Practical medicine and medical diagnosis / by Byrom Bramwell.

  • Byrom Bramwell
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practical medicine and medical diagnosis / by Byrom Bramwell. Source: Wellcome Collection.

    149/164 (page 141)
    observed, of the imvudiate prognosis (of the patient's getting better or dying of acute disease), and not of the secondary or remote prognosis (of the probability if he gets better, whether there will be complete restoration to health, or more or less permanent disablement). One of the most striking differences between acute disease and many chronic affections is this, that acute affections, acute croupous pneumonia, for example, tend either to death or recovery, and that even in the most severe and apparently hopeless cases recovery not unfrequently takes place; whereas in many chronic affections there is little or no tendency to recovery, and we know as a matter of fact, that when the disease is far advanced, death must result; it is only a matter of time; we know in short, in many chronic affections, such as phthisis, cirrhosis of the kidney, aortic incompetence, etc., that when the process of destruction has advanced to a certain degree—which we can, as it were, measure and ascertain by careful clinical investigation —that recovery is no longer possible. In many acute affections it is, in fact, literally true that ' while there is life there is hope.' In such cases, unless the patient is actually in articulo, the most able and experienced physician is not justified in saying that the patient can not get better; all he is justified in saying is, that the condition is so grave that in his opinion the patient will not recover; in other words, that in his opinion the chances are strongly against recovery; he is not justified in excluding the possibility of recovery altogether. It must of course be understood that fliese state- ments apply to those cases in which the patient has been previously healthy—more especially to children and robust adults, whose vital and recuperative powers are still in full activity. Now just as a favourable opinion produces in many cases a most beneficial tonic and restorative effect, so the effect of an unfavourable opinion is, in others, most deleterious and depressing. And since it is the duty of the physician to do everything in his power to prolong life, and since, in some cases of acute disease it is impossible, however severe and apparently hopeless the condition may appear, to absolutely exclude the possibility of recovery, I hold that it is the bounden duty of the physician to administer the mental restorative of a favourable opimon, even when he is convinced in his own mind that the chances are strongly against recovery-just as it is his duty to administer alcoholic stimulants or any other remedies. _ I repeat that in some cases of acute disease where life is hano-ino- m the balance the effect which the opinion of the physician produces on the miiid of the patient, is of itself sufficient to turn the scale and to determine whether death or recovery shall take place. Further I