Prognosis. ' 29 



To give a sound prognosis the practitioner must have a thor- 

 ough knowledge of pathology, he must have acute powers of ob- 

 servation, and he must be quick to appreciate every point that 

 makes for or against the patient in the particular case. 



The causes of the trouble must be carefully considered. Are 

 they transient or permanent ? Are they removable or irremova- 

 ble? Are they external or internal? As a rule an internal 

 cause is the more redoubtable. Some lesions are necessarily 

 fatal, as a needle penetrating the heart or an attack of rabies or 

 milk sickness. Is the cause an enzootic one ? If so can the 

 patient be removed from the locality ? Is it a fatigue fever or 

 an infectious one ? Is it a simple inflammation or an infecting 

 one ? The latter are usually much more grave. In case of con- 

 tagious disease, can its propagation be prevented ? Is it of a 

 fatal or non- fatal type ? Is it situated in a tissue favorable to a 

 fatal extension (anthrax in lung), or in one unfavorable (anthrax 

 in the tip of the tail) ? Disease in a single vital organ like the 

 heart is necessarily much more grave than in one of a symmetri- 

 cal pair (kidneys, lungs), one of which can carry on the func- 

 tions. The regular progress of the disease and especially an 

 uninterrupted improvement, following on a critical perspiration 

 or urination, is a good prognostic sign, whereas unevenness of 

 temperature, pulse and respiration, with temporary aggravations 

 of the general symptoms, should demand a less hopeful progno- 

 sis. The persistence of the malady is also an unfavorable indi- 

 cation. A relapse after partial recovery is a serious indication 

 unless due to some obvious and easily removable cause, and un- 

 less the former convalescent condition is speedily restored on its 

 removal. A complication is a serious indication whether it con- 

 sists in an embolism or new centre of the same disease, or the 

 supervention of a second disease upon the first. The system has 

 just so much more to contend with and the very supervention of 

 the second focus or malady argues a special susceptibility, de- 

 bility, or lessened power of resistance. 



The prompt success or entire insuccess of treatment proves 

 valuable. 



The preservation of appetite, the slow, uniform descent of the 

 temperature, and the improvement of pulse and breathing are 

 among the most valuable indications. 



