When asked by a trainee how he knew that an acutely ill patient had multiple sclerosis, Harvard neurologist Raymond D Adams quipped: “How does a farmer know his sheep?” The parallel between a farmer's intuition and a clinician's judgment was apt. This anecdote is from the mid-1970s, when no therapies for multiple sclerosis existed, and clinical diagnosis relied on recognition of the phenotype and exclusion of mimics. Direct tissue examination, usually at autopsy, was the true gold standard for diagnosis.

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诊断多发性硬化症：艺术与科学

哈佛大学的神经病学家雷蒙德·亚当斯（Raymond D Adams）在接受培训生的询问时，如何得知一名急性病患者患有多发性硬化症：农民的直觉与临床医生的判断之间的相似之处是恰当的。此事发生于1970年代中期，当时尚无多发性硬化症的治疗方法，临床诊断依靠表型的识别和模仿物的排除。通常在尸检时进行直接组织检查是诊断的真正金标准。