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Physician to Ancon Hospital, Canal Zone. Panama. When Cabot, in 1910, published his splendid pa- per entitled A Study of Mistaken Diagnoses, based on an analysis of i.ooo autopsies and a com- parison with clinical findings,' the medical staff of this hospital was very much interested, and prof- ited accordingly. Cabot's study is rather an origi- nal conception and of courageous Tofranil 50 Mg veracity, com- pared with the average paper, which Buy Tofranil usually speaks of success achieved and carefully avoids mentioning any serious failures encountered. Two years later, when the same author published a further studv on similar lines in 1912. under the title of Diagnostic Pitfalls.- the value of such studies, both to the pa- tients in our care and to ourselves as a profession, was brought home, and it was decided to undertake a study of a number of consecutive diagnoses in fatal cases coming to autopsy here in the tropics. Our aim, in the following analvsis. has been to ascertain, primaril}-. the Buy Cheap Tofranil errors made by the medical stafif of this hospital in determining the actual cause of death among a population in the tropics where the negro and mulatto outnumber the white in a ratio of about 6 to i. Secondarily, it has been our desire to profit by our mistakes, and to avoid pre- ventable errors Order Tofranil in the future, bv determining the cause of failure to diagnosticate, as shown at au- topsy. The autopsies were all performed by Dr. Her- bert C. Clark, pathologist of the board of health laboratory. Samuel Darling, M. D., chief of the laboratory. We are greatly indebted to Doctor Clark for his careful and accurate work, and the •Read at Purchase Tofranil the meeting of the Isthmian Canal Medical Association, May 17, 1 913, and puljlished with the kind permission of Colonel W. C. Gorgas, U. S. A., Chief Sanitary Officer, and Lieutenant Colonel Chas. F. Mason, U. S. A., Superintendent of .\ncon Hospital. 'R. C. Cabot: A Study of Mistaken Diagnoses, Journal of the American Medical Association, October 15, 1910. 'R. C. Cabot: Diagnostic Pitfalls, Journal of the American Medicisl Association. December 28, 1912. help willingly granted in elucidating many obscure points in pathological finding^. Purchase Tofranil Online Before going into detailed analysis a few prelim- inary remarks are necessary, for, as Cabot states in his first paper, "it is not a simple matter to collate ante mortem, and post mortem matter in an intelli- gent way." All patients admitted to the hospital mori- bund, that is to say, patients dying in the first twenty- four hours after admission, are excluded from this series. The object of this is self evident, when one considers Tofranil Uses the Order Tofranil Online impossibility of obtaining a historv or of making a satisfactory physical, microscopical, chemical, or bacteriological examination in manv of these cases. This exclusion is not a^ much in the favor of the clinician as may be supposed, for many fatal malaria or lobar pneumonia patients, both easily diagnosticated in even the moribund state, die within a few hours after admission to the hospital. The latitude given the clinician is an- Tofranil Tablets other point necessitating preliminary explanation. We regret to say that the system of granting the clinician and the pathologist the privilege of giving a primary and an immediate cause of death has never been definitely adopted in this hospital. As an example of the confusion created by the method of giving a single pathological entity as a cause of death, we might cite a case of pernicious malaria fever, complicated, as such severe infections always are. by acute toxic or degenerative nephritis. The Tofranil Price patient lives long enough to have his circulating blood and organs cleared of the infecting parasites by the specific quinine treatment. Buy Imipramine Xevertheless, he dies in four or five days of acute degenerative nephritis and suppression of urine, because his kidneys were unable to take care of the malarial toxines contained in the destroyed plasmodia. In this case the clinician Cheap Tofranil may give estivoautuirnal malaria as the cause of death, while the patholo- gist's report may read acute degenerative nephritis or acute infection of undetermined origin. Another bad feature resulting, when the Tofranil Mg pathologist is held to give only either a primary or an immediate cause of death, is the habit formed by the Buy Tofranil Online clinician to include all complications of the primary dise?se in his diagnosis so as to find confirmation with the pathologist. This "gunshot" method is as objec- tionable in diagnosis as in prescribing, and leads to similar errors. A very good system of Buy Imipramine Online diagnosis is the Generic Tofranil one ad- vocated by Dr. Henr\- B. Baker, former secretary of the Michigan board of health, and adopted by this board. Doctor Baker gives the primary Tofranil Cost cause of death, the immediate cause of death, and the con- tributing factors in both clinical and pathological ■iBht, IQI.1, by A. R Elliott Publishing Compari 402 DEEKS AND BAETZ: FATAL MEDICAL CASES IN THE TROPICS. diagnoses. A recent case of ours serves as a good example. .'\n aortic aneurysm developed in a pa- tient afflicted with tertiary syphilis. This aneurysm. by compression and erosion, causes an empyema of the pleural cavity. Rupture of the aneurysm re- sults in sudden death. Tofranil Online The diagnosis here would read: syphilis as the primary cau~e of death, hem orrhage from rupture of aortic aneurysm as thu immediate cause of death, Tofranil Pm and empyema of the pleural cavity as a contributory factor. In so diag- nosticating, a correct conception can be formed as to the role syphilis plays as a cause of death. Under our system it is often impossible to do this-

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