So much for the general prognosis in each of these kinds of cardio-vascular disorder and disease. But it is the particular prognosis that we have to attempt to estimate--that is, the prognosis in the individual patient as he comes before us and asks us that trying question, "What is my prospect of life and health"? We diagnose, if possible, the precise nature of his cardiac affection, and apply to the best of our ability the conclusions which I have just submitted to you, and at the same time we estimate as correctly as possible the man's personal condition, character and disposition. For, whatever may be determined with respect to the average patient by an analysis of a large number of these cases, the individual patient's future in disease of the heart of every kind, degenerations included, greatly depends on the care that he takes of himself. This introduces us to another consideration. However earnestly we may attempt to estimate the prognosis on a strictly rational system--that is, by basing it on an accurate and complete diagnosis--we cannot deny that when the individual patient is before us we are influenced directly by certain of the symptoms and signs, without asking ourselves what their respective pathological meaning may be. True bradycardia, the story of an unmistakable attack of angina pectoris, a loud aortic diastolic murmur, the _bruit de galop_--these instantly give us great concern before we have had time to translate them into the language of morbid anatomy. Very naturally we attempt to carry this method too far, and to reach a prognosis, as it were, by a short cut, by attaching a prognostic value to each clinical phenomenon--palpitation, præcordial oppression, faintness, lethal sensations, and so on. Now, quite irrespective of the unscientific character of this proceeding, it is of little practical service. Even when we have listened to an account from a middle-aged man of an attack of angina pectoris, what can we tell him of his prospect of life until we have learned whether he be guilty of excessive smoking or drinking, whether he be gouty, whether he have lately strained his heart or no? What I do regard as really valuable prognostically, in the way of a simple clinical observation, is the determination of progressive symptoms and signs. A man of 72 complains of oppression over the lower sternal region as often as he climbs a hill. Twelve months later he comes and tells us that he has had an attack of severe pain across the top of the chest during the night. Another year passes, and he returns to say that now he cannot hasten on the street without præcordial distress; and it is noted that the second aortic sound, previously thick in character, is slightly blowing. By the fourth year of observation the patient, having had influenza in the interval, complains of an auto-audible murmur, and of actual pain in the chest; there is now a fully-developed aortic diastolic murmur, and his ankles swell occasionally.