Debility and/or Loss of Weight the Diagnostic Approach

Abstract

These last few decades have given us greatly increased precision of diagnosis and therapeutic power, and we, no longer merit Matthew Arnold's rebuke. These revolutionary changes have been produced as a result of a great spirit of free enquiry, a search for facts and their explanation. Such a search is dependent initially on the development of a working hypothesis, and this is just what a tentative diagnosis is. From this point our search is for facts uncoloured by accepted authority, popular opinion or personal prejudice.

In medicine Galen of Pergamum was the "Master" for many centuries, and from 200 A.D. the dead hand of Galen's authority lay upon medicine for over 1300 years. The mighty Leonardo da Vinci first questioned Galen's views and in England in 1620 Francis Bacon in his "Novum Organum" urged men to abandon their four idols-accepted authority, popular opinion, legal bias and personal prejudice. Yet, despite Leonardo da Vinci and Bacon and even the revolutionary work of Harvey in 1628, it was not until the time of Lister (186o) that medicine ceased to be a traditional empirical art bound to the words of the Master and accepted authority.

There are for us three kinds of facts, viz. symptoms, signs and the results of investigations, and upon these we base our diagnosis. It is because of the difficulty in setting down an accurate account of the first of these that medicine will be for ever an art.