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A sign is an indication of some fact or quality; and a medical sign is an objective[1] indication of some medical fact or quality that is detected by a physician during a physical examination of a patient. A sign is an entity which signifies another entity A natural sign is an entity which bears a causal relation to the signified entity as thunder is a sign of storm "n objective account is one which attempts to capture the nature of the object studied in a way that does not depend on any features of the particular subject who studies it A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs A patient is any person who receives medical attention care or treatment. [2]

There is a strong implication that the signs have no meaning for a patient, and may not even be noticed by them; yet they are full of meaning for the physician, and are often significant in assisting a physician to identify the disease(s) responsible for the patient's symptoms.

Examples include elevated blood pressure, a clubbing of the fingers (which may be a sign of lung disease, or many other things), and arcus senilis. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated In Medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the Fingers and fingernails that is associated with a Arcus senilis (or Arcus senilis corneae) is a white or gray opaque ring in the corneal margin (peripheral corneal opacity present at birth or appearing later in life and becoming

The term sign is not to be confused with the term indication, which denotes a valid reason for using some treatment. In Medicine, an indication is a term describing a valid reason to use a certain test medication procedure or surgery

Contents

Signs and semiotics

The art of interpreting clinical signs was originally called semiotics in English. Semiotics, semiotic studies, or semiology is the study of sign processes (semiosis or signification and communication signs and Symbols both This term, then spelt semeiotics (derived from the Greek adjective σημειοτικός: semeiotikos, "to do with signs"), was first used in English in 1670 by Henry Stubbes (1631-1676), to denote the branch of medical science relating to the interpretation of signs:

…nor is there any thing to be relied upon in Physick, but an exact knowledge of medicinal phisiology (founded on observation, not principles), semeiotics, method of curing, and tried (not excogitated, not commanding) medicines…[3]

Eponymous signs

A number of medical signs are named after the doctors who first described them. Henry Stubbe or Stubbes (1632 Partney, Lincolnshire – 1676 Bath) writer and scholar [4]

A list of eponymous medical signs is available. Eponymous medical signs are those that are named after a person or persons usually the physicians who first described them but occasionally named after a famous patient

Signs versus symptoms

Signs are different from symptoms: the "subjective" experiences, such as the fatigue, that patients might report to their examining physician. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from

For convenience, signs are commonly distinguished from symptoms as follows: a symptom is something abnormal, that is relevant to disease, experienced by a patient, whilst a sign is something abnormal, that is relevant to disease, discovered by the physician during his examination of the patient:

…a sign is an objective symptom of a disease; a symptom is a subjective sign of disease. [5]

According to King, it is an essential feature of a sign that there is both a sign and a thing signified. And, because "the essence of a sign is to convey information", it can only be a sign if it has meaning. Therefore, "a sign ceases to be a sign when you cannot read it". [6]

A slightly different definition views signs as any indication of a disease that can be objectively observed (i. e. by someone who isn't the patient), whereas a symptom is merely any manifestation of a disease that is apparent to the patient (i. e. reasons why diseases are bad). From this definition, it can be said that an asymptomatic patient is uninhibited by disease. With this set of definitions, there is some overlap--certain things may qualify as both a sign and a symptom (e. g. a bloody nose).

Types of signs

Medical signs may be classified by the type of inference that may be made from their presence,[7] for example:

“ "[If the patient's facial] appearance may be described thus: the nose sharp, the eyes sunken, the temples fallen in, the ears cold and drawn in and their lobes distorted, the skin of the face hard, stretched and dry, and the colour of the face pale or dusky. … and if there is no improvement within [a prescribed period of time], it must be realized that this sign portends death. "[8] ”
“ [Thus] a symptom is a phenomenon, caused by an illness and observable directly in experience. We may speak of it as a manifestation of illness. When the observer reflects on that phenomenon and uses it as a base for further inferences, then that symptom is transformed into a sign. As a sign it points beyond itself — perhaps to the present illness, or to the past or to the future. That to which a sign points is part of its meaning, which may be rich and complex, or scanty, or any gradation in between. In medicine, then, a sign is thus a phenomenon from which we may get a message, a message that tells us something about the patient or the disease. A phenomenon or observation that does not convey a message is not a sign. The distinction between signs and symptom rests on the meaning, and this is not perceived but inferred. [9] ”

Technological development creating signs detectable only by physicians

Prior to the nineteenth century there was little difference between physician and patient. Most medical practice was conducted as a joint co-operative interaction between the physician and the patient as equals. [10][11] Whilst each noticed much the same things, the physician had a more informed interpretation of those things: “the physicians knew what the findings meant and the layman did not”. [12]

Advances in the 19th century

However, the patient was gradually removed from the medical interaction[10][11][13] due to significant technological advances such as:

“ "The process through which “the physician can assess the state of the underlying lung by sensing the character of vibrations by gentle taps on the chest wall […something which…] greatly facilitated the diagnosis of pneumonia and other respiratory diseases” [14] ”

The techniques, which had been first described by the Viennese physician Leopold Auenbrugger (1722-1809) in 1761, became far more widely known following the publication of Corvisart’s translation of Auenbrugger's work in 1808. Percussion is a method of tapping on a surface to determine the underlying structure and is used in Clinical examinations to assess the condition of the Thorax or Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Respiratory Disease is the term for Diseases of the Respiratory system. Josef Leopold Auenbrugger or Leopold von Auenbrugg (b November 19 1722, Graz, Austria; d Jean-Nicolas Corvisart ( February 15, 1755 &ndash September 18, 1821) was an important figure in the history of French medicine

Alteration of the relationship between physician and patient

The introduction of the techniques of percussion and auscultation into medical practice immediately altered the relationship between physician and patient in a very significant way, specifically because these techniques relied almost entirely upon the physician listening. (King observes that the introduction of the stethoscope did not immediately revolutionize medicine; because, although the physicians could certainly hear some thing via these techniques, they had no idea whatsoever of what those particular sounds, in those particular rhythms, in those particular combinations actually meant. In other words, although they certainly were being bombarded with noises, they were noises that signified nothing at all. )[15]

Not only did this greatly reduce the patient's capacity to observe and contribute to the process of diagnosis, it also meant that the patient was often instructed to stop talking, and remain silent.

As these sorts of evolutionary changes continued to take place in medical practice, it was increasingly necessary to uniquely identify data that was accessible only to the physician, and to be able to differentiate those observations from others that were also available to the patient, and it just seemed natural to use "signs" for the class of physician-specific data, and "symptoms" for the class of observations available to the patient.

King proposes a more advanced notion; namely, that a sign is something that has meaning, regardless of whether it is observed by the physician or reported by the patient:

The belief that a symptom is a subjective report of the patient, while a sign is something that the physician elicits, is a 20th-century product that contravenes the usage of two thousand years of medicine. In practice, now as always, the physician makes his judgments from the information that he gathers. The modern usage of signs and symptoms emphasizes merely the source of the information, which is not really too important. Far more important is the use that the information serves. If the data, however derived, lead to some inferences and go beyond themselves, those data are signs. If, however, the data remain as mere observations without interpretation, they are symptoms, regardless of their source. Symptoms become signs when they lead to an interpretation. The distinction between information and inference underlies all medical thinking and should be preserved. [16]

Signs as tests

In some senses, the process of diagnosis is always a matter of assessing the likelihood that a given condition is present in the patient. Diagnosis is the identification by Process of elimination, of the nature of anything In a patient who presents with haemoptysis (coughing up blood), the haemoptysis is very much more likely to be caused by respiratory disease than by the patient having broken their toe. Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained Each question in the history taking allows the medical practitioner to narrow down their view of the cause of the symptom, testing and building up their hypotheses as they go along.

Examination, which is essentially looking for clinical signs, allows the medical practitioner to see if there is evidence in the patient's body to support their hypotheses about the disease that might be present.

A patient who has given a good story to support a diagnosis of tuberculosis might be found, on examination, to show signs that lead the practitioner away from that diagnosis and more towards sarcoidosis, for example. Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Examination for signs tests the practitioner's hypotheses, and each time a sign is found that supports a given diagnosis, that diagnosis becomes more likely.

Special tests (blood tests, radiology, scans, a biopsy, etc. Radiology is the medical specialty directing Medical imaging technologies to diagnose and treat diseases A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues ) also allow a hypothesis to be tested. These special tests are also said to show signs in a clinical sense. Again, a test can be considered pathognonomic for a given disease, but in that case the test is generally said to be "diagnostic" of that disease rather than pathognonomic. An example would be a history of a fall from a height, followed by a lot of pain in the leg. The signs (a swollen, tender, distorted lower leg) are only very strongly suggestive of a fracture; it might not actually be broken, and even if it is, the particular kind of fracture and its degree of dislocation need to be known, so the practitioner orders an x-ray. The x-ray film shows a fractured tibia, so the film is said to be diagnostic of the fracture. The tibia, shinbone, or shankbone is the larger and stronger of the two Bones in the Leg below the Knee in vertebrates and connects

Examples of signs

See also

References

  1. ^ eMedicine/Stedman Medical Dictionary Lookup!
  2. ^ Definition at University of Western Ontario
  3. ^ Stubbe, H. In Medicine ( Gastroenterology) ascites (also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more Cachexia (kəˈkɛksiə is loss of weight, Muscle atrophy, fatigue weakness and significant loss of appetite in someone who is not actively trying to Caput medusae is the appearance of distended and engorged Paraumbilical veins which are seen radiating from the Umbilicus across the abdomen to join Systemic In Medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the Fingers and fingernails that is associated with a In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages cf Death growl, a vocalization style used in heavy metal music Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Gynecomastia, or gynaecomastia, ˌgaɪnəkoʊˈmæstiə is the development of abnormally large Mammary glands in Males resulting in breast enlargement which Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained Hepatosplenomegaly is the simultaneous enlargement of both the Liver ( Hepatomegaly) and the Spleen ( Splenomegaly) Jaundice, also known as icterus (attributive adjective "icteric" is yellowish discoloration of the Skin, sclerae (whites of the eyes Lymphadenopathy is a term meaning "disease of the Lymph nodes. Palmar Erythema is reddening of the palms at the Thenar and Hypothenar eminences Splenomegaly is an enlargement of the Spleen, which usually lies in the left upper quadrant (LUQ of the Human abdomen. The stethoscope (from Greek στηθοσκόπιο, of στήθος stéthos - chest and σκοπή skopé - examination) is an acoustic A radiologic sign is an "objective" indication of some medical fact or quality that is detected by a Physician during examination of a radiograph (i The University of Western Ontario (known as Western, as well as UWO or Western Ontario) is a public research University located in London (Henry Stubbes), The Plus Ultra reduced to a Non Plus: Or, A Specimen of some Animadversions upon the Plus Ultra of Mr. Henry Stubbe or Stubbes (1632 Partney, Lincolnshire – 1676 Bath) writer and scholar Glanvill, wherein sundry Errors of some Virtuosi are discovered, the Credit of the Aristotelians in part Re-advanced; and Enquiries made. . . . , (London), 1670, p. 75
  4. ^ See list of eponymous medical signs, and "Who Named It?" [1] for more information on eponymous signs. Eponymous medical signs are those that are named after a person or persons usually the physicians who first described them but occasionally named after a famous patient
  5. ^ King, Lester S. (1982). Medical thinking: a historical preface. Princeton, N. J: Princeton University Press. ISBN 0691082979.  , p. 75.
  6. ^ King (1982), pp. 73-74.
  7. ^ King (1982), pp. 80-81
  8. ^ Chadwick, J. & Mann, W. N. (trans. ) (1978). Hippocratic writings. Harmondsworth [Eng. ]: Penguin, 170-171. ISBN 0-14-044451-3.  
  9. ^ King, 1982, p. 81
  10. ^ a b Jewson, N. D. , "Medical Knowledge and the Patronage System in 18th Century England", Sociology, Vol. 8, No. 3, (1974), pp. 369-385.
  11. ^ a b Jewson, N. D. , "The Disappearance of the Sick Man from Medical Cosmology, 1770-1870", Sociology, Vol. 10, No. 2, (1976), pp. 225-244.
  12. ^ King (1982), p. 82.
  13. ^ Tsouyopoulos N (1988). "The mind-body problem in medicine (the crisis of medical anthropology and its historical preconditions)". Hist Philos Life Sci 10 Suppl: 55–74. PMID 3413276.  
  14. ^ Weatherall, D. . Science and the Quiet Art: The Role of Medical Research in Health Care. New York: W. W. Norton & Company, 46. ISBN 0-393-31564-9.  
  15. ^ King (1982, p. 83)
  16. ^ King (1982), p. 89.

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