The growth of medicine from the earliest times to about 1800

by Albert H. Buck

19. In acute diseases the prognosis as regards either death or recovery, is very uncertain.

44. Corpulent persons are more likely than those who are slender to die a quick death.

V.—7. When epileptic attacks occur before the age of puberty, a change for the better may be looked for; but if the disease makes its first appearance when the individual has already reached his twenty-fifth year, he may be expected to carry the affliction with him to the time of his death.

9. Consumption most commonly attacks persons who are between the ages of eighteen and thirty-five.

14. When a consumptive person has attacks of diarrhoea, a fatal issue may be anticipated.

VII.—1. If in the course of an acute illness the extremities grow cold, it is an unfavorable sign.

14. If, after a blow upon the head, stupefaction or delirium manifests itself, the outlook is bad.

[The total number of the aphorisms is 422.]

The Book of Prognoses.—1. I believe that it is best for a physician to acquire a certain degree of practice in the power to predict how the disease is likely to terminate; for if, when he is in the presence of his patient, he is able to state, not only what is going to take place in the future course of the malady, but also certain other facts which relate to the past behavior of the attack, but which were omitted from the account given to him of the previous history of the case, he will impress the patient with the belief that he is thoroughly familiar with the disease from which the latter is suffering, and that consequently he is a physician in whose knowledge and skill he can place entire confidence. Then, besides, he will be the gainer in another respect: his knowledge of what is likely to be the subsequent course of any given disease will enable him to treat it in the most effective manner. The ability to restore all his patients to health would of course be a greater power than that of correctly predicting the future behavior of a malady in any particular case. This ability, however, is clearly unattainable. One patient dies by reason of the severity of the disease itself, even before the physician is called in; a second one, shortly after the latter’s visit; and a third lingers on for a day or two after the doctor’s arrival, dying before the latter’s art has had time to produce a beneficial effect in hindering the advance of the malady. The observation of these different events should enable the physician to become acquainted with the nature of the diseases observed, and—more particularly—to learn to what extent, in individual instances, they manifest a strength greater than the patient’s power of resistance. At the same time, he must not forget that in many cases divine interference plays a part in directing the course of the disease. And thus, if he pays heed to all these things, the physician will merit the confidence of his patients and will gain the reputation of being a clever and skilful practitioner.

IV.—It is better when the physician, upon the occasion of his first visit, finds the patient lying upon one side, with his hands, neck and thighs slightly flexed, and the entire body placed in a perfectly natural position, like that which a man assumes in bed when he is in a state of health. It is not so well when the physician finds the patient lying upon his back, with his hands, neck and thighs extended. But if the latter is found curled up and sliding down toward the foot of the bed, this is an unfavorable sign. Finally, if he is found with rather cold feet projecting from under the bedclothes, and with his arms outstretched and his neck and thighs exposed, his condition may be considered dangerous, for this attitude of the body betokens an agitated state of the mind. If the patient sleeps with his mouth constantly open, lying upon his back and with his thighs strongly flexed and widely separated, it may be assumed that death is near at hand. If he lies upon his belly when it is known that he was not in the habit of sleeping in this manner before he was taken ill, the inference is warranted either that he is delirious or that he is suffering from pain in the lower part of his abdomen. Finally, if the patient shows an inclination to maintain a sitting posture while the malady is still in an active stage, this feature must be looked upon as a grave symptom and especially so in inflammation of the lungs.