Chapter 21 - Domestic Management of the Sick Room
Choice of the Sick Room
Freezing Mixtures
Bed Sores
Diet in Disease and Convalescence
Fluid Aliments

21.5 Prognostics

Prognostics. In every disease the medical attendant is naturally called upon to deliver his opinion of the degree of danger which hangs over the patient: hence, it is unnecessary to enter into any minute details on the subject of prognostics. But, as in many diseases changes occur, in the absence of the practitioner, which ought instantly to be examined into, in order that the danger likely to accrue from them may be averted, it is important that the friends and ordinary attendants of the sick should be aware of their presence, so as to obtain the immediate assistance of the medical attendant. Were this information, also, more generally diffused, many unnecessary visits would be saved to the physician, and much unfounded suspicion of danger prevented from distressing and torturing the minds of the friends of the sick. In Fevers delirium alone should excite no alarm, unless it be very high, or of the low, muttering, incoherent kind. In jaundice, and in diseases of the chest, it is alarming; and in the latter stages of pulmonary consumption, its presence always indicates the approach of death. Great confusion of thought, loss of recollection of the most recent occurrence, a restless, wandering eye, and a correspondent vacancy or confusion of countenance, are always to be dreaded in fevers and in diseases of the brain. An expression of great anxiety is equally alarming in all acute diseases; and a presentiment of death is still more to be dreaded. Hoarseness, with constant spitting, occurring at an early period in small pox, is very unfavorable. Squinting in affections Of the head ought to be particularly noticed and mentioned to the attending practitioner; and the same remark applies to a greatly contracted, or a dilated, or an immovable condition of the pupil of the eye; or the turning up of the pupils under the upper eyelids. Deafness is not an unfavorable occurrence in continued fever; but a sudden attack of headache in pulmonary diseases ought instantly to be mentioned to the physician. The Sudden Disappearance of Pain in inflammatory affections of the bowels is always to be dreaded; but it does not in every instance portend the existence of mortification. Cough, depending on inflammation of the bronchial membrane, suddenly supervening on a suppressed eruption, is always to be dreaded. in Croup, when the breathing is audible, or when there is a crowing sound in inspiration, or a cooing or croaking respiration, danger is present. In Whooping Cough, when the paroxysms suddenly increase in violence, and the face becomes livid, and the thumbs are drawn across into the palms of the hands, the appearance of convulsions may be anticipated: hence immediate notice of these symptoms should be communicated to the medical attendant. Rigors invariably excite alarm; but they are only dangerous in chronic internal diseases, in which they often indicate the formation of pus, or the existence of suppuration. Pallidness of the countenance, with a slight degree of lividity, axe symptoms of hazard in inflammation of the lungs. The Position of the Patient as he lies in bed, especially in fevers, is of much importance. Constantly lying on his back, with a tendency to sink to the bottom of the bed; a propensity to keep the arms and the feet out of bed, and to uncover the trunk; or to pick the bed clothes; tremors; twitching of the tendons; grinding of the teeth, and sleeping with the eyelids half open, and the white of the eyes only seen; are all justly regarded as symptoms of great danger. Fainting (Syncope) is to be considered alarming in diseases of the heart, or during profuse bleeding from the nose, or from any other part: deep sighing, also, under such circumstances, is most unfavorable, and often indicates rapid dissolution. Hiccup, in the advanced stages of either acute or chronic diseases, is invariably alarming. Difficulty of Swallowing, also, in the advanced stages of fever, palsy, and affections of the head, always indicates extreme danger; vomiting, on the contrary, is not unfavorable, unless it be very severe and protracted; but, if the ejected matters be putrid, or feculent, then the vomiting is always to be dreaded. Coma, or an irresistible propensity to sleep, following the sudden suppression of gout, or the cessation of periodical bleeding in piles, or the healing of old sores, is always alarming, and requires prompt medical assistance. Convulsions without fever or any affection of the head seldom prove dangerous; but they are never free from danger when they are accompanied with stupor or coma. They are also dangerous when inflammatory fever is present. They are less dangerous in women than in men, in the young than in advanced age. In infancy, convulsions are more to be dreaded in the robust than in the delicate and irritable child. Diarrhea is, under every circumstance, an unfavorable event, when it occurs either in fevers, or in the termination of chronic diseases; and the passing of involuntary stools, when scarcely any diarrhea exists, is equally to be dreaded. Retention of the Urine, as well as itŐs involuntary discharge, is always an unfavorable symptom. Purple Spots appearing on the skin, livid lips and cheeks, oozing of blood, sudden flushing followed by pallor, are unfavorable symptoms; and the appearance of edematous swellings of the legs and Skin in the last stage of organic diseases always indicate approaching death. When purple spots, also, appear in small pox, with flattening of the pustules on the trunk of the body, and a white, pasty aspect of the eruption in the face; and if, at the same time, the extremities become cold, any hope of recovery can scarcely be entertained. Great and continued or progressing emaciation in chronic diseases, and what is termed the facies Hippocratica, are to be dreaded. Excoriations on the parts on which the body rests, for example, the haunches, or the lower part of the back, especially if these become livid and sloughy, always indicate extreme danger. Great Difficulty of Breathing, even to a feeling of suffocation, is not necessarily hazardous in asthma; for although few diseases are so little under control by the interference of the physician, yet asthma seldom proves fatal, unless it tends to the production of other diseases. In Consumption, partial sweating, as of the head, the chest, or the limbs, is always an unfavorable symptom. When pregnancy occurs in a woman laboring under consumption, the disease is arrested until after delivery, as if Providence threw a shield over the mother for the safety of the offspring. The Sudden Disappearance of Swelling of the Legs, in chronic organic diseases, is indicative of approaching death. When a child, instead of rallying after any acute disease, becomes emaciated, and the belly is large and tympanitic, there is always much danger.

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