“Beware the snap diagnosis” is a warning that every great clinician gives his students. Knowing that disease dons subtle masks that may mislead even the wariest, the modern physician rigorously checks his diagnostic judgment against laboratory findings.
But every doctor has known the satisfaction of spotting some obscure sign or telltale symptom that enables him to determine the patients malady at a glance. Vast medical knowledge, sharpened observation, plus an occasional flyer into the realm of pure intuition, are essential to any practitioner of the Fine Art of Diagnosis as the following anecdotes will show.
“DOCTOR, this cigarette cough is beginning to get on my nerves,” said a middle-aged man as he entered Dr. Frank Billings office on a scorching summer day. The left side of the patients face was streaming with perspiration, but oddly enough the right side was bone-dry. Dr. Billings noted also that the right eye-ball was slightly sunken.
On this flash observation, Dr. Billings decided that the man had a cancer of the right lung. In the physicians chain of reasoning were several diagnostic links. He knew that cancer at the apex of the lung sometimes spreads to nearby lymph nodes in the neck. These, in turn, compress (and, in effect, paralyze) certain nerves controlling the eye and the sweat glands of the face. The patients peculiar goosey cough not unlike a cigarette hack rounded out Dr. Billings diagnostic sketch, which was afterward tragically confirmed by the X ray.
A WOMAN in her early 30s gazed despairingly into the piercing eyes of a distinguished Baltimore physician. Her lips and fingernails were blue, and a cross-hatching of fine wrinkles lay about her eyes. Her complaint was an almost constant headache that seriously impaired her earnings as a seamstress.
The doctor asked a point-blank question: “Do you take headache powders often?”.
“Oh, yes, Doctor. Three or four a day. They help me a lot.”.
“They may help you,” said the doctor, “but” he pointed to her bluish fingernails “its plain that theyve given you a bad case of acetanilide poisoning.”.
The woman was taken off the powders and the bluish discoloration (caused by the action of excessive acetanilide on the blood) gradually went away. Faulty vision, which had etched wrinkles at the corners of her eyes, was the cause of her headaches. Properly fitted glasses corrected this condition and the headaches disappeared.
AN EMACIATED young man complained to Dr. Myron Sesit of a dragging fatigue that made it increasingly difficult for him to perform his duties as clerk in a dairy store. His blood pressure was critically low, and a faint brownish discoloration was observable on the back of his hands.
“How long have you felt weak and tired?” asked the physician.
“Ever since I left my last job in a delicatessen.”.
Dr. Sesit probed a bit deeper. “Did you, on that delicatessen job, eat a great deal of salty, highly spiced food?”.
“I sure did, Doc. Couldnt get enough pepper relish, salt herring and stuff like that. And how I miss those pickles on this dairy job.”.
“Young man, youve got Addisons disease,” said Dr. Sesit. “One of its earliest symptoms is fatigue, accompanied by low blood pressure. While you were a delicatessen clerk, you kept your blood pressure jacked up with huge daily doses of salty, spiced food, and thereby masked the chief sign of your illness. Now that youve switched jobs, the mask is off and the true nature of your trouble is finally exposed.”.
Until recently, sufferers from Addisons disease (a disorder of the adrenal glands) were doomed to slow wasting death. But on treatment with cortin, derived from the adrenal cortex, the young dairy clerk regained his strength, and now leads a life of normal activity.
RUMOURS reached Dr. Burton Chance of Philadelphia that one of his highly respectable lady patients was overindulging in alcohol. She had been seen staggering along the street on several occasions, and when she entered his examination room she navigated most unsteadily between the chairs and table.
Knowing her to be most abstemious, Dr. Chance suspected that her wavering gait was due to some impairment of vision. Yet barely was she seated when she leaned forward and with a murmured apology removed a scarcely visible thread of lint from the lapel of his coat.
The patients keen direct vision gave Dr. Chance his diagnostic clue. Her staggering must be caused, he reasoned, by some defect in her side-to-side vision. Further investigation revealed a tumor pressing on the optic nerves as they extended from the brain. The tumor was removed by a neural surgeon, and the patient regained both her full vision and her reputation for temperance.
A RICH, irascible spinster, obviously undernourished, complained to a Boston skin specialist of a severe eczema on her left hand.
“A dozen doctors have said Im allergic to wheat, beef, chicken everything I like,” she complained. “My diets been cut till Im starving to death.”.
“I dont think your skin trouble can be traced to diet,” soothed the doctor. “If that were the case, both hands would be affected. Apparently you touch something with your left hand that you dont touch with your right. Have you any idea what it might be?”.
“Cant think of a thing,” snapped the patient.
Shortly thereafter, the physician read in the newspaper that his patient had won a prize for her beautiful primroses at a flower show. Visiting her home, he found her caring for her beautiful primroses at a flower show. Visiting her home, he found her caring for her plants. In her right hand she held a watering pot, while with her left she plucked away the dead leaves of the prize winning primroses.
In silence the M.D. scribbled on his prescription pad: “One cotton glove, to be worn on the left hand while watering flowers.”.
A few days later he received from his patient a three-figured check and a one-line note: “Youre not a diagnostician,” said the note. “Youre a medical detective!”.
