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You have only to read Cullen's description of inflammation of the lungs or of the bowels, and compare it with such as you may find in Laennec or Watson, to see the immense gain which diagnosis and prognosis have derived from general anatomy.
No condition can be properly treated, no operation should be performed, and no prognosis is of value without a proper consideration of the sufficiency of the circulation, and the condition of the circulation cannot be properly estimated without an accurate estimate of the systolic and diastolic blood pressure.
Extrasystoles are due to abnormal irritability of the heart muscle, and may or may not be noted by the patient. If they are noted, and he complains of the condition, the prognosis is better than though he does not note them. It has long been known that asthma, emphysema, whooping cough, and prolonged bronchitis with hard coughing will dilate the heart.
We know, however, that these men had by observation detected nearly every feature of importance in fractures of the skull, their indications and contra-indications for operation and their prognosis. They had anticipated nearly everything of importance that has come to be insisted on even in our own time in the handling of these difficult cases.
The prognosis depends on the character of the inflammation and the promptness and thoroughness of the treatment. Acute laminitis may respond to prompt, careful treatment in from ten to fourteen days. Subacute laminitis responds readily to treatment. The prognosis is least favorable in the chronic form. The preventive treatment is very important.
The general treatment for diabetes must, of course, be employed whether amputation is performed or not. The prognosis even after amputation is unfavourable. In many cases the patient dies with symptoms of diabetic coma within a few days of the operation; or, if he survives this, he may eventually succumb to diabetes. In others there is sloughing of the flaps and death results from toxæmia.
If large portions of an organ, the lung, a kidney, parts of the liver, or the brain itself, may be lost by accident, and the patient still live, the physician is taught the lesson of nil desperandum, and that if possible to arrest disease of these organs before their total destruction, the prognosis and treatment thereby acquire new and more hopeful phases.
If small hemorrhages occur in the arterioles of the extremities, of course the prognosis is not serious. Sometimes some of the smaller vessels of the brain may become obstructed and cerebral degeneration occur.
It appeared that he had suffered some convulsion, some delirium, and that he had fallen; that the fall had accelerated his end, according to the prognosis of Frere Sylvain. We raised the vicomte; he was cold and dead. He held a lock of fair hair in his right hand, and that hand was tightly pressed upon his heart."
As stated above, if pericarditis develops during the progress of chronic disease, such as interstitial nephritis, or during sepsis, or from abscesses or growths in the region of the pericardium, the prognosis is bad. In acute pericarditis, absolute mental as well as physical rest is essential.
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