In typhoid fever many of the good and bad signs are the same as in typhus, belonging to closely similar general conditions. But in typhoid fever we observe also as favorable signs the lessening of tympanites, more nearly natural fecal stools, and the absence of tenderness in any part of the abdomen. As unfavorable, increase of tympanites and diarrhoea, sometimes large hemorrhages from the bowels; worst of all, at a late stage, sudden increase of abdominal distension, with dulness on percussion, coldness of the skin, great rapidity and feebleness of the pulse following perforation of the bowel, resulting usually in fatal peritonitis.
In scarlet fever, measles, and small-pox it is a favorable sign for the eruption to come out well at the usual time; its sudden recession threatens malignancy. In small-pox a confluent eruption marks a dangerous case, and so does the occurrence of distinct pustules in the throat. Early in scarlet fever stupor is very threatening, though not necessarily mortal. Late in the same disease bloody urine, or, worse yet, suppression of urine, may well cause alarm.
In all children's diseases the early occurrence of convulsions shows a severe but not always a dangerous attack. The late occurrence of convulsions is commonly much more serious in its significance.41 Convulsions are always of vastly less importance, prognostically, in children than in adolescents or adults. Yet they are always serious signs. While recovered from in the large majority of cases, they may at any time be fatal.
41 Yet I saw a case of acute cerebro-meningitis, in a girl ten years of age, in which a violent convulsion occurred on about the sixth day of the disease, and was followed by convalescence.
These enumerations, selected as examples merely, might be much farther extended but that the special prognosis of each disease will be fully set forth in the several articles upon them in the body of this work. Those now given may suffice for the illustration of the method and general principles by which the physician must be guided in his anticipation of the progress and result of cases of disease. The caution may be repeated, to observe great care in forming a conclusion in regard to prognosis in every instance, and still more in expressing it, unless in the presence of very clear and positive evidence.
HYGIENE.
BY JOHN S. BILLINGS, M.D.