The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee.

  • Elliotson, John, 1791-1868.
Date:
1844
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Licence: Public Domain Mark

Credit: The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    » the ease. This is, perhaps, an exercise of patience; but it is a highly gratifying exercise, especially when it is found that a correct diagnosis has been made. Prognosis of Diseases.—The judgment formed as to what will happen in a case, is called prognosis.* It is quite essential to the formation of a correct progno- sis, that an accurate diagnosis should have been previously made; for if the nature of the affection be not known, it is difficult to pronounce an opinion as to the pro- bable termination. For the sake of making a prognosis, all the symptoms must be observed, and the history of the case learned,—exactly as in making a diagnosis; but there is something more than that to be done. The direct tendency of the dis- ease ought to be known;—the course which the disease is always inclined to run; and the course which it is likely to run in the particular individual, according to age,—sex,—previous habits,—and all those circumstances which I have previously mentioned, as to individual peculiarilies;b and in proportion as it is in our power to put into practice requisite curative means. There are some cases in which, if we were allowed to practise our art freely, we should make a favourable prognosis; but in which, our hands being tied,—as they are when others, ill informed or inac- tive, are called in over us,—we must give an unfavourable prognosis;—simply be- cause the patient must be allowed to die. In making a prognosis, there is frequently less skill required than in establishing a diagnosis; for some persons, with a sort of tact, will tell whether an individual is in danger or not, without knowing what is the matter with him. Many persons who have no knowledge of medicine, or at least very little, have such strong perceptions, that—from the aspect of an indi- vidual, and from general observations of their own—they are enabled to give a very correct prognosis, either favourable or unfavourable. This I know to be the case. There are a great many intelligent officers, who—from seeing their men fall around them in batde, and sick in hospitals—have become, in one sense of the term, good doctors; and though they are not able to cure the disease, or tell what is the matter, they will be able to give a shrewd and correct guess as to how matters will turn out. But although some people, by nature, are well qualified for this, while others are not, yet the medical man must be taken as he is; and whether he does or does not possess sufficient natural sagacity to make an accurate prognosis, it is his duty to make as careful a diagnosis as he can;—in order that he may make as good a prognosis as possible. If his intellect be not of an acute description, yet, by know- ing the case, and by the aid of science and minute observation, he will be able to form as good an opinion, as the man who, by nature, is qualified for these thino-s; and if with science and observation be combined native sagacity, then I need not say, that his prognosis will be much superior to that of that of the individual who trusts alone to his natural powers. Such, therefore, is what is meant by diagnosis, and prognosis; and I cannot too strongly recommend the most careful attention in establishing the former. Whether the patient can be cured, or not, it should be a solemn rule to investigate the case to the utmost. It is only by this plan we can profit ourselves, or that those who come after us can profit. If we be not careful, we cannot advance science; and the next generation will be none the better for us. Diathesis.—There is a term which 1 have not yet explained, or even mentioned; —namely, the word diathesis.0 When the body is particularly predisposed to any kind of affection, it is said by some to have that particular diathesis, or a dispo- sition to it. The term, however, is generally limited to two states;—an inflam- matory state; and a state of weakness, or debility, if not of putrescency. One is called the philogistic, or sthenic (which means strong); and the other the asthenic, or weak. When, for instance, a person labouring under any par- ticular complaint, is in a high state of excitement, with a fidl and strong pulse, and increased heat of body, he is said to have the sthenic'1 or phlogistic6 diathesis:—in * From wfo, before; and yima-Ku, to know. A From oQirot;, strength. >> See Pages 48 and 49. • From <puyi£i», to burn. • From hardnfM, to dispose.