In pneumonia the best signs are the lowering of a high temperature, reduction of the number of respirations to 20 or 25 in the minute, expectoration of sputa less and less tinged with red or brown, and gradual reduction of the region of dulness on percussion. Worst, in the same disease, are an axillary temperature over 106°, respirations 40 or more per minute, with delirium, and expectoration becoming more abundant, grayish, and purulent; also with continued dulness on percussion and abundant mucous râles on auscultation.
In croup the best sign is, after a hoarse, dry, barking cough and dyspnoea, a soft, liquid râle, heard in the larynx and trachea during respiration or coughing. Worst, in croup, is a steadily or paroxysmally increasing difficulty of breathing, with a dry hissing or whistling sound of respiration and cough succeeding the barking sounds of the earlier stage.
In phthisis pulmonalis among the best signs are the patient's increasing in weight, coughing and expectorating less, ceasing to have hectic and night sweats. These may give renewed hope, even before much change is discernible in the physical signs. Of bad omen are intense hectic fever, incessant cough with abundant nummular sputa, copious perspirations, diarrhoea, breathing growing shorter and shorter, and extreme emaciation and debility.
In all organic affections of the heart an extremely rapid and irregular pulse, with orthopnoea and increasing anasarca, and especially the Cheyne-Stokes respiration (described under DIAGNOSIS), must cause unfavorable expectations.
In obstruction of the bowels the best of all symptoms is, usually, of course, a copious fecal evacuation. Yet a few cases have occurred in which a very large evacuation, delayed by obstruction for a week or two, has been almost immediately followed by collapse and death. The worst signs in cases of obstruction are (besides long-unyielding constipation) stercoraceous vomiting, a small, rapid pulse, and increasing coldness and clamminess of the surface of the body.
In cholera infantum the best signs are cessation of vomiting and purging, the discharges growing more nearly natural, the face becoming less shrunken in aspect, sleep taking the place of coma vigil or waking apathy, and water or milk, when taken, remaining on the stomach. Worst, in the same disease, are incessant rejection of everything swallowed, watery passages from the bowels every half hour or hour, shrinking of the face and body to skin and bone, with an apathetic expression of the open or half-open eyes, the latter rolling often from side to side.
In epidemic cholera good signs are the arrest of vomiting and of rice-water discharges from the bowels, rapid movement of the blood in the veins after removal of momentary pressure, return of natural color and warmth to the skin, with filling up of the pulse at the wrist. Bad signs in cholera are shrinking of the cheeks and of the flesh upon the hands, deepening ashiness or blueness of the skin, coldness and clamminess to the touch, dyspnoea, loss of pulse, incessant vomiting and purging of rice-water stools, constant cramps of the limbs, and suppression of urine.
In acute cerebral meningitis good signs are lessened temperature of the head, quiet sleep without stertor, disappearance of delirium, more natural pulse, and attention to surrounding objects, without disquietude. Bad signs in the same disease are deep stupor, strabismus, convulsions, paralysis, involuntary defecation and urination.
In typhus fever good signs are the pulse becoming slower and fuller, the skin less hot, more soft and moist, the tongue moist and clean, the face losing its dusky flush, and consciousness returning instead of muttering delirium.40 Bad, in the same fever, are deepening of the flush of the countenance, profound stupor, rapid and feeble pulse, lying on the back and sinking down toward the foot of the bed, with suppression of urine.
40 Incidentally, it may be mentioned that the return of the pulse to its normal rate is often considerably delayed in convalescence from typhus and typhoid fevers and other protracted diseases. If, then, the temperature is not above 99° F., and is stable from morning to night, the tongue is clean and moist, and appetite begins to appear, we need not be alarmed, although the pulse continues as high as 90 or 100 per minute, in a case attended by positive debility.