Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1902
Catalogue details

Licence: In copyright

Credit: Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    nostic element which you might well consider the most important of all—the man’s record or previous history. Next we take the pathological facts—the extent, situation, distribution and stage of the pulmonary lesion, the state of the rest of the pulmonary tissues, and the condition of the other viscera, particularly the heart, arteries, and kidneys. Each individual fact under this head is of some service to you; each has its prognostic value which you may estimate, and which constitutes a “ point” in your judging or judg- ment of the case, for recovery or against it. Lastly, there is the great order of purely clinical facts—such as are before you at the bedside —purely clinical phenomena and clinical course—the temperature, the rate and characters of the breathing, the pulse, the nervous symptoms, the presence of complications, the sputa; and the day of the illness, the features of its invasion, development, and progress, and the proximity of crisis. Thus, it appears that in acute pneumonia, which I have used, as I proposed, solely as a useful because readily appreciable illustra- tion, the many facts that are turned to account in framing a prog- nosis may be arranged in different orders, and arranged thus with great advantage. With a little trouble and thought and practice, we can fairly estimate the chances of recovery in every acute disease about which we have substantial knowledge. If this method is useful in acute disease, how essential it must be in chronic disease, where prognosis relates to years, and involves the review and correct appraisement of a vast number of facts and considerations, complexly related to each other, particularly in chronic valvular disease, the course of which in great measure de- pends on the patient’s own management of himself. With this con- viction in our minds let us now turn to the proper subject of my address, and examine the different kinds of knowledge out of which we frame a prognosis of chronic valvular disease of the heart. The rough-and-ready or routine prognosis is familiar: the patient is disabled for laborious, exciting or harassing occupations; his life is insecure and uninsurable; death may occur suddenly at an unexpected moment. This broad statement is variously elabo- rated and paraphrased in equally indefinite terms. Now, such a prognosis was once all that could be offered to a patient or a patient’s friends—in the days when etiology and pathological anatomy and clinical investigation were not so full and exact as they are now. TIow very different it is at the present time I shall try to show you.