Failure of the heart in valvular disease / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Failure of the heart in valvular disease / 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.

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    Prognosis. The whole aspect of cardiac prognosis is manifestly changed by the preceding considerations. The first point that becomes clear to us is that there are two distinct and different directions in which prognosis has to be applied, namely, first as regards the valvular disease, and secondly as regards compensation. The prognosis of valvular disease has to be distinguished from the prognosis of cardiac failure. The former, the prognosis of heart disease as it is generally understood, is chiefly con- cerned with the particular valve affected: it teaches us, for instance, that aortic incompetence is a more serious lesion than aortic obstruction: it is mainly statistical in its method, and general in its appHcation. The latter, the prognosis of. cardiac failure, is concerned with the caxise of failure : it teaches us, for instance, that aortic incompetence in a drunkard is a far more unfavourable condition than aortic incompetence in an overworked but temperate man : it is specific, personal, imme- diate in its application. I am afraid this distinction is too often forgotten. When his opinion is required of the prospect of a case of cardiac disease with symptoms of failure, the practitioner begins to prognose with a few words of general encouragement. He is most careful to dispel from the minds of the patient and the patient's friends the popular mistake that a diagnosis of heart disease is tantamount to a death-warrant. He says that cases often recover and keep well : that rest and tonics will do much to restore the heart. But his reassurance does not take a proper form. Instead of saying, These symptoms have come on because such and such a circumstance which I have discovered (nervous, toxic, nutritive, &c.) has interrupted the healthy action of the heart, and they may be expected to disappear if you are more careful and more fortunate in future, he proceeds to employ what I have called the statistical method —to apply to the case before him the results that have been arrived at in Assurance Societies with respect to the com- parative value of life in the different forms of mitral and aortic disease. In following this plan the practitioner has made a great omission. He has thought too much of the disease,