingly at the close of the examination rather than at the beginning! When the nature and extent of the patient's disease come to be estimated, then they are of priceless value. How they are to be used is a part of medical teaching, for which so much has to be, or has been, paid; and the embryo medical man is supposed to be familiar therewith. But much precedes resort to these aids. First, it is desirable to know something about the individual. Private patients are not mere social units, nor yet numbered entities illustrating this or that form of disease. They are human beings, with the feelings belonging thereto. Life is sweet to all: and there are few patients who do not hold themselves as valuable lives. 'Mine is a valuable life, doctor!' is the remark of the breadwinner of the family, or of the mother of numerous offspring, or may be of a social waif or failure! Consequently they like to see the medical man approach the case with interest, and, if possible, with sympathy. They may not be able to form a fair estimate of his knowledge; but some opinion of him they will bear away with them. It is desirable in every way that that opinion be a favourable one. And the opinion formed will greatly depend upon how the doctor goes about his examination. He may soon demonstrate his familiarity with private patients, or betray his want of acquaintance with them; a matter the patient will soon note, or that friend which usually accompanies the patient to the doctor in the first visit will certainly observe. Two brains are pitted against one. While the doctor is observing the patient, the onlooker is taking the measure of the doctor. Young practitioners sometimes overlook this item. Proceed, then, in full consciousness of being the object of eager scrutiny! It is your duty to the patient to take pains: it is your duty to yourself to make it perfectly clear that you are taking pains, my young professional brother! Above all things avoid haste in your examination. The malady is of deep interest to the patient, even if of little scientific interest to you. When you are known to be a busy man, patients will excuse haste; but at first haste is looked upon as indicative of lack' of zeal. Proceed systematically. By so doing you will not be so liable to overlook some important matter, which may escape recognition otherwise. Place the patient in a good light, so as to give the eye every advantage. Observe closely while putting your questions. Do not hurry the patient. Perhaps the latter is most eager to tell you something. It is usually well to let him do so. Until he has done so, his mind is disturbed and unequal to giving such answers to questions as are desirable. If not to the point altogether, some of it probably is worth noting. The first thing to be done, after putting down the patient's name, is to inquire his age. If a lady, a little tact may be requisite to get over this matter without giving some offence. This matter of age is a cardinal fact. By it you may measure almost all you can elicit. But of this anon. The Family History.-Patients attach much importance to the doctor 'knowing their constitution.' With a stranger all is new. How are you to learn the constitution? Inquire first, 'Is your father alive? If so, if well. If not, what does he suffer from? If dead, of what did he die? Ask if he had a stroke, or dropsy, or fits, or was 'asthmatic-this covers every form of difficulty of breathing with the laity. The answer will often give you a clue to the malady or diathesis of your patient. Ask if there is any family malady. If his father's brothers and sisters are alive, or what they died of. If there is any family ailment, by this you will learn it. If the patient can tell you nothing, the probability is there is not any family ailment; and this negative information is worth the trouble it costs. Then proceed in the same careful manner over the mother's side. Then it is well to ask the patient to which side he is said 'to take.' Such information is leading up to the next matter viz., the individual; and will usually tell whether it is the nervous system, the thoracic organs, or the abdominal or pelvic viscera, which first fail. The History of the Individual.—It is well next to proceed, 'Have you been generally healthy? Were you a strong child? What maladies of childhood did you have?' Out of this, much that is useful may often be gleaned. Of course at first the youthful practitioner gleans but little. As his self-education progresses, he learns more and more by such questioning. |