1st. The habitual state of health of the subject. The genus, breed, age, environment, habits, (pet dog, watch dog, hound, sheep-dog, ox, bull, cow, milch cow, sheep in the field or housed, pig in pen or at large, diet, regimen, water, race horse, draught horse, work, exposure, etc.) as well as the personal equation of temperament, idiosyncrasy, heredity, etc., must all be carefully considered.
2d. The history of the present illness as to its apparent cause, mode of invasion, duration and progress.
3d. The objective symptoms by which it is manifested. All that can be ascertained in the way of symptomatology, local and general, the probable existence of interdependent disease, and all actual structural lesions and disorders of function should be thoroughly investigated. As supplementary to the more prominent objective symptoms any fever or other constitutional disorder must be sought for; a mental list must be made of the diseases which resemble this one, and these must be excluded one by one by careful attention to the differential symptoms; other diseases which are probably subsidiary to this, should be similarly investigated and excluded; any really diagnostic sign of the suspected disease must be carefully established and the diagnosis finally placed on a solid foundation. The discovery of a constitutional (febrile) disease to which a distinctive name can be given is by no means the end of the diagnosis; the structural lesions of the disease may be largely localized in an unimportant organ where they may remain circumscribed without compromising life, or they may be seated in a vital organ which will render the disease grave to the last degree or necessarily fatal. For example: Anthrax of a dense, dry part of the skin may be a mild local disease; anthrax of an internal organ is usually fatal. Every local complication therefore, should be as carefully diagnosed as the connected constitutional disorder.
But diagnosis cannot always be certain. In the early stages of certain fevers two forms may be as yet indistinguishable and a day or two may be required to develop differential symptoms. In some occult forms of disease all differential symptoms may fail us. A method of diagnosis which has hitherto been applied only to tuberculosis and glanders is manifestly capable of much wider application, to diseases attended with a febrile reaction. This consists in a hypodermic injection of a minimum dose of the sterilized and filtered products of the culture of the disease germ, which produces no effect on the healthy system but causes febrile reaction or local inflammation, or both, in the diseased. This will be treated more fully under the respective diseases.
In connection with such a method, but above all when no such resort has been had, the obscure case should be seen frequently, the course, duration, and termination of the disease should be noted, also its tendency—sporadic or epizootic, and finally the result of treatment. This last resort may often secure diagnosis and cure at once as when a course of iodine cures an obscure actinomycosis.
SYMPTOMATOLOGY. SEMEIOLOGY.
Definition. Symptom. Sign. Constitutional symptoms—local, objective, subjective, direct—idiopathic, indirect—symptomatic, premonitory. Anamnesis. Position. Movements. Decubitus. Acute. Chronic. Fever. Sthenic. Asthenic. State of limbs, muzzle, nose, snout, palmar-pad, hoof, bill, digits, mouth. Thermometry. Normal temperature, in doors, in field, at work, in hot season, in nervous subject, in thirst, in youth—age, starvation, plethora, cold, sleep, rest, stimulants, suppressed perspiration, eliminants, antipyretics. Fever temperature, morning, evening, transient elevation, persistent rise, sudden fall—collapse, crisis. Fatal elevation. Rise during defervescence. Pulse. Respiration. Skin, staring coat, pallor, coldness, dryness, harshness, mellowness, pliancy, hidebound, yolk, clapped wool, scurfy, lesions, itchiness, tenderness, loss of hair, emphysema, anasarca, sweat, sebum. Expression, life, dullness, paralysis, dropsy, jaundiced, eye, discolorations, photophobia, amaurosis, pinched face. Nasal mucosa, red, violet, etc., nodules, polypi, osseous disease, pentastoma, œstrus, discharge from teeth—sinuses—actinomycosis—tumors. State of the bowels, kidneys, nervous system.
The usual basis of diagnosis must be a clear and intelligent observation of the symptoms of disease. A symptom is an appreciable evidence of disease. A symptom however may indicate illness, without affording the means of diagnosis, while the term sign is often used for a pathognomonic symptom—one by which the disease can be identified. Used in this sense a sign may be said to be a diagnostic symptom.
1. Constitutional Symptoms are such as affect the entire system, like a rise of body temperature, or a shivering fit.
2. Local Symptoms are confined to a definite area as redness, tenderness, swelling, ulceration.