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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