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June 14, 1913


Author Affiliations

Chief Admitting Physician, Mount Sinai Hospital NEW YORK

JAMA. 1913;60(24):1864-1866. doi:10.1001/jama.1913.04340240024010

The term "significant" is used advisedly. There are certain symptoms or signs which at all times are indicative of pathologic processes. Their theoretical value in diagnosis we would never think of denying; and yet practically it is just this evidence that we are prone to overlook in rendering our decisions, blinded as we often are by an over-abundance of signs, the very multitude of which tends to obscure the clinical picture. Symptoms such as hematemesis, melena and chills, and physical signs like petechiae, localized tenderness and markedly dilated veins always signify abnormal conditions, and cannot under any circumstances be discarded as valueless diagnostic evidence. They mean something—they are what are termed in this paper "significant signs."

I am firmly convinced that many mistakes in diagnosis are avoidable, the errors in these instances being the result of inability to discriminate between salient and unimportant facts. The "snap" diagnostician startles his audience,