Prognosis
Categories: UncategorizedSources: Disturbances Of The Heart
Janeway [Footnote: Janeway, T. C.: A Clinical Study of Hypertensive
Cardiovascular Disease, Arch. Int. Med., December, 1913, p. 755.]
presented statistics of 458 patients with high blood pressure, 67
percent of whom were men. Of these 458 patients 212 had died, and he
found that the women with high blood pressure lived longer than men
with high blood pressure. They did not seem as likely to have
apoplexy or cardiac fai
occur between the ages of 40 and 70.
While he believes that a systolic pressure of over 160 mm. is
pathologic, he does not find that any definite prognostic
conclusions can be drawn from the height of the pressure. Of course
the most important concomitant symptoms of high pressure are
cardiac, renal, and cerebral, and the typical headache, as he terms
it, is a symptom of serious import. In considering headache in
persons over 40, we must eliminate the eye headaches produced by the
need of presbyopic glasses or by the need of stronger lenses, as
this need is a frequent cause of headache. Dizziness and vertigo may
occur without headache, and drowsiness, though not so frequent a
symptom as insomnia, often occurs.
Janeway finds that all kinds of apoplectic attacks may occur from
simple transient aphasia to complete hemiplegia, and thirteen of his
patients who had died and thirteen of those living at the time of
this report showed failure of eyesight as an initial symptom of
arterial disease.
Janeway deplores the too frequent diagnosis of neurasthenia in these
patients. This diagnosis probably accounts for the frequency with
which neurasthenics have been said to have high blood pressure.
Patients with high blood pressure may show all kinds of symptoms
simulating neurasthenia, but hypertension is a much better diagnosis
than neurasthenia for such patients, and will lead to more rational
treatment.
Ninety-seven of these patients had hemorrhages somewhere, most
frequently epistaxes, sometimes hemoptysis. Janeway did not find
that purpuric spots on the skin occurred early in the disease in any
of his patients.
Gastro-intestinal disturbances were not much in evidence unless the
kidneys were insufficient. Intermittent claudication in the legs
occasionally occurred. While angina pectoris and edema of the lungs
were not infrequent causes of death in men, it was a rare cause of
death in women. Dyspnea is a frequent symptom, and one for which
many patients seek medical advice.
A constant systolic blood pressure of over 200 shows a probability
that the patient will ultimately die either of uremia or of
apoplexy. Janeway found that those patients who are to die from
cardiac weakness show cardiac symptoms early in their disease. He
found that rapid continuous loss of weight pointed to an early fatal
termination.
Of the 212 patients who had died, seventy-one had shown cardiac
insufficiency at the time of the first examination; twenty-one
showed albumin or casts at that time. Of course it should be
repeatedly emphasized that chronic interstitial nephritis may be in
evidence with either albumin or casts alone, or without either being
present.
Janeway sums up his conclusions by stating that "from the time of
the development of symptoms indicative of cardiovascular or renal
disease, four years will witness the death of half the men and five
years of half the women. By the tenth year half the remainder will
have died, leaving one fourth both of the men and the women who have
lived beyond ten years." The causes of death he would place in the
following order: gradual cardiac failure; uremia; apoplexy; some
complicating acute infection; angina pectoris; accidental causes;
acute edema of the lungs and cachexia. An early occurrence of
myocardial weakness shows a 50 percent probability that death will
be caused by cardiac insufficiency. Heart pains comprise another
important indicator of future cardiac death, perhaps not an angina.
Nocturnal polyuria would indicate a uremic death in about 50 percent
of the patients, and typical headache or cerebral symptoms show the
probability of uremic death in more than 50 percent, and death from
apoplexy in a large number of the other 50 percent As just stated,
rapid loss of weight is a bad symptom.
Janeway [Footnote: Janeway, T. C.: A Study of the Causes of Death in
One Hundred Patients with High Blood Pressure, THE JOURNAL A. M. A.,
Dec. 14, 1912, p. 2106.] has previously reported seven patients with
hypertension who had diabetes. Diabetes generally, on the other
hand, causes a low blood pressure. Patients with this trouble and
with hypertension, and without nephritis, probably have an increased
secretion from the suprarenals.
We may sum up the prognosis in hypertension as follows: Hypertension
alone is not of unfavorable omen; if it is not readily reduced by
ordinary means, it is more serious. If associated with kidney, heart
or liver defect, it is most serious. If there are such serious
conditions as edema, ascites, lung congestion, cyanosis and great
dyspnea, the prognosis is dire.
Obesity being a cause of high blood pressure, it should be treated
more or less energetically, even if the individual does not continue
to add weight.
Stone [Footnote: Stone, W. J.: The Differentiation of Cerebral and
Cardiac Types of Hyperarterial Tension in Vascular Disease, Arch.
Int. Med., November, 1915, p. 775.] believes that the higher the
diastolic pressure the greater danger there is of cerebral death,
while a patient with a very high systolic, but a diastolic pressure
of 100 or lower, is in more danger of cardiac death. He urges a
greater consideration of the pressure pulse in determining the load
of the heart and the great danger from a sustained diastolic
pressure of over 105 as sooner or later bound to cause myocardial
symptoms. This load of the heart is also shown by an increased pulse
rate and increased respiratory efforts. In cardiac failure, as the
systolic pressure falls the diastolic is likely to be increased, and
the pressure pulse thus diminishing, allows insufficient blood to go
to the medullary centers, and death soon occurs. Therefore, in acute
illnesses a sustained pressure pulse gives a better prognosis than a
diminishing pressure pulse. The strenuous measures that should he
used to lower a high diastolic pressure are contraindicated when the
diastolic pressure is already low, even if the systolic pressure 1s
high. If a high systolic pressure begins to fall more or less
rapidly the heart shows fatigue, and should be stimulated by
digitalis or strophanthin.
Rowan [Footnote: Rowan, J. J.: The Practical Application of Blood
Pressure Findings, THE JOURNAL A. M. A., March 18, 1916, p. 873.]
finds that a diastolic reading of 100 mm. or more usually means that
there is a narrowing of the lumen of the vessels, owing to
stimulation of the vasoconstrictors, although it may mean the
existence of a true arterial fibrosis. While a real atheroma
generally causes a reduction in diastolic blood pressure, or at
least but slight increase, he has found in syphilitic cases with
arteriosclerosis a high diastolic pressure. If the blood pressure
cannot be reduced by ordinary measures, arteriosclerosis is probably
present. Several blood pressure examinations must be made, while the
patient is being treated, to establish the diagnosis.
Rowan finds the reading of the pulse pressure to be of great
importance, as this will indicate, sometimes before any other
symptom is present, that the patient is either improving or doing
badly, and it also aids in indicating the proper medicinal
treatment.
In arteriosclerosis the systolic pressure may be high while the
diastolic is low; hence there is a large pressure pulse. If the
heart becomes weak the systolic pressure will drop, and any
improvement caused, especially in aortic regurgitation, is by an
increase of the systolic pressure.
Rowan finds, as has long been recognized, that a conclusion as to
whether or not cerebral hemorrhage will occur cannot be made from
the condition of the radial arteries, as patients with soft radials
may suffer from cerebral hemorrhage, while those "with hard,
sclerosed, pipestem-like arteries may live to a great age and die of
anything rather than apoplexy."
Swan, [Footnote: Swan: Interstate Med. Jour., March, 1915, p. 186.]
has studied the blood pressure in fifty cases of disturbed thyroid,
and finds that functional myocardial tests show that the myocardium
is nearly always disturbed in these patients.
Before taking up the subject of treatment of high blood pressure, it
may be suggested that a high diastolic pressure with a falling
systolic pressure may require vasodilators on the one hand or
cardiac tonics on the other, and sometimes the decision can be made
only by proper tests. In other words, if the diastolic pressure is
lowered the heart will be relieved. On the other hand, if the
diastolic is being raised by an increased venous pressure from a
failing heart, digitalis, strychnin and caffein may be of benefit in
lowering the diastolic as well as raising the systolic. However, if
there is a high systolic and a low diastolic pressure, vasodilators
are often contraindicated.
More
-
Period Of Eruption Or Appearing Of The Rash
Commonly, on the second day, towards evening, sometimes on the third, and only in very bad cases later, the rash begins to make its appearance, under an increase of the above symptoms, especially of the fever and delirium, and continues to come out ... Period Of Incubation Or Hatching
The time which passes between the reception of the contagious poison into the system and the appearance of the rash, is called the period of incubation; incubation or incubus meaning, properly, the sitting of birds on their nests, and figuratively, ... Perversions In The Guidance Of The Body
SO evident are the various, the numberless perversions of our powers in the misuse of the machine, that it seems almost unnecessary to write of them. And yet, from another point of view, it is very necessary; for superabundant as they are, t... Philosophy Of Disease And Cure
In every part of the animal economy, polar derangements in the electro-vital principle are liable to occur. These derangements are always the real foundation of disease. They may be occasioned by a thousand agencies, which act as the procuring cause... Phylacteries
They ware in their foreheads scrowles of parchment, wherein were written the tenne commaundements given by God to Moses, which they called philaterias. JOHN MARBECK, Book of Notes and Common-Places: 1581. There we... Physical Care
REST, fresh air, exercise, and nourishment, enough of each in proportion to the work done, are the material essentials to a healthy physique. Indeed, so simple is the whole process of physical care, it would seem absurd to write about it at all. The... Physical Signs In Esophageal Foreign Body
There are no constant physical signs associated with uncomplicated impaction of a foreign body in the esophagus. Should perforation of the cervical esophagus occur, subcutaneous emphysema, and perhaps cellulitis, may be found; while a perforation of... Physical Signs Of Bronchial Foreign Body
In most cases there will be limitation of expansion on the invaded side, even though the foreign body is of such a shape as to cause no bronchial obstruction. It has been noted frequently in conjunction with the presence of such objects as a common ... Physical Signs Of Tracheal Foreign Body
If fixed in the trachea the only objective sign of foreign body may be a wheezing respiration, the site of which may be localized with the stethoscope, by the intensity of the sound. Movable foreign bodies may produce a palpatory thrill, and the rum... Physics Of Aortic Lesions
Next in frequency to mitral insufficiency is aortic insufficiency, which occurs most frequently in men. The cavity of the heart that is most affected by this lesion is the left ventricle, which receives blood both from the left auricle, and regurgit... Physics Of Mitral Stenosis
Mitral stenosis, though less common than mitral regurgitation, is a frequent form of disease of the valves, especially in women. Often this condition is associated with regurgitation; but in a simple mitral stenosis the greatest hypertrophy is of ne... Piles - Hemorrhoids
One important matter in all cases of habitual piles, is, to keep the bowels regular. Much can be done for this purpose by diet and regimen. On rising from bed in the morning drink freely, from a gill to half a pint of cold water, at least half an ho... Plain Every-day Common Sense
PLAIN common sense! When we come to sift everything down which will enable us to live wholesome, steady, every-day, interesting lives, plain common sense seems to be the first and the simplest need. In the working out of any problem, whether... Plate V Laryngeal And Tracheal Stenoses:
1, Indirect view, sitting position; postdiphtheric cicatricial stenosis permanently cured by endoscopic evisceration. (See Fig. 5.) 2, Indirect view, sitting position; posttyphoid cicatricial stenosis. Mucosa was very cyanotic because cannula was re... Pleurisy
This is inflammation of the Pleura of one or both lungs, generally confined to one side. It is known by sharp pain in the side of the chest, increased by taking a long breath, or coughing, or by pressing between the ribs. The cough is dry and painfu... Pleuroscopes
As mentioned above the anterior commissure laryngoscope and the esophageal specula make very efficient pleuroscopes; but three different forms of pleuroscopes have been devised by the author for pleuroscopy. The retrograde esophagoscope serves very... Pleuroscopy
Foreign bodies in the pleural cavity should be immediately removed. The esophageal speculum inserted through a small intercostal incision makes an excellent pleuroscope, its spatular tip being of particular value in moving the lung out of the way. T... Pleuroscopy For Disease
Most pleural diseases require a large external opening for drainage, and even here the pleuroscope may be of some use in exploring the cavities. Usually there are many adhesions and careful ray study may reveal one or more the breaking up of which ... Pneumonia
Its Cause and Prevention. The other great disease of the lungs is pneumonia, formerly known as inflammation of the lungs. This is rapid and sudden, instead of slow and chronic like tuberculosis, but kills almost as many people; and unfortunately, un... Pneumonia
Take B D current, forceful as the patient can bear, and treat briefly--say five to seven minutes, several times a day, until relief is experienced. Place N. P., long cord, low on back of neck, and move P. P. over all the upper part of the lungs. ... Polar Antagonism
When the conducting cords are of equal length, as commonly they should be, each of the two poles or electrodes produces a polar effect in the patient directly the opposite of that produced by the other. Also, at any point in either half of the circu... Polarization
It may be proper, in this place, to spend a few words upon electrical polarization in general. Electrical polarity may be defined as a characteristic of the electric or magnetic fluid, by virtue of which its opposite qualities, as those of attrac... Polarization Of The Circuit
I have said, in effect, a little above, that, while the current is running, the entire circuit is one complete magnet, which extends from the inner or positive sides of the zinc plates, where the current commences, all the way around to the outer or... Position For Bronchoscopy And Esophagoscopy
The dorsally recumbent patient is so placed that the head and shoulders extend beyond the table, the edge of which supports the thorax at about the level of the scapulae. During introduction, the head must be maintained in the same relative positio... Positive And Negative Effort
DID you ever have the grip? If you ever have you may know how truly it is named and how it does actually grip you so that it seems as if there were nothing else in the world at the time--it appears to entirely possess you. As the Irishman sa... Positive And Negative Manifestations
Acute diseases are to be regarded as electrically positive, and chronic affections as negative. The exceptions are rare, if any at all. Malignant cholera, which is eminently acute, might by some be considered as an exception. In negative diseases, t... Practice On The Dog
Having mastered the technic of introduction on the cadaver and trained the eye and fingers by practice work on the rubber tube, experience should be had in the living lower air and food passages with their pulsatory, respiratory, bechic and deglutit... Practice On The Rubber-tube Manikin
This must be carried out in two ways. 1. General practice with all sorts of objects for the education of the eye and the fingers. 2. Before undertaking a foreign body case, practice should be had with a duplicate of the foreign body. It is ... Precautions To Be Observed
As long as compensation is complete, there are no medication and physical treatment necessary for the damaged heart. The patient, however, should be told of his disability, and restrictions in his habits and life should be urged on him. The most imp... Prejudice Of Physicians Against The Water-cure
The greatest, and the most serious, difficulty lies in the prejudice of physicians against the Water-Cure. This prejudice, although in the treatment of the diseases before us, it is founded on no other reasons but ignorance, lack of courage and the ... Preliminary Remarks
The author wishes to caution the reader not to rely merely on the forms of treatment here prescribed, but to study thoroughly the principles taught in the preceding pages, until he shall have mastered them, and can judge for himself of the correctne... Preparation Of Medicine
As it often becomes necessary for the practitioner to make more or less of his own dilutions and attenuations, some brief instructions especially to new beginners, may not come amiss. Medicine is prepared by mixing it with distilled water, or puri... Preventative Fasting
During the years it takes for a body to degenerate enough to prompt a fast, the body has been storing up large quantities of unprocessed toxins in the cells, tissues, fat deposits, and organs. The body in its wisdom will always choose to temporarily... Prevention
If the patient is weak, the circulation depressed, the blood pressure low, and the heart rapid, the drug advisable to produce rest and sleep is almost always morphin or some other form of opium. Morphin, with few exceptions, is a cardiac tonic and a... Priessnitz's Method The Wet-sheet-pack
a remedy which, alone, is worth the whole antiphlogistic, diaphoretic, and, indeed, the whole curative apparatus of the profession, in ancient and modern times, for any kind of fevers, and especially for eruptive diseases. Nor did the physicians bef... Problems
THERE are very few persons who have not I had the experience of giving up a problem in mathematics late in the evening, and waking in the morning with the solution clear in their minds. That has been the experience of many, too, in real-life problem... Prognosis
Janeway [Footnote: Janeway, T. C.: A Clinical Study of Hypertensive Cardiovascular Disease, Arch. Int. Med., December, 1913, p. 755.] presented statistics of 458 patients with high blood pressure, 67 percent of whom were men. Of these 458 patients 2... Prognosis
A foreign body lodged in the esophagus may prove quickly fatal from hemorrhage due to perforation of a large vessel; from asphyxia by pressure on the trachea; or from perforation and septic mediastinitis. Slower fatalities may result from suppuratio... Prognosis
If the foreign body be not removed, the resulting chronic sepsis or pulmonary hemorrhage will prove fatal. Removal of the foreign body usually results in complete recovery without further local treatment. Occasionally, secondary dilatation of a bron... Prognosis And Convalescence
The duration of acute endocarditis varies greatly; it may be two or three weeks, or the inflammation may become subacute and last for several months. Although mild endocarditis rarely causes death of itself, it may develop into an ulcerative endocar... Prolapsus Uteri Falling Of The Womb
Take the B D current, of good medium force, and give general tonic treatment (see page 95), on alternate days, ten minutes, passing briefly over the several parts. After this, treat five to eight minutes with uterine electrode, in the manner prescri... Prophylaxis
If one put into his mouth nothing but food, foreign body accidents would be rare. The habit of holding tacks, pins and whatnot in the mouth is quite universal and deplorable. Children are prone to follow the bad example of their elders. No small obj... Proteins Or Meats
Proteins, the First Foods. There are proteins, or meats, both animal and vegetable; and no one can support life without protein in some form. This is because proteins alone contain sufficient amounts of the great element called nitrogen, which forms... Pseudo-angina
While this name is more or less unfortunate, it has long been in vogue as a designation for pains and disturbances referred by a patient to his heart. Therefore with the distinct understanding that if the diagnosis is correct the name is a misnomer,... Pulmonary Insufficiency Pulmonary Regurgitation
If this rare condition occurs, it is probably congenital. A distinctive murmur of this insufficiency would be diastolic and accentuated in the second intercostal space on the left of the sternum. It should be remembered that aortic murmurs are often... Pulmonary Phthisis Consumption
After tubercles have been formed extensively in the lungs, and have softened down over considerable area, carrying down the pulmonary tissue with them into a state of pus, there is commonly but little hope of successful treatment. But where they are... Pulmonary Stenosis Pulmonary Obstruction
If stenosis is actually present in this location, the lesion is probably congenital. It might occur after a serious acute infectious endocarditis, but then it would be associated with other lesions of the heart. It has been found to be associated wi... Pulse Testing For Allergies
Coca's Pulse Tests are extraordinarily useful and simple tools for at-home allergy detection. My clients have succeeded at using this approach without supervision. Coca's test works on this simple principle: pulse elevations are caused by any allerg... Pulsus Alternans
By this term is meant that condition of pulse in which, though the rhythm is normal, strong and weak pulsations alternate. White [Footnote: White: Am. Jour. Med. Sc., July, 1915, p. 82.] has shown that this condition is not infrequent, as demonstrat... Punctures Case I
A.B. received a severe punctured wound by a hook of the size of a crow-quill, which pierced into the flesh between the thumb and fore-finger on the outside of the hand; scarcely a drop of blood followed, but there was immediately severe pain and tum... Punctures Case Ii
Mrs. Middleton, aged 40, wounded her wrist, on the ulnar side, by the hook of a door post; there was a considerable flow of blood at first, but this ceased suddenly and the arm immediately became affected with great pain and swelling. The lunar caus... Punctures Case Iii
A female servant punctured the end of the finger by a pin; there succeeded much pain and swelling, and it appeared that the nail would separate, and the cuticle all round the finger was raised by the effusion of fluid. This fluid was evacuated and a... Punctures Case Iv
The present case is somewhat more severe than those which have been already given, and what is of great importance, the caustic was not applied immediately after the accident. William Chantry, aged 50, received a stab in the wrist with a hay-fork ... Punctures Case Ix
James Joynes, aged 12, was bitten by an ass, on each side of the middle finger; the wounds were severe, and almost immediately followed by swelling and great pain. The lunar caustic was well applied within half an hour after the accident. On the ... Punctures Case V
Mr. Cocking's son, aged 12, received a stab in the palm of the hand from a penknife three days ago, which has been followed by much swelling and pain, the punctured orifice being nearly closed. I applied the lunar caustic as deep as possible within ... Punctures Case Vi
A little boy, aged 12, received a stab by a penknife a few days ago, in the fore part of the thigh; there are now great pain and swelling, the orifice is nearly closed, and he has feverishness with headach. I applied the lunar caustic deeply in the ... Punctures Case Vii
Mr. Parr, aged 30, of delicate habit, trod upon a needle which pierced the ball of the great toe; a free crucial incision was made but the needle could not be found; a poultice was applied to the wound and over the poultice a cold lotion. In the ... Punctures Case Viii
This case illustrates the mode of treatment by the lunar caustic, of those terrible effects of punctured wounds which have been neglected in the beginning. B. Unwin, aged 40, washerwoman, applied to me on July the 10th, 1820, with severe inflamma... Punctures Case X
Mr. Worth's daughter, aged six, was thrown down by a dog and bitten severely on the face and forehead in three places; one of the wounds in the cheek was deep from the penetration of the dog's front teeth, and the parts were much bruised. The lunar ... Punctures Case Xi
Mrs. G. was bitten by a little dog on forefinger about a fortnight ago. There is now a very irritable, inflamed, fungous sore. I removed the fungous by a pair of scissors and applied the lunar caustic to form an eschar. On the succeeding day, I f... Punctures Case Xii
A servant maid was bitten by a dog in four places--severely on the forearm--three days ago. Adhesive plaster had been applied. There is a wound across the arm two inches in length and three-fourths of an inch in breadth, attended by dull pain, and s... Punctures Case Xiii
Am old man applied leeches to the instep for inflammation occasioned by a bruise. Several very irritable sores were produced with some swelling. I applied the lunar caustic to form an eschar. On the following day, the eschars were adherent, the sw... Putrid Symptoms
Next to those most dangerous forms--most dangerous, because the organic power (the _vis medicatrix naturae_), from which the restoration of health must be expected, and without which no physician can remove the slightest symptom of disease, becomes ... Putrid Symptoms Gargle Solution Of Chloride Of Soda Drink: Chlorate Of Potass Liquor Calcii-chloridi
Should _putrid symptoms_ make their appearance (21), I would strongly advise the acid in full and repeated doses, as well as the frequent repetition of the packs. In putrid cases, not only the syrup, but also the gargle will do good service. Garglin... Quacks And Quackery
Quackery and the love of being quacked, are in human nature as weeds are in our fields. DR. J. BROWN, Spare Hours. They are Quack-salvers, Fellowes that live by senting oyles and drugs. ... Quacks And Quackery Continued
An English physician, who practised during the early part of the reign of King James I, described the charlatan of that period as shameless, a mortal hater of all good men, an adept in cozening, legerdemain, conycatching, and all other shifts and ... Quiet Vs Chronic Excitement
SOME women live in a chronic state of excitement all the time and they do not find it out until they get ill. Even then they do not always find it out, and then they get more ill. It is really much the same with excitable women as with a m... Radiotherapy
Radium and the therapeutic roentgenray are today our only effective means of retarding the progress of esophageal malignant neoplasms. No permanent cures have been reported, but marked temporary improvement in the swallowing function and prolongatio... Rapid Relief From Colon Cleansing
During fasting the liver is hard at work processing toxins released from fat and other body deposits. The liver still dumps its wastes into the intestines through the bile duct. While eating normally, bile, which contains highly toxic substances, is... Raw Food Healing Diets
Next in declining order of healing effectiveness is what I call a raw food healing diet or cleansing diet. It consists of those very same watery fruits and nonstarchy vegetables one juices or makes into vegetable broths, but eaten whole and raw. Hea... Rebellion!
_This is preaching rebellion!_ I know it is, and it is with great reluctance that I preach it, as I am by no means in favor of taking medical matters out of the hands where they belong, to place them into the hands of such as have had no medical ... Recent Wounds Contusions And Burns
Use the B D current, strong force as can be borne. Bring the lesion under P. P., and place N. P. at discretion, in view of the location of the injury. Treat five to eight minutes, twice or thrice on the same day. Unless the injury is very severe, no...