Of the internal organs

In order to arrive at a correct diagnosis it is necessary to be able to iden­tify the signs of the disease, and to reveal the appropriate changes in the pa­tient. Various methods are used to reveal and study the numerous symp­toms of the disease. These methods include questioning the patient, measuring his body temperature, and complicated techniques of examina­tion (microscopy of the formed elements of the blood, chemical studies of the bodily fluids, X-ray examination of the patient, etc.).

A healthy person does not feel any unpleasant sensations. Pain, nausea, vomiting, elevated body temperature, enlargement of certain internal organs, e.g. of the spleen, occur only in the sick, and are considered as signs or symptoms (Gk symptoma that which happens) of diseases. Some symptoms indicate changes that occur in the entire body (e.g. elevated temperature), while others (e.g. diarrhoea) may only indicate dysfunction | of a particular organ or a system, or changes in the structure of an organ (e.g. an enlarged and firm spleen).

Pain or nausea are subjective symptoms experienced by the patient. These sensations reflect objective changes that occur in the patient's body. Signs of the disease that are revealed by the physician during his examina­tion of the patient, e.g. jaundice or enlarged liver, are objective symptoms of the disease.

It is almost impossible to diagnose a disease by only one symptom. A correct diagnosis can only be established by investigating several symp­toms. Most incorrect diagnoses are the result of an insufficient examina­tion. The main requirement is therefore a thorough and systematic ex­amination of the patient. A correct diagnosis can be established if the physician follows a definite plan in his examinations.

The examination begins with an interview. The patient tells his com­plaints which often are of no less importance than a thorough objective ex­amination of the patient. Some diseases are diagnosed almost exclusively by the patient's complaints. Angina pectoris, for example, is frequently diagnosed almost entirely from the character of pain in the region of the heart. Cholelithiasis is diagnosed by attacks of pain in the right upper ab­dominal quadrant. A detailed questioning of the patient concerning the

time of the onset of the disease, its early symptoms (until the time of medical examination) is even more important in establishing a correct diagnosis. All this information is usually called anamnesis morbi, i.e. remembering the present disease by the patient, as distinct from anamnesis vitae which is the history of previous diseases of the patient. Stages of development of the present disease are traced back while collecting an anamnesis from the history of the disease as given by the patient himself and also from the information supplied by his relatives.

Another stage of examination is objective examination of the patient's condition at the present time (status praesens). This examination includes various diagnostic procedures (inspection, measuring temperature, percus­sion, auscultation, palpation, laboratory tests, X-ray examination, etc.) and reveals changes in the patient's body and deviations from normal structure and function of various organs that could not be sensed by the patient himself.

As a rule, a patient undergoes repeated examinations during his obser­vation by medical personnel. These examinations reveal subjective and ob­jective changes in the state of the patient, the disease progression, and the efficacy of the therapy given. This is information on the course of the disease (decursus morbi).

All information obtained by questioning the patient and by objective examinations, information on the course of the disease and the prescribed treatment are recorded to make a history of the case. A complete diagnosis (i.e. the main disease and the accompanying diseases and complications, if any) are given on the first page.

At the end of the history record, when observation of the patient is over, a conclusion or epicrisis should be given, where the special character of the disease and the result of the treatment should be described.