Prognosis is the art of forming an estimate of the probable future of a case, an attempt to tell whether the patient is progressing towards recovery or death.

General prognosis refers to "disease" in the abstract, as that the common history of a cold or of quinsy makes it wholly probable that the patient so suffering will recover, whereas the general history of advancing tuberculosis warrants an extremely unfavorable view of the outcome.

Special prognosis is the estimate formed of the probable outcome in any particular case, as when the judgement in one patient with pneumonia is '"favorable," while in another case it is "unfavorable."

All prognostic decisions must be based upon a knowledge of the conditions present, and the amount of reactive power possessed by the sick organism. As these cannot be fully known in any given case, there is always an element of uncertainty in any prognosis, no matter by. what methods the patient is cared for. Medical prognoses are often misleading for they are based upon medical experience, while cases cared for without poisonous and suppressive methods frequently mock at medical prognosis. Their estimates) are of no value except where their methods are employed. Even then they are largely guesses; for, as Dr. Tilden expresses it, "Not one of the best practitioners can tell from one clay to another how his patients will be. Not one can truthfully say that there is not an element of doubt in every case that is not known to him. Not one can tell, after the first twenty-four hours of medication, whether the symptoms presenting themselves are those of disease proper, or are due to drugs. Not one can tell, if his patient is suffering from disease free from drug action, food-poisoning, deranged emotions, or mental depression, after the disease has been under treatment for a day or two."

He adds that during the twenty five years he practiced, "the chaotic nonsense misnamed the science of medicine," that he did not know why people were sick, nor why they got well, nor why they died. He says: "When visiting the sick and treating them in the regular medical way, I had no idea how I should find them at the next call. I did not know if the disease would end soon or late. I did not know if the disease would take on a severe form, or quickly run. its course. I did not know if there would be complications or not. In fact, I did not know anything that would make me comfortable regarding the outcome of the disease, and, of course, I could not say anything of a real comforting nature to the patients or their friends. I had the usual stock-in-trade subterfuges and little nothings that are worked off on a confiding public everywhere. Here is one for example :'If no complications arise, the patient will get well.'"

There may always be hidden conditions or circumstances which operate to the disadvantage of the patient. A hidden weakness, a prior cachexia, drug damages, or organic weakness may result in a fatal termination when least expected. One is most likely to meet with such results in adults, in middle life, and beyond, who have suffered for years with chronic "disease." While in such cases a favorable opinion may be fully justified, and therefore should be given, it should be offered in moderate language rather than with too great assurance.

Whether in general or in special prognosing, it is necessary always to keep in mind the vital fact that the processes of life are ceaselessly striving to maintain the living state and restore health. This natural curative power is not one that operates merely occasionally or feebly, but one that is ever present, ceaselessly active, and sufficient to restore health in the great majority of cases. The tendency of living matter to return from a biogonic state to its regular or healthful state is our reliance for recovery when sick, for, by no artificial means,--by no "art of medicine"--can the injured tissues and organs be converted into their healthy state. The body is dowered with an intense vigor of renewal and we may always look forward hopefully, even where the prospects are not so promising.

A frequent, full, and firm pulse and vigorous heart indicates a capacity for a higher grade of vital action and should favor the restoration of health.

A frequent pulse coetaneous with smallness of size, indistinctness of the pulse-wave, and feebleness of heart, indicates the retrogression of vital capacity and is of decidedly unfavorable significance.

Disturbances of function are evidences of pathology; but when the disturbances are full and strong, they exhibit a vigor of vital resistance to the encroachments of pathogen that is altogether in favor of the patient. It is only when these become feeble from any cause, that they supply prognostic evidence of an unfavorable character.

On the one side, the vital activities failing--the body approaching the state of death--the measure of their failure serving as an index of how near they are approaching to complete cessation, the prognosis is unfavorable.

On the other hand, the vital activities are returning toward their natural degree of vigor, and the measure of their aproach to the healthful standard is an index to the diminution of danger.

A gradual clearing and moistening of the tongue, gentle yet free restoration of diminished or suppressed secretions, a returning normality and evenness of temperature, a steady approach of the pulse to normal, general relief of the nervous system, sleep, and returning rationality, are favorable signs in acute affections. It will be observed that these signs all proceed directly from the vital functions and indicate an approach to the normal standard which constitutes health. Dr. Jennings says: "No one who is hard sick ever gapes until there is a change for the better in the specific disease through which he is then passing."

Involuntary evacuation of the bowels or kidneys, drenching perspiration, subsultus tendinum (convulsive twitching), the hippocratic countenance (a cadaverous appearance of the face), sudden accessions of yellowness, hiccough, receding or absent pulse, great trembling of the tongue when protruded, difficulty or impossibility of protruding the tongue, difficulty of swallowing, or of speech, prolonged restlessness, black vomit, great coldness of the extremities, drawing up and rigidity of the extremities, walking delirium, or delirium that asks to be taken home when not away from home, a failing heart, or failing respiration, are the most prominent danger signs in acute "disease." All of these are never found in one case and the presence of only one of them in one case need not call for a fatal prognosis. The concomitant existence of two or several of these should cause apprehension. It will be noticed that these signs also proceed directly from the vital functions, but that they are derived from failing functions and represent a course away from the normal standard which constitutes health.

One must, of course, try to estimate the amount of pathogen and of structural damages that the vital activities must overcome and repair and every consideration must be given to the fact that when the vital efforts must be long-continued, they lessen in vigor from weariness due to an excess of waste over nutrition.

A correct estimate of the vital recuperative ability possessed by a patient is the basis of a good prognosis. Numerous factors must be considered in estimating the vital recuperative power possessed by a patient. Advanced age lessens the propects of recovery. Children under three years appear to be able to resist the prevailing forms of treatment less well than older children. Patients who have suffered with larval deficiency "diseases" are less viable than the well nourished. Previous debilitating influence, such as alcoholism, excessive venery, drug habits, long continued over-work, grief, mental or emotional strain, lend an unfavorable aspect to any "disease." The constitutionally debilitated easily die. The constitutionally robust recover from conditions and complications where recovery seems impossible.

Cause is first, last and all the time, more important than prognosis. If the doctor understands cause, he can frequently turn an unfavorable prognosis into a favorable one. If he does not understand cause, he may kill his patient by suppressive measures, even though the patient might otherwise recover.

There is no inevitable "course of disease"--any "disease." The course of biogony is determined by the correlations of certain necessary antecedents and where any one of these is lacking or withdrawn, the "inevitable course" ceases to be "inevitable." One of the necessary antecedents to the "course of disease," as described in medical text-books, is medical care, and where this is lacking the so-called "disease" (the biogony), whether acute or chronic, does not run true to form. Almost every one knows of cases that have been pronounced hopelessly incurable by medical men, who have subsequently recovered health under Christian Science, Chiropractic, or other forms of jollying the patient, or who have abandoned all practitioners and have recovered. A prognosis ceases to have validity when the mode of care under which it is given is abandoned and other care accepted.

The prevailing medical thought is that in so-called self-limited "diseases," the chief function of the physician is to guard against complications. How are they to guard against complications when they do not know their cause? How are they to guard against complications when they are, unwittingly, the cause of the complications.'? The first dose of drug given often starts a complication. Fear that the doctor often inspires and his insistence upon "good nourishing food to keep up strength," are common causes of complications. The doctor masks symptoms and suppresses curative operations with his drugs, and poisons his patient with fear and food, so that his prognoses are always extremely uncertain.