Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1902
Catalogue details

Licence: In copyright

Credit: Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    4/14 (page 2)
    a common complaint that treatment is neglected as a subject of medical education. If this be just, what are we to say of instruc- tion in prognosis! The student has mainly to learn it up from text- books on systematic medicine; but too often we find that in these prognosis is discussed in a manner which is not only useless practi- cally, but even gives an erroneous notion of what prognosis truly is. We are told, for example, with respect to a certain acute disease, that the majority of cases may be expected to recover; of another, that the mortality is twenty per cent. Now, you will observe that these two statements, valuable as they may appear to be for prog- nostic purposes, are not only of no value for estimating the prog- nosis in the individual case when it comes before you, but strictly are not statements of prognosis at all. Both of them are accounts of the mortality of the respective diseases; statements of facts. But prognosis, or forecasting or prophecy, is not a statement of facts. Practical prognosis—i.e., prognosis in individual cases—is an ex- pression of opinion that a man will die, or will live, or will be permanently disabled, or will live the average term of life, or may marry with safety and advantage, or will never be fit to enter the army, or will benefit by retiring at once from work. Of course, like every opinion that is worth stating or accepting, prognosis in prac- tical medicine is founded on facts; and what the student ought to be taught in theoretical medicine is which of the many facts he learns respecting each disease can be employed in estimating and framing a prognosis. Such parts of his knowledge as he can thus employ are called “ the elements of prognosis.” Experienced prac- titioners, like my present audience, have almost unconsciously sifted the facts respecting each of the more common diseases from this point of view so thoroughly for themselves, that they can tell with wonderful correctness what is going to happen. They say they can do so “ from experience,” by “ common sense,” by “ the look of the case,” they “ hardly know how.” ISTow this is empiricism in prog- nosis: valuable in the hands of the experienced practitioner, but useless to the student or young practitioner, because not available by him. Prognosis in pathology, like prognosis in meteorology or weather-forecasting, ought to be rational, that is, a practical appli- cation of scientifically determined facts. Of these there is now a vast number, and still a great and steady increase; and every por- tion of this knowledge has some bearing, direct or indirect, con- structive or destructive, on prognosis, just as it has on treatment.