Introduction to the outlines of the principles of differential diagnosis : with clinical memoranda / by Fred. J. Smith.

  • Smith, Fred. J. (Frederick John), 1857-1919
Date:
1899
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Licence: Public Domain Mark

Credit: Introduction to the outlines of the principles of differential diagnosis : with clinical memoranda / by Fred. J. Smith. Source: Wellcome Collection.

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    CHAP. may apparently be produced either by the microbes or the tissues. (4) Such antitoxin can be obtained, with more or less success (by methods which need not here be entered upon), in quantities and condition available for therapeutic uses. (5) It should follow, and has in many cases already been proved to follow, that the injection of such antitoxin, if effected early enough in the disease, is efficacious in curing the patient. These propositions would appear to be scientifically demon- strated, but there is one point which is still in doubt, and that the most important one from our present point of view; it is this— does each separate and identifiable microbe produce a special and specific toxin, i.e. a poison of definite composition—as definite, say, as morphine or other alkaloid—peculiar to itself and requiring for its neutralisation an equally definite and specific antitoxin ? or, on the other hand, do many different microbes produce a common toxin, so that the antitoxin produced by one microbe or method of preparation can be used for the toxin of another kind of microbe ? All the evidence—at least the weight of evidence—we at present possess points in the direction of the former of these two supposi- tions being the true one. Witness the almost conclusive clinical experience in the treatment of diphtheria, of rabies, and of tetanus, as well as the brilliant successes and the disappointing failures in cases of septic disease, in which the particular microbe at work is less definite or less familiar, and where success has been com- pulsorily attributed to the right antitoxin, failure being due either to the wrong antitoxin or to a too late application. I think, there- fore, we shall be obliged ultimately to admit its truth, and we can see at once on this admission how enormous is the importance of the third step in diagnosis, to be able to say, This case of illness is due to this particular microbe, and I must use its antitoxin as quickly as possible. Besides this therapeutical use of a completed diagnosis, the principle of toxins and antitoxins has lately been applied to that completion itself, vide Typhoid Fever. May we not hope in the future to see the two procedures more frequently working hand in hand, complementary to one another ? Causes of Disease in General In the special sections of this work we shall always be consider- ing diagnosis as an induction from symptoms. We may here in the
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