DIAGNOSIS. — PROGNOSIS. 19 



Symptoms, however accurately noted, are only of use in so 

 far as they lead us to know and understand the morbid state 

 of the parts under review. In forming a diagnosis we have to 

 determine, (1) Whether the disease is acute or chronic — rarely 

 have we in our patients to hesitate as to the reality of illness ; 

 (2) Whether it involves the entire system or only some particular 

 organ ; (3) If a systemic disease, of what class and whether it is 

 free from complication ; if some particular organ or set of organs 

 are only invaded, to what extent ? also, is the disturbance one 

 of function merely, or is there evidence of textural change ? 



The certainty and rapidity with which a diagnosis may be 

 made varies much in some forms of disease ; from the pro- 

 minence of certain clinical phenomena or pathognomic 

 symptoms there may be no difficulty — the abnormal state of 

 parts may be clearly presented for our recognition. In others, 

 even after comparing in the mind the relationships which 

 exist amongst various generic affections in the matter of their 

 symptomatology, and the exclusion from our reckoning — 

 because not existing — of others in some degree similar, it may 

 often be a difficult matter to form a correct diagnosis. 



In many instances, particularly those Avhich are rather 

 obscure, much may be obtained from patiently waiting and 

 Avatching the disease as it develops itself. 



Prognosis. — In attempting to give a ' prognosis,' or forecast, 

 of the probable termination of any case, having determined 

 from a consideration of its causation and a careful analysis of 

 s}Tiiptoms its true character, there is always required a good grasp 

 of material collected by observation, with a due appreciation of 

 surrounding and indwelling influences. We have first to settle 

 Avhat points are to be determined, and how many of these 

 apply to the case under consideration. Usually there are 

 submitted for solution such questions as — (1) Whether the 

 probabilities of life or death are greater ? (2) If these are in 

 favour of recovery,is it likely to be prolonged or readily reached? 

 may it be expected to be complete, with a restoration to full 

 normal functional activity ; or only of a partial character, entail- 

 ing Aveakened organs or tissues less capable of fulfilling natural 

 activities, or more susceptible of contracting the same or some 

 other disease ? 



To determine these and many other points it is ever found 



2—2 



