SOME OBSERVATIONS UPON THE MICRO-ORGANISMS OF MEAT POISONING AND THEIR ALLIES
Authors: H. D. R. Morgan
Journal: BMJ (1905)

TIm 1257 and even effasion into Brome of the joints being present and producing a considerable resemblance to rheumatic fever.Usually some symptoms very soon occur that show that the case is not one of ordinary rheumatic fever or of scarlet fever or measles, but the fundamental point is that we should not adopt any form of treatment which may be harmful should the case turn out to be one of enteric fever.Tuberculous peritonitis is a disease that is apt to be very protean in its manifestations, sometimes coming under observation simulating cirrhosis of -the liver, in other cases presenting resemblances to malignant growth, in others simulating acute intestinal obstruction under a,band.Again, many very chronic diseases of the nervous system, tabes for example, sometimes may have an apparently sudden onset, in other words the patient quite suddenly becomes ataxic, although it is not very obvious to what this sudden onset of symptoms is due.On examination such patients show well-marked signs of the disease, and very often a history is obtained that points to the conclusion that the malady has really long been present.It cannot be too fre- qluently urged that acute symptoms may occur quite suddenly both in the course of chronic and of latent diseases as well as at the onset of acute maladies.Erromr Dependent on Treatment.We must also, I am afraid, admit that some of our errors in diagnosis are dependent on our treatment.It is well recognized that some of the most disastrous errors in the diagnosis of abdominal diseases arise from the too-ready administration of morphine to relieve the pain, so that all the ,symptoms and sometimes even the signs of the underlying condition are masked.Belladonna is a drug which not uncommonly produces very ,marked symptoms in the course of its use in the treatment of disease.Thus, meningitis may be erroneously diagnosed in a case of phthisis where the whole trouble is really dependent on the employment of belladonna administered to relieve the cough.Again, in Graves's disease the use of belladonna may ,produce excitement almost of a maniacal kind and simulating very closely the profound psychical disturbance that is seen in the more serious forms of Graves's disease.Alcohol is not uncommonly pushed to an extent to produce coma, which is then regarded as dependent on the underlying malady, and sometimes anomalous symptoms may be de- pendent, as every practitioner knows, on the patient secretly obtaining some variety of alcohol.The Natural History of Disease.In order to avoid as far as possible errors in diagnosis, we must not only be cautious in interpreting the value of sym-*ptoms and careful in our examinations to detect physical signs, but it is of paramount importance to be familiar with the natural history of disease, and especially to know .thoroughly the various modes of onset of particular affections, and the very diverse clinical pictures that are produced by one -and the same disease in different individuals.Gastric ulcer, phthisis, malignant endocarditis, general paralysis of the insane, tuberculous peritonitis, and granular kidney are all instances of common maladies which may present very dif- ferent modes of onset, and it is far more important to recognize the various clinical types or groups of symptoms presented by common diseases than to remember all the various symptoms which may be produced by any given disease.The important point is that these symptoms may in different instances of the same disease be differently grouped.Thus, one patient with gastric ulcer will present symptoms of a haemorrhagic type, another simplythose of chronic gastritis, a third perhaps will only present signs of anaemia, and a fourth no signs at all until a perforation occurs.What is true of gastric ulcer is true of many other common chronic diseases, and the importance of studying the natural history of acute or chronic diseases cannot be overestimated if we wish to avoid errors of diagnosis.DESTRUCTION OF A BRAZILAN MEDICAL SCHOOL.-TheMedical College of Bahia, Brazil, with all its equipment and valuable library, was almost totally destroyed by fire in March.The loss of the referenee books and numbers of rare works of the early masters and files of medical journals is irreparable, but the Government is already taking steps to replace the building and to equip it with modern appliances.