Prognosis

“ Physicians are not at all eager to impart their knowledge about prognosis, because this knowledge is so limited and so faulty. No scientific man likes to make definite statements upon so indefinite and hazy [Pg 24] a matter as prognosis. ”

“ But he gives us no concise prognostic data; in fact one feels on reading his paper that the diagnosis must be made post hoc. This problem is manifestly of equal importance from the social and the scientific standpoint: until we can predict the outcome our treatment must be empiric and palliative; we confess ourselves ignorant of the disease process if we cannot make a prognosis. ”

“ The prognosis for cure is extremely unfavorable, but the prognosis for a reasonable amount of happiness and a large amount of usefulness is, in my experience, excellent and though, of course, new habits will have to be formed and new ways of looking at life assumed, if this can be quietly and persuasively made clear to the patient early in the case, much of the more or less inevitable suffering that the patient will have to endure may be lessened. ”

“ PROGNOSIS.—The very few reported cures in so common a disease as general paralysis, and the circumstances under which they have been reported, lead to the suspicion that there was an error in diagnosis or that the mistake was made of supposing a remission to be a cure, as has often happened. The course of the disease is more rapid in men than women, and in young persons than in the older. ”

“ A knowledge of prognosis will help the home visitor greatly in the solution of such problems. But it must be added that such knowledge as she already possesses about the prognosis of a disease, such as tuberculosis or heart trouble or kidney trouble, must always be supplemented by all the information that she can gain from the doctor as to the present prognosis in the case of the particular patient with whom the social worker has to deal. For the general prognosis of a disease is greatly modified by the particular circumstances in each individual case. ”

“ The prognosis regarding the restoration of the ligaments and the thickened surfaces to their natural condition, and the restoration of the displaced organs which complicate the disease, will depend upon the extent and duration of the affection and upon the treatment. As a rule, the prognosis is good where the patient has sufficient courage and fortitude to submit to a prolonged course of treatment, with the abstemious habits of life which may be necessary. ”

“ The prognosis is, in the majority of cases, good. A cure can be effected in any case, provided the directions followed are faithfully carried out, especially in a private institution, where absolute control of patient and nurse is possible, and where the number of patients is limited. ”

“ We must also save heart patients from the unfavorable influence of a bad prognosis, and of too serious a diagnosis, both of which may be quite unjustified, for the rule is that the longer a man has been studying the heart, the less likely is he to be confident in his diagnosis, or unfavorable in his prognosis. ”

“ Of course, no one can gainsay there is a group of cases having in the natural course of events a prognosis of fatality within a term of years, say three to five years, and we have cases in our series which go to show that even with the modern intensive treatment the characteristic down-grade symptomatic progress and ultimate fatality occur. ”

“ SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC. Every medical practitioner must have met with a certain class of cases which has set at defiance every effort at diagnosis, baffled every treatment, and belied every prognosis. ”

“ The cases offering most in the way of a favorable prognosis are those in which there is not great acceleration of the action of the heart, this organ being free from organic disease, and those in which, exclusive of the affection under consideration, there are no marked unhealthful conditions. ”

“ V. Let me advise you, in your visits to the sick, never to appear in a hurry, nor to talk of indifferent matters before you have made the necessary inquiries into the symptoms of your patient's disease.
VI. Avoid making light of any case. “Respice finem” should be the motto of every indisposition. There is scarcely a disease so trifling, that has not, directly or indirectly, proved an outlet to human life. This consideration should make you anxious and punctual in your attendance upon every acute disease, and keep you from risking your reputation by an improper or hasty prognosis. ”

“ So many incidental factors of physical, mental, and social life, with all of the complicated background of the same, come in to make the total result, that experiment and trial with the individual case, while hesitating to give an exact prognosis, is perhaps the only sane procedure. What we do know definitely is the immensely favorable outcome in Cases 1, 4, 7, 19, and the promising betterment in several other instances—all in direct contradiction to what we had expected from survey of previous literature. ”

“ The patients die in fatal cases from exhaustion due to insomnia, lack of nourishment, and their constant activity of body and mind. The prognosis is usually favorable, taking all cases together, but in delirium tremens secondary to surgical injuries or operations the prognosis is serious. ”

“ The prognosis is more favorable in young adults than in persons of advanced age. Patients, who without relief have worn the ordinary supports sold at the stores will, as a rule, manifest extreme sensitiveness as to the fit of any of the supports which may be applied. ”

“ The final diagnosis is with respect to the nature of the lesion. While the second diagnosis may be said to possess the greater scientific interest, this one must be admitted to possess paramount practical importance, as from it we derive the indications for rational treatment and the data of prognosis. The third diagnosis is to be made by the application of the observer's knowledge of general pathology and etiology; hence it is in this field that the best-trained physician succeeds—where the experienced practitioner may sometimes eclipse the brilliant specialist. ”

“ He ought to learn accurately the constitution of every one of the seasons, and of the diseases; whatever that is common in each constitution and disease is good, and whatever is bad; whatever disease will be protracted and end in death, and whatever will be protracted and end in recovery; which disease of an acute nature will end in death, and which in recovery. From these it is easy to know the order of the critical days, and prognosticate from them accordingly. ”

“ If a physician prognosticates, upon seeing the intemperances and debaucheries of men, that they will fall into such a distemper, is his prognostication any cause of their disease, or of the sharpness of any symptoms attending it? ”

“ Francis Adams,181 “contains a rich treasure of observations which cannot be too much explored by the student of medicine. His prognostics are founded upon the appearance of the face, eyes, tongue, the voice, hearing, the state of the hypochondriac region, the abdomen, the general system, sleep, respiration, and the excretions. We can do little more, in this place, than express our high sense of the value of the Hippocratic Treatises on Prognostics, and recommend the study of them to all members of the profession who would wish to learn the true inductive system of cultivating medicine.” ”

“ Cure in the Secondary Stage.—The estimation of the prospect of recovery when the secondary symptoms have appeared and the germs are in the blood is difficult, owing to the rapid changes in our knowledge of the disease, which are taking place almost from day to day. The patient usually presses his physician for an estimate of his chances, and in such cases, after carefully explaining why our knowledge is fallible and subject to change, I usually estimate that for a patient who will absolutely follow the advice of an expert, the prospects are well over 90 per cent good. ”

“ The very notion of Diagnosis in our modern sense of the word depends upon Morbid Anatomy. The older physicians seldom attempted to determine the seat of an ailment. [8] Disease was looked upon not as a condition depending upon disordered physiological functions, but as something external, attacking a previously healthy person, disturbing, and, if not expelled by art, finally destroying him; while any structural changes which were found after death were regarded rather as the effects than the causes of the symptoms during life. ”

“ In laying before the reader the pathology of the solids, as far as it is yet ascertained, it is my most anxious wish to enable him constantly to make for himself, as he proceeds, the association between the morbid appearances that are found after death, and the symptoms that were present during life. For this reason every case that is adduced to illustrate any morbid change is preceded by a brief account of the symptoms that were observed, day by day, at the bed-side of the patient. ”

“ Disease is now so well understood—every step in its march laid down and foreseen—the approach of danger accurately estimated—the liability of the patient, according to his powers of resisting it, to succumb earlier or to hold out longer—all is theoretically so clear that a wholesome suspicion of error in the verdict of the attendants seldom suggests itself. ”

“ There is, however, one precaution which must be observed, and without which the whole of the system just described is as uncertain and conditional as the rest of science. Before we can argue from what is to what has been, we must first know for certain what is. Before we can conclude that a patient has been healed by faith or cured miraculously of an incurable complaint, we must first have medical evidence to show that he had the disease. ”

“ It is to avoid this that practical medicine has devoted so much of its attention to the discovery of a certain—and early—sign of death. By this we understand the discovery of a certain prognostic sign of general death. We want a prognostic sign enabling us to assert that the life of the brain is now extinguished and will never be reanimated. ”

“ As an unprepared death is an occasion of the most poignant regret to the friends of the deceased and to the attending clergyman, it is with the idea of furnishing some data by which the occurrence of death without due anticipation may be rendered more infrequent, that the following medical points on the possibilities of a fatal termination in certain diseases have been brought together. Unfortunately, even with all our progress in modern medicine, they must be far from adequate for all cases. ”

“ They run a course of so many days or weeks, and then, unless death or some complication supervenes, there is a steady progressive recovery. The temperature falls, the mind clears, the strength returns, the patient is as he was before, with one important exception, that he is now, to a greater or less extent, and for a longer or shorter time, resistant or immune against the particular malady from which he has suffered. ”

“ With regard to the prognostics made by those who practice gymnastics, he recommends them not to be made in a charlatan manner, but with suitable caution, and directs minute attention to be paid to the circumstances of the patient, which one has superior advantages in observing under this system. He says, for example, that a physician who feels a patient’s belly and pulse, pays attention to the breathing at the nostrils, and listens to the speech, and sound of the respiration, will be less likely to be deceived in forming a prognostic on his patients than he who neglects these things. ”

“ Pain is so often prolonged and accentuated by dwelling in its memory, living in a self-pity of the time when it shall come again! The patient who comes to his test with the bodily and mental repose already acquired, cuts off each day from the last, each hour from the last, one might almost say each breath from the last, so strong is his confidence in the renewal of forces possible to those who give themselves quite trustfully into Nature's hands. ”

“ The doctor sat down opposite me and said: "You weep, Mademoiselle, and perhaps the word 'saved,' seems to you only as a bitter mockery, when coupled with the name of a patient whose life was despaired of before this last illness seized him. But it is just on this illness that I found my hope of saving him. Nature has risked a bold experiment and has succeeded. ”

“ When a patient dies, the medical practitioner who attended such patient during his illness is to cause a statement to be entered in the case-book, setting forth the time and cause of death, and the duration of the disease of which the patient died, and a copy of such statement, within two days, must be transmitted to the coroner. ”

“ Hence it is that the diagnosis of injury and disease in the extremes oflife is beset by especial difficulties, since the entire body is as silent as are the brain, the pericardium, the mediastinum, and other symptomless areas. For the same reason, when a patient who is seriously ill with a painful disease turns upon the physician a glowing eye and an eager face, and remarks how comfortable he feels, then the end is near. ”

“ While watching the progress of my malady, seeing day by day the advancing steps of the disease that never sleeps, I recognise in myself a strange adaptation in my mind and feelings to the more developed condition of my illness. ”

“ When the physician discovers certain signs or symptoms which constitute the diagnosis of any disease, he regards those signs as the effects of a disease already in existence, and treats the patient accordingly. ”