Symptoms

SYMPTOMS (from Greek symptoma - coincidence), characteristic manifestations or signs of various pathological conditions. It might be more correct to consider S. only phenomena indicating disorders of functions, i.e., dynamic signs but not anatomical changes (A. M. Levin), which represent actual manifestations of the pathological process, such as a tumor in cancer. However, in the broader clinical understanding, S. are considered all signs characterizing pathological conditions. The number of known and described S. is very large, but probably an equal number are not described, since out of hundreds and thousands of patients suffering from even the same and very characteristic disease, each person suffers in their own way. It is also necessary to note that during careful examination, especially when questioning patients, in many cases S. are discovered that are not described anywhere and have not even been encountered by very experienced and attentive clinicians. Therefore, when examining patients, in each individual case, each S. must be identified, classified, and compared with other S., thanks to which its origin and significance for diagnosis, prognosis, and choice of treatment methods can be interpreted. Identification of S. By the method of identification, S. are divided into two main, more or less equivalent groups: subjective and objective. Many tend to attach primary importance to objective symptoms, whereas in reality so-called subjective symptoms, especially in diseases of abdominal organs and in earlier stages or not sharply expressed forms of many diseases, have no less or even greater significance (Mekenzie). Subjective S. are usually all S. about which the patient reports on their own initiative or characterizing their condition in response to questions from the examiner. These include 2 heterogeneous subgroups that must be strictly distinguished. 1. S. truly subjective, determined by the patient's self-awareness, for example: sensation of fatigue, malaise, drowsiness, emptiness in the head, palpitations, lack of air, constant thirst, appetite disturbance, heartburn, nausea, difficulty urinating, tenesmus during defecation, change in sexual desire, etc. 2. S. conditionally subjective, determined by the patient's self-observation, but sometimes (even more accurately) also by objective observation (in children, in the less developed or in an unconscious state). These include observable disorders of functions: visible flushes of blood, shortness of breath, attacks of suffocation, cough, regurgitation, unusual amount of food consumed, perspiration, salivation, diarrhea, anuria, polyuria, obvious sleep disorders and other disorders. Objective S. as the 2nd main group can be divided into 4 main subgroups. 1. Demonstrative S., determined by direct perception during general examination of the patient: by appearance, by touch, by sound manifestations, by smell from the patient, and by the combination of different manifestations. These include characteristic features in the general somatic and mental appearance of the patient and their behavior, characteristic posture, movements; deviations in body structure and shape of individual parts; features of facial expression, eyes, mimicry, changes in color, condition, and local temperature of the skin; visible peristalsis of abdominal organs and much else. This also often includes underestimated sound S.: speech disorders, pronunciation, voice, breathing, groans, cough with its sound characteristics, etc., as well as various characteristic odors. These undoubtedly objective demonstrative S., which have enormous significance, are often completely overlooked during general examination, or are partly characterized as subjective, since the examiner does not verify them with their own observation. 2. Characteristic features of the patient's excretions, detectable by direct observation. Unfortunately, this readily available method of identifying often very demonstrative S. is often completely unused, although it may have no less and even greater significance than usually single and partial laboratory examination, which under certain conditions may not even be feasible. 3. Objective changes detectable by special techniques of systematic clinical examination of the patient - by means of methodical inspection, palpation, percussion, shaking, auscultation, various measurements (for example, blood pressure, temperature, etc.). 4. S., detectable by more complex methods of examination, such as graphic method, endoscopy, X-rays, probing and catheterization, trial punctures, laboratory examination. Origin of S. As expressions of various pathological conditions, S. can be subdivided into 3 categories, representing: 1) temporary or permanent change (strengthening, weakening, disappearance or perversion) of normal manifestations of life (for example, hyper-, hypo-, an- or paresthesia of the skin, weakening of hearing, loss of appetite, sleep disturbance, increased pulse, polyuria, constipation, etc.); 2) change in various natural or artificially induced reflex acts (for example, coughing turns into cough, belching into regurgitation or vomiting, contractions of circular muscles into spasm, knee reflex disappears, Babinski reflex appears, etc.); 3) direct expression of certain structural changes; these include various S. associated with processes such as violation of integrity, increase, decrease, change in shape and position of organs, etc. S. relating to all the above categories may represent phenomena of a simpler or more complex order. Thus, bleeding from the lungs - S. of violation of integrity of pulmonary vessels and thereby very often S. of destructive tuberculosis of the lungs; ataxia - S. of disorder of reflex regulation of movement, which in turn is a symptom characteristic of degeneration of the posterior columns of the spinal cord and thereby for tabes dorsalis. Qualification and interpretation of S. Many S., for example cough, are observed in very different diseases, however, in different cases, cough has very different characteristics, representing a series of sound features. It is in determining exactly these features of each S. and the conditions of occurrence of these features that the qualification and interpretation of S. consist, making it possible to differentiate this S. in each individual case and in certain diseases and thereby determine the nature of this disease. Thus, a silent, frequent cough, intensifying when inhaling and when trying to speak, and causing pain in the larynx area, undoubtedly indicates deep damage to the vocal cords. The intensity of manifestation of S. should also be the subject of special attention, because along with S. obvious, dominant (Cabot), having great significance, such as intestinal bleeding in typhoid fever, sometimes it is very important to discover S. elusive and poorly expressed, having no less, and sometimes even greater significance; such are, for example, even single roseolas and a slight enlargement of the spleen in suspected typhoid fever, single pustules in varioloid, slight unevenness of pupils and knee reflexes in the initial stage of progressive paralysis. Localization of S. has the same significance as their qualification. This especially applies to pains (see Symptomatic pains). Therefore, it is necessary to distinguish not only the nature of pains, but also the place of their origin, the greatest intensity of their manifestation (as determined by the patient himself and by palpation), as well as the direction and place of their spread (irradiation). Great significance also belongs to localization in relation to many other symptoms (for example pigmentation). The reliability of symptoms has enormous significance for diagnosis and prognosis. The question about this arises mainly in relation to S. truly subjective. Such S., however, to a large extent can be verified, since they often find expression in the patient's mimicry, in body position, in his movements, in his entire behavior, which can be learned from his surroundings as well as by direct observation. In addition, many subjective S., such as weakening of vision, hearing, etc., ability to concentrate, remember, etc., can be verified by precise examination methods. The reliability of S. reported by the patient, if they cause doubts in the accuracy of self-observation, can be verified by more detailed questioning of the patient and his surroundings, by comparison with other S. characterizing the patient's condition, and with the conditions of his life. The reliability of demonstrative objective S. can be doubted only in case of suspicion of voluntary or involuntary simulation, for example in hysterics. Objective changes detected by clinical examination may be incorrectly established, especially with insufficient technical skill of the examiner. Diagnostic significance S. have only if they are reliable, accurately classified and correctly interpreted. Such S. can be subdivided into: 1) constant and non-constant; 2) essential and insignificant; 3) characteristic and non-characteristic; 4) pathognomonic, i.e., directly indicating a specific disease, and non-pathognomonic.

One must keep in mind that characteristic signs may be non-constant, non-essential, and non-pathognomonic, for example, herpes in lobar pneumonia. Essential and even pathognomonic signs may still be non-constant, for example, localized dullness corresponding to the consolidation of one of the lung lobes is absent in central pneumonia. Characteristic symptoms are by no means always pathognomonic, for example, the febrile state, characteristic of lobar pneumonia, is a symptom that is still non-pathognomonic, since it also occurs in many other infectious diseases. But a critical drop in temperature, which had been at high figures with small fluctuations, is a pathognomonic symptom for this disease. Attacks of high fever around noon every other day are pathognomonic for three-day malaria. The prognostic significance of a symptom is naturally determined by how much this symptom has importance for judging the outcome of the disease. In this sense, symptoms can be considered as: 1) indifferent, 2) favorable, 3) unfavorable, 4) threatening (signum mali ominis), and 5) hopeless. Understanding the prognostic significance of certain symptoms in various diseases and the correct assessment of a given, sometimes even minor, symptom in an individual case is practically very important. Thus, the petechial rash in typhus is a constant symptom and therefore prognostically indifferent, but a hemorrhagic rash is a symptom of unfavorable significance; slight bleeding from the lungs in tuberculosis is prognostically not serious, whereas profuse bleeding is serious, but usually not directly life-threatening, whereas intestinal bleeding in typhoid fever is a threatening symptom. A sharp drop in cardiac activity in infectious diseases, when the pulse curve rises rapidly upward and the temperature curve goes steeply downward, is understood as a hopeless symptom, the so-called fatal cross (crux mortis).-Therapeutic significance of symptoms. Although the basic principle of rational therapy is the desire to eliminate the very cause of the disease, it is often impossible to implement this principle. Therefore, practically therapy is mainly reduced to regulating the disrupted functions of the body and suppressing the phenomena from which the patient's well-being and condition suffer most. Therefore, when establishing a treatment plan, it is necessary to take into account all symptoms, and not only those dangerous to life, but also those unpleasant for the patient's well-being, especially pains, all the more so that poor well-being hinders the return to normal.

G. Gurevich. J. M. Marion Sims (1813-83), a famous American gynecologist, who became especially renowned for operations on urogenital fistulas. In 1849, he achieved the first flawless success in history in suturing a urogenital fistula. For his operations, Sims invented vaginal mirrors—the most common instrument of the modern gynecologist—and introduced silver sutures. Sims lived for several decades, operating everywhere and thus strongly promoting the spread of these operations. Here in Europe, in his spare time, Sims engaged in the literary processing of his views and achievements, with special attention to the treatment of infertility, and was one of the first to say that in this issue, male infertility deserves more attention than was given to it earlier. The book he published ('Clinical notes on uterine surgery', N.Y., 1866) was immediately translated into German, and from the second German edition into Russian. It was translated into Russian by students of Moscow University under the editorship and in the edition of E. Pavlinov (M., 1871). This Russian translation played a certain role in the development of gynecology in Russia. And all of Sims' activity was of such great importance for the development of modern gynecology that American biographers of Sims not without reason call him its 'father'.