Education And Debate

ABC of General Surgery in Children: NOTHING NEW

BMJ 1996; 312 doi: (Published 27 January 1996) Cite this as: BMJ 1996;312:239
  1. N H Naqvi

    Prognostic scoring

    Prediction of outcome of disease and risk assessment by a system of scoring has now been widely accepted in modern medicine. The concept is not new. Hippocrates wrote in Prognostica, “I hold that it is an excellent thing for a physician to practise forecasting.”

    Substantial evidence of prognostic scoring was found in an Arabic manuscript—the MS 329 at the John Rylands University of Manchester library entitled The Sufficient in the Interpretation of the Mujiz. This was a commentary on the famous treatise Mujiz written by Ibn-un-Nafis (died in 1288), chief physician at Cairo's Nasiri Hospital, who also described the pulmonary circulation.

    The author of MS 329 was Sadid-Uddin-Alkazruni, who lived during the late 14th century and the manuscript is known as Sadidi after the author. Two tables are given (see figure). Each table contains various numbers in three vertical and six horizontal columns. In the resulting 18 boxes Arabic numerals are recorded. The table on the right is assigned to survival of a patient and the table on the left to one who will not survive. The four lines in Arabic text are difficult to read but a broad translation is as follows:

    “Some (or a physicians … have described a numerical method by which prognosis of death or survival may be made with the help of two tables, one for survival and the other for death…. To the total number of days of illness add the number according to Abjed system of patient's and mother's name. Then … remaining days of the month and number 40 are added. From the grand total 30 is deducted in a serial fashion. The resulting number is compared with those in the tables and the prediction is made accordingly.”

    The scoring system described does not seem to be based on any rationality except that the total number of days of illness were taken into account, but it shows that the concept of making prognosis by scoring is not new. The manuscript was copied in 1723 AD in Saharanpur, India.—N H NAQVI is a consultant anaesthetist in Bolton

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