DIAGNOSIS AND PROGNOSIS. 31 
brain symptoms, are very generally of grave significance, and a fatal result 
may be anticipated in most cases if such symptoms persist even for a few hours. 
Notable emaciation is not so very important in acute diseases, but in all chronic 
affections the outlook is always very serious indeed. Emaciation alone, also 
when the cause cannat be determined, is a very discouraging symptom. When 
convulsions have lasted for half an hour, or recurred after an interval of free- 
dom from them produced by chloral, ether, or chloroform, they may be regarded 
as almost certain to prove fatal. A rapid, flickering, and feeble pulse is a very 
unfavorable sign. When the temperature of the body falls three or four degrees 
below the normal, and remains down, speedy death may be apprehended; a 
rise of more than five degrees above the normal is also of grave significance 
unless a fall soon occurs. Death approaches through one of the three vital 
organs, the heart, lungs, or brain ; the first to falter in its action governs the train 
of symptoms which follows. Among the signs of a dying state are coldness of 
the feet and legs, a sudden pinching of the expression, sinking and fixedness 
of the eyes, blueness of the lips and tongue, cold and clammy perspiration, 
dropping of the jaw, muscular twitchings, stupor, and a jerking inspiration, if 
not dependent upon diseases of the lungs. Death itself, as vital force departs, 
is not painful, even though intense suffering may have preceded it. 
