The Ypsilanti daily press. (Ypsilanti, Mich.) 1928-1962, 1943-06-03
BY Logan clendsnlns. N. D.


quainted with the patient himself
in order to prescribe treatment
wisely, we discussed in detail the
first step which is taken, namely
the gathering Of the patients his
tory of his illness.
The average patient in the mod
ern age is inclined TO underrate
the importance Of this item. He
has become familiar with the
many machines the modern ply
stefan uses and ascribes TO them,
as he does 10 all machines, an in
human kind Of accuracy. He is in
clined 70 believe, therefore, that
what he tells the physician about
his symptoms is very much less
important that what can be gath
cred by the precision machines.
He also is conscious of the
vagueness and inaccuracy Of a
good deal Of his own testimony. No
two people describe an event, even
if they have just witnessed it, ex-
actly the same or exactly ac-
curateiy. How much Tess exact
then must be the testimony of. a
person about his own feelings. He
is not good judge of himself.
Physician Overcomes Inaceuraey
The physician, however, knows
all OF this and discounts all of it
and frames his questions to over
come the inherent inaccuracy.
Then too, symptoms have a way
of falling into patterns and the
doctor of wide experience can us
ually tell when the patient is.
drawing the long bow and when
he is sticking strictly to the truth.
There is series of articles
which appear in the Neto England
Journal Of Medicine, which many
of my professional friends read
religiously, week by week. These
are stenographic accounts Of a
conference at the Massachusetts,
General Hospital in which the hos
pital record of the patient is read
out and analysed by a member Of
the staff.
The correct diagnosis is known,
although the analyst has not been
informed of it. In looking over
several hundred of these lately, /
noted that the largest part of the
report was in every case devoted
to the history and whatever else
the analyst may have neglected,
he spent a good deal of time in
weighing the significance Of the
history, which is the patients
statement. He may have failed
TO comment on the x-ray or the
laboratory findings or other rec
ords but he always paid respectful
attention to the history.
Digestive Diseases
As a final illustration, we may
take the diseases of the digestive
system. Early in this century the
surgeons who opened up the abdo-
men to see what was the matter
with people who had dyspepsia
taught US that the most important
feature Of making a diagnosis was
the patients symptoms. For in
stance, the patient tells you that
he has discomfort in relation to
meals; meals do not increase his
discomfort, but relieve it.
He wakes up in the mornings
with some indigestion, which is re-
lieved by breakfast. He is then
comfortable until about II, when
his discomfort returns, relieved
by lunch. 1t returns again about
5 in the afternoon, relieved by din
ner, and may wake him up in the
middle Of the night so that he has
learned to have a glass Of milk by
his bed to keep him comfortable
through the sleeping hours. This
history is recited monotonously by
patients with duodenal ulcer and
all the x-rays and the stomach
washings and the machines on
earth, if they contradict this his
tory, are wrong.
The human nervous system Is
just as delicate a machine as any
in the laboratory, and it records
the patients symptorns-