On First Looking into Cabot's Differential Diagnosis

doi:10.1059/0003-4819-128-5-199803010-00018

On First Looking into Cabot's Differential Diagnosis

Theodore B. Schwartz, MD

Rush Medical College; Chicago, IL 60612-3864 Note: The title of this essay is a paraphrase of the title of a poem by John Keats, “On First Looking into Chapman's Homer.” Keats's title has lingered in my memory since my high school days, when I found that if a comma were inserted after the second word, it could be looked upon as a British version of “Casey at the Bat.” Acknowledgment: The author thanks Genevieve Schwartz for editorial assistance and support. Requests for Reprints: Theodore B. Schwartz, MD, 200 Lee Street, Evanston, IL 60202.

In contrast to those who endure the woes engendered by present-day strictures and retrenchments, physicians at the turn of the century should have been a happy lot. Totally autonomous, they were present at the creation of modern, scientific medicine and had readily available a wealth of reliable sources of contemporary medical knowledge. Foremost among these was Osler's monumental Principles and Practice of Medicine [1], but other respectable texts, such as Anders's Practice of Medicine [2], also served well. However, the neophyte needed to select his books with care. He or she (usually he) would have done well not to become entrapped by such doctrinaire authors as Charles E. de M. Sajous, whose massive two-volume work, The Internal Secretions and the Principles of Medicine [3, 4], insisted on the centrality of the adrenal system in the development of all human ills.

For the harried practitioner seeking a direct route from a presenting symptom to a specific diagnosis, there was French's Index of Differential Diagnosis [5], a sturdy, well-constructed compendium that has survived to the present day [6] and has spurred the publication of at least a dozen similarly oriented texts. For details on treatment, the no-nonsense physician consulted Hare's Textbook of Practical Therapeutics [7], which had already undergone 11 revisions by 1905.

For me, however, the piece de resistance is Cabot's Differential Diagnosis [8, 9]. A mint-condition copy of this two-volume work was given to me by a friend in trade for an early Polaroid Land camera. I was delighted. Here was an opportunity to be transported back into the medical world of 1911-1914, as reported by Richard Clarke Cabot (1868-1939), perhaps the outstanding clinician of his day. I decided that the journey would be well worth taking.