Chapter I. Practical Diagnosis.
In the "moving pictures" we see a practical illustration of how the modern physician examines a patient and forms a "snap shot" diagnosis. He walks into the room, lays down his hat and medicine bag, grasps the wrist of the patient, pulls out his watch, appears to count the pulse, rolls his eyes up in his head, which he shakes, and with an owlish look of great wisdom writes out a prescription, reaches out his hand—"two dollars, please"—grabs his hat and trunk and away he goes. You must bear in mind that it has taken him four years at a medical college to learn how to do all this properly and ethically. What does he know about the patient's condition? Practically nothing.
An old gentleman had a sick child and called a doctor, who examined the child about as described above and then began to prepare the medicine. The father asked, "What ailed the child?" The doctor replied, "Oh, it's a little cold and some fever." The old gentleman said, "Doctor, I will pay you for the visit but you need not leave any medicine." The second doctor came and examined the child in about the same manner and his diagnosis was as indefinite as the other. He was not allowed to leave any medicine for the child. The third doctor came; he examined the child and then began to prepare the medicine. The father said, "What ails the child, doctor?" "Why it's measles, any fool ought to know that," was the doctor's answer. "All right, doctor, you may prescribe for the child." The old gentleman was sensible. No doctor should be allowed to give a dose of medicine unless he can give an intelligent reason why he gives it, what he gives it for, and what he expects it to do.
We send our boys to college four years so they can learn how to play football; we send them to medical college four years more to learn how to practise vivisection on the human body. They are then turned adrift upon a confiding public loaded down with technical knowledge and cannot diagnose a simple case of measles.
I always impress the idea upon my students that the very first thing that a doctor must learn is to know how to read the pulse. Not one doctor in a thousand can do it. No man can do two things at a time; you cannot be counting the pulse and reading it at the same time. Keep your watch in your pocket. Just imagine what you could tell from the pulse if you had to depend upon it to diagnose the case as they do in one country across the great ocean. How does it feel to you? What impression do you get from it? Is there a hardness, a tension to it? If so then there is pain or congestion somewhere in the body, constriction of the capillaries, a focus of inflammation. If it feels weak, has a discouraged feeling, it means enfeebled nerve power and weakened vitality. Again we may have what I call the "sledge hammer" pulse. The heart is driving the blood through the blood vessels with all its force. The blood is being driven to the brain or lungs in an unnatural quantity. Then we have the intermittent pulse which shows functional disease. Bear in mind that behind the heart is the nerve power. It is the "man behind the gun." As that gets weak and enfeebled it will affect the heart and circulation. At times the pulse may seem quick yet there is an impression of weakness to it, of a machine which is being driven beyond its power. It gives a jarring feeling to the pulse. When the nerve power and circulation are about normal the pulse feels full, strong and regular. The blood runs clear and there is no tension or friction anywhere.
After the pulse we examine the tongue. Many pages have been written describing the different coatings on the tongue. That never interested me. I want to know how the tongue itself looks underneath the coating. Red papillae on the tongue showing through the coating indicates the invasion of some disease. I have noticed this twenty-four hours before an attack of pneumonia or measles. In health the tongue is usually moist; very little coating and few fissures are seen. It is a bright red color. In some forms of kidney trouble there will be transverse fissures and often perpendicular ones also. Deep red fissures far back on the tongue will be seen in long standing cases of prolapsus uteri. A dark appearance of the tongue, almost purple, shows imperfect oxidation of the blood. The appearance of the tongue will tell if the patient is digesting his food properly or not.
The eye is another organ that we must study carefully. It often confirms what we have seen in the pulse and tongue. With tension of the pulse we usually get contraction of the pupils. If the white of the eye has a pearly tint—an unnatural brightness about it—there is a drain upon the system. You can see it exemplified in phthisis pulmonalis, advanced cancer, Bright's disease and ulceration of the stomach. The yellow clouded appearance of the eye denotes toxic matter in the blood. A greenish tint denotes decomposition of albumin. From my experience I can always tell a patient's condition; whether they are improving under my treatment by looking at their eyes as soon as they come into the office. A clear eye with bright expression tells you that your patient feels better and is better.