Prognostication

“ And since for the most part the resisting faculty is not coupled with the prognostic, because so perfect a disposition is rare, and since the force of nature takes its course without hindrance when the primary natures are concerned, an opinion has been produced that absolutely all future events are inevitable and unescapable. But, I think, just as with prognostication, even if it be not entirely infallible, at least its possibilities have appeared worthy of the highest regard, so too in the case of defensive practice, even though it does not furnish a remedy for everything. ”

“ As often rises ere they rise."
Prognostication can hardly be part of the evidence for survival. The two things are not essential to each other; they hardly appear to be connected. But one knows too little about the whole thing to be sure even of this, and I decline to take the responsibility for suppressing any of the facts. I know that Mr. Myers used to express an opinion that certain kinds of prevision would constitute clear and satisfactory evidence of something supernormal, and so attract attention ”

“ A physician should not be forward to make gloomy prognostications, because they savor of empiricism, by magnifying the importance of his services in the treatment or cure of the disease. But he should not fail, on proper occasions, to give to the friends of the patient timely notice of danger, when it really occurs ”

“ For the medicine-man it then becomes more important to secure the fulfilment of his verdict than to risk the chance of recovery falsifying his prognostications. The probability is that the patient would die, if for no other reason than that the medicine-man foretold his death, but that gentleman will take no risks. ”

“ Part I It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselves to such a physician. ”

“ The elements of medical prognosis are essentially involved in diagnosis. Our ability to anticipate the mode of progress, duration, termination, and results of any case of illness depends upon our knowledge—1, of the nature of the malady, with its tendencies toward death, self-limitation, or indefinite continuance; 2, the soundness or imperfection of the patient's constitution, with or without special predispositions or the consequences of previous ailments ”

“ 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. ”

“ 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. ”

“ The prognosis of disease, like its causation, is a subject on which the social worker should know almost as much as the doctor. This is possible because medical knowledge on this subject is still so very limited. For [Pg 23] the purposes of one who has to combat the poverty, sorrow, idleness, and corroding fears which disease produces, knowledge of prognosis is a most useful tool. For example: if one is to make plans for the care of a group of children during their mother's illness, one must have some idea how long that illness is going to last. ”

“ 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. ”

“ 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.” ”

“ Moreover, if the diagnostics and prognostics be of the greatest moment in physic, and are only to be collected from long and accurate observation, then the records left us by the ancients, who were so assiduous in their observations, so clear and exact in their descriptions, must be allowed to contain a valuable treasure of medical knowledge.
We have seen, in the present age, many learned physicians, who, though they readily admit the improvements of the moderns, nevertheless apply themselves with great industry to the study of the ancients ”

“ 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. ”

“ The Prognostics of Hippocrates are not of one time or place, but extend through every age, and through the whole world; inasmuch as the prognostic signs have been proved to be true in Libya, in Delos, and in Scythia, and it should be well known that every year, and at every season of the year, bad symptoms bode ill, and good symptoms good. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ By calling attention to certain symptom-complexes, which are especially characteristic of certain mental disorders, he gave us the means by which we are able at the present time to predict with a fair degree of certainty what the future life of a given patient will be. We can now tell without great fear of contradiction which of our patients are going to spend the rest of their lives in institutions. ”

“ In the course of certain cases of protracted disease, such as consumption or cancer, the patient, if he possesses the necessary scientific qualifications, can calculate the probabilities of his life and determine within a few days at what time he will die. ”

“ 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. ”

“ 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. ”

“ No earthly skill could do anything for him. Diagnosing the character of the insidious disease which was then undermining a once powerful and active organisation, I felt constrained to add he would live six weeks. I held the envelope, with its contents, in my left hand, and wrote the impressions as they came with my right. I remember hesitating about sending that letter, but eventually sent it. The accuracy of my diagnosis, description of [66] the patient, and the fulfilment of the prophecy as to his death were substantiated in a Swansea paper, The Bat. ”

“ Every case that terminates fatally is examined after death, and an account of the morbid appearances is entered in a book kept for the purpose. In this manner, in the progress of years a mass of facts accumulates relating to the statistics, the types, the symptoms, the causes, the diagnosis, the pathology and the treatment of the disease, whether successful or unsuccessful, which both on account of the fullness and accuracy of the record and of the extent of the period it embraces, cannot but be of great value. ”

“ Cases may be pointed out in which something which could have no real effect but to make persons think of misfortune, was regarded not merely as a prognostic, but as something approaching to an actual cause of it. ”

“ 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. ”

“ An autopsy has revealed traces of the disease of which I died, and this after a hundred years! If they were as expert in diagnosing the living as they are in cutting up the dead, fewer of the mistakes of the doctors would have to be buried from sight and mind. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Even in those cases in which the physician feels it to be almost certain that the final issue will be a fatal one, it is not proper to give up wholly the idea of recovery, in his conversations with the patient or with his friends. This remark must not be understood to apply to those cases in which the evidence of approaching death is not to be mistaken, and so far as human wisdom can see it is absolutely certain that the patient will die. ”

“ It is impossible to tell in such cases where life ends, and where death begins. Hundreds of patients have recovered, who have been pronounced incurable, to the great disgrace of our profession. I know that the practice of predicting danger and death upon every occasion, is sometimes made use of by physicians, in order to enhance the credit of their prescriptions if their patients recover, and to secure a retreat from blame, if they should die. But this mode of acting is mean and illiberal. It is not necessary that we should decide with confidence at any time, upon the issue of a disease. ”