Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, October 08, 2002
    Way Cool Diagnosis of the Week

    I'm chatting with my suitemate and she says, "You know that patient I had you look at with me last week?"

    "Yes." (She had a swelling on her neck that didn't look like a lymph node or a cyst and we couldn't figure out what it was.)

    "Well, it's scrofula." (That's a localized soft-tissue infection caused by tuberculosis.)

    "NO WAY! Samuel Johnson had that!" I was really quite thrilled to hear this.

    "Samuel Johnson? Was he a president?"

    "Uh, no. He was a writer, an eighteenth-century writer."

    "Oh. Well, I sent her to the ear-nose-and-throat guy, who gave her antibiotics and she still didn't get better, then she finally said, 'Oh, my mother had tuberculosis in her neck once.' So I gave her the skin test and it was really strongly positive. But her chest X-ray was completely clear!"

    "Yep, sometimes you see that." The patient in question is from India. One thing about LA, you never know when you might see some sort of unusual tropical disease since we've got so many people from so many places. It's one of the things I love about being here.

    "Well, Infectious Disease wants a biopsy so we're going to do that this week."

    "Let me know the results when you get them back."

    I'm glad she let me know about this patient - I've never seen a case of scrofula in my life. But I can't believe she didn't know who Samuel Johnson was.



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