DIAGNOSIS


Diagnosis in the cases of skin diseases, with indicated homeopathic remedies from the Diseases of the Skin by Frederick Myers Dearborn. …


The proper treatment of cutaneous diseases is dependent in a large measure upon correct diagnosis. Otherwise the management of the case is apt to be haphazard and unscientific. It is not sufficient to say that the disease is papular, pustular, etc., but it must be recognized as a clinical entity which embraces not only its initial manifestations, but all its changes, terminating in the natural ending of the disease. Provided the investigator has the proper amount of text-book knowledge supplemented by the experience of clinical observation, he should be able to make a correct diagnosis in the great majority of cases. If he fails in this particular, it is either due to negligence in the examination or less often to the rarity or peculiarity of the disease in question. A diagnosis should never be made without sufficient examination and even the most expert may require repeated examinations before arriving at a definite conclusion. An effort should be made to see things as they are and not hunt for facts to fit a name, which is the last if not the least in importance. As sight and touch form the chief means of examination, the patient should be seen in good daylight. Direct sunlight or artificial light modify color, especially the shades of yellow, to such an extent as to be at times misleading. If possible, the room should have walls of neutral tint so as not to reflect their color upon the skin. The temperature of the room should be warm enough to permit partial or entire exposure of the skin surface without discomfort or injury to the patient. In this particular it is often best to insist upon seeing the whole or at least the greater part of the eruption, because the disease may be atypical in one location and characteristic in another.

While the subject of special diagnosis will be considered in connection with separate diseases, there are general principles which can be studied profitably, as illustrating the collecting and grouping of facts for the purpose of diagnosis. To accomplish this purpose, systematic work will well repay the investigator, for the apparent ease with which an expert diagnostician arrives at his conclusions by a seemingly rapid and superficial survey of the symptoms is only accomplished by long practice, frequent opportunity and systematic methods. Inquiries that enable the investigator to make a diagnosis can be tabulated on sheets made for that purpose. Usually these records are too complicated to be appreciated by the student or too detailed to be used by the practitioner and only interest the specialist. In my service at the Metropolitan Hospital, I employ an exhaustive four-page history which, in brief, includes statistical data, hereditary history, antecedent personal history, a sheet with suggestive procedure which is followed in the examination of the patient and his eruption, microscopic and bacteriological examinations, discharge or mortuary record, final or corrected diagnosis and resulting scientific conclusions. However, it is not necessary to amplify these details, but rather to illustrate the relationship existing between the various factors that contribute to a knowledge of etiology and hence establish a diagnosis. The same facts which enable the physician to distinguish one disease from others furnish important indications for treatment, and together with a knowledge of the probable therapeutic effect form the basis for an opinion as to the probable course or termination of the disease (prognosis). Following is a graphic arrangement (Crocker’s grouping, modified) of the diagnostic elements and their relation to further essentials in practice:

Frederick Dearborn
Dr Frederick Myers DEARBORN (1876-1960)
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war