Arteriosclerosis, especially of the coronary arteries of the heart, makes the prognosis much more unfavorable. In such cases wa should be guarded in making a prognosis, even in mild attacks of stenocardia which are in themselves insignificant, because we can only draw the conclusion from these attacks that the blood-vessels of the heart are affected, but we cannot say to what extent they hava suffered; furthermore these milder attacks are often followed by more severe and even dangerous ones, and possibly by intracranial hemor rhage.
In cases of sclerosis the treatment is rendered more difficult in that the mechanical part cannot be carried out to the extent which the indications would require were it not for this existing complica tion. These severe attacks have an unfavorable influence upon the prognosis in proportion to their severity and duration, since each attack works structural changes in the heart muscle, increasing its in sufficiency and hastening death. The milder attacks may be of im portance as regards treatment and the course of the disease in so far as they direct our attention at once to the existence of dangerous con ditions connected with the heart vessels which threaten the patient and permit us in time to take precautionary measures against them.
Diabetes aggravates this disease in proportion to the quantity of sugar in the urine and the decomposition of albumin. The prognosis
is rendered less unfavorable if the appearance of sugar in the urine is exclusively or for the greater part due to the ingestion of sugar forming substances, and if it decreases materially or disappears en tirely when the latter are reduced or when an absolutely diabetic regi men is carried out.
These patients may be made comfortable for a long time if we al ways carefully watch the extent of the glycosuria which stands in direct proportion to the decomposition of albumin. It is also to be remembered that these milder cases in the majority of instances be come transformed into severer ones. In case the quantity of nitro genous substances iu the urine surpasses the equivalent of the nude composed sugar the prognosis is altogether unfavorable and oc currence of diabetic coma is at any moment to be dreaded.
Albuminuria, when appearing as congestive albuminuria accom panied by slight congestive oedema and without any complication, may disappear, if the heart muscle can be strengthened, and if the patient is not too old.
After the occurrence of chronic nephritis, contracted kidney, and general dropsy, the organs never again regain their former condition for any length of time, and for the most part death after a short period ends the long and varied course of the disease.