Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATION. 2l9
accuracy is that it is the surest way of ar- ent he has tuberculosis or heart disease,
riving at an earh' and correct diagnosis. He must know what inroads the disease
This is a matter of the first importance in has made, how much lung tissue is itivolvtuberculosis,
the early stages of which are ed, the degree of hypertrophy of the heart,
overlooked in a large percentage of cases, and the stage his alJection has reached
It is needless to reiterate that a delayed that is he must know what his chances are,
diagnosis in consumption usually means a as nearly as they can b« estimated. It is
hastened end, whereas 7(J% to 90% of the true that such questions are often impossiearly
cases will get well under the best care, ble to answer. Nevertheless, accurate ex-
On the other hand, tuberculosis should not aminations will go far toward diminishing
be hastily diagnosed. A boy of 14 was pro- the number unanswered or wrongly announced
by several physicians to be in a swered.
hopeless stage of consumption. He drifted 5. As a rreans of determining the most
into my hands, and repeated and painstak- effective treatment, the importance of diaging
examinations revealed a large abscess nosis prior to treatment would seem to be
in the upper part of the right lower lobe, bepond controversy. Vet it is a continual
This diagnosis was later confirmed by a temptation to treat symptomatically, and
surgeon. Dr. Willis Jones, of Atlanta, who not lay the axe at the root of the tree. As
saw the case with me. In many diseases therapy is becoming more scientifically exof
the heart a correct diagnosis cannot be act, the necessity for accurate diagnosis is
reached except by an accurate and i)ro- becoming more and more imperative. Far
longed examination. And correct diag- be it from me to decry the efforts and
nosis of heart lesions means much more achievements of our predecessors, but the
than a scientific refinement. It means prog- general methods and shotgun prescriptions
nosis and treatment based on something of former times can no longer prevail,
definite; it frequently means prolongation Though far from the goal of our dreams,
of life. In this connection, I desire to refer we now recognize certain definite proced-
.
to life insurance examinations. A few ures will be productive of certain results in
few years ago I heard a leading physician certain cases. Hence the key to the door
publicly refer to insurance examinations as lo relief and recovery lies in the accurate
"casual," meaning it
should be so regarded.
was proper they diagnosis. Here again I beg to cite the
I am convinced by early diagnosis of tuberculosis as the chief
many personal experiences that the chest hopeof the victims of that prevalent scourge,
examination for insurance is eminently in- 6. Finally, I venture to urge the value of
accurate. Six months ago I found a man well kept case records ''hich are invaluable
to be in the second stage of pulmonary personal assets to every physician. The
tuberculosis, who had been passed the week very taking and keeping of such records
before by an examiner for a prominent com- fosters accuracy. FL-rthermore, such recpany.
The man died a few months later, ords are of great value for their own sake.
Do not examiners owe their companies the and if compiled and edited would contribmost
accurate chest examinations they are ute their quota to our knowledge. It has
capable of making? long seemed to me that the physicians of
.5. The progress or decline of many chest the South should contribute far more largely
affections can only be intelligently followed than they do to the medical literature of our
by accurate examinations at regular intervals.
This is particularly true of pulmoncountry.
How may accuracy be attained, seeing
ary tuberculosis. In many of these tuber- it is so important? First, by obtaining carecular
cases the symptoms do not accurately ful case histories. The getting of a firstcorrespond
with the real condition of affairs class history is almost a fine art in many
in the lungs. A patient may have gained instances. Often it takes time and patience,
his full quota of weight, and have most of and such skillful interrogation as a lawyer
his symptoms disappear. Yet on careful might well envy. The object is to have the
examination an area of moisture may be patient state only essential facts bearing on
found, indicating an active process, and his malady without asking him leading
the necessity for the utmost caution, the questions. This is often very difficult, and
lack of whicli will often result in relapse, yet a history so taken is of the highest value.
This is no fanciful statement, but is based as the first correct step,
on personal experience. So, also, in many Second.—Accuracy is to be attained by a
forms of heart disease, from the patient's painstaking physical examination which
Standpoint the greatest value attaches to does not stop short of any procedure of
repeated accurate examinations. demonstrable value necessary to clear reas-
4. The question of prognosis can only be onable doubts in the mind of the examiner.
answered honesily after an accurate exam- I am satisfied that the results of the examination.
It is not enough to inform a pati- ination should be charted. My own method
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