THE BOOK OF PROGNOSTICS
by Hippocrates
Translated by Francis
Adams
THE BOOK OF PROGNOSTICS
IT APPEARS to me a most excellent thing for
the physician to
cultivate
Prognosis; for by foreseeing and foretelling, in the
presence
of the sick, the present, the past, and the future, and
explaining
the omissions which patients have been guilty of, he will
be
the more readily believed to be acquainted with the circumstances
of
the sick; so that men will have confidence to intrust themselves to
such
a physician. And he will manage the cure best who has foreseen
what
is to happen from the present state of matters. For it is
impossible
to make all the sick well; this, indeed, would have been
better
than to be able to foretell what is going to happen; but
since
men die, some even before calling the physician, from the
violence
of the disease, and some die immediately after calling him,
having
lived, perhaps, only one day or a little longer, and before the
physician
could bring his art to counteract the disease; it
therefore
becomes necessary to know the nature of such affections, how
far
they are above the powers of the constitution; and, moreover, if
there
be anything divine in the diseases, and to learn a foreknowledge
of
this also. Thus a man will be the more esteemed to be a good
physician,
for he will be the better able to treat those aright who
can
be saved, having long anticipated everything; and by seeing and
announcing
beforehand those who will live and those who will die, he
will
thus escape censure.
2. He should observe thus in acute diseases:
first, the
countenance
of the patient, if it be like those of persons in
health,
and more so, if like itself, for this is the best of all;
whereas
the most opposite to it is the worst, such as the following; a
sharp
nose, hollow eyes, collapsed temples; the ears cold, contracted,
and
their lobes turned out: the skin about the forehead being rough,
distended,
and parched; the color of the whole face being green,
black,
livid, or lead-colored. If the countenance be such at the
commencement
of the disease, and if this cannot be accounted for
from
the other symptoms, inquiry must be made whether the patient
has
long wanted sleep; whether his bowels have been very loose; and
whether
he has suffered from want of food; and if any of these
causes
be confessed to, the danger is to be reckoned so far less;
and
it becomes obvious, in the course of a day and a night, whether or
not
the appearance of the countenance proceeded from these causes. But
if
none of these be said to exist, if the symptoms do not subside in
the
aforesaid time, it is to be known for certain that death is at
hand.
And, also, if the disease be in a more advanced stage either
on
the third or fourth day, and the countenance be such, the same
inquiries
as formerly directed are to be made, and the other
symptoms
are to be noted, those in the whole countenance, those on the
body,
and those in the eyes; for if they shun the light, or weep
involuntarily,
or squint, or if the one be less than the other, or
if
the white of them be red, livid, or has black veins in it; if there
be
a gum upon the eyes, if they are restless, protruding, or are
become
very hollow; and if the countenance be squalid and dark, or the
color
of the whole face be changed- all these are to be reckoned bad
and
fatal symptoms. The physician should also observe the appearance
of
the eyes from below the eyelids in sleep; for when a portion of the
white
appears, owing to the eyelids not being closed together, and
when
this is not connected with diarrhea or purgation from medicine,
or
when the patient does not sleep thus from habit, it is to be
reckoned
an unfavorable and very deadly symptom; but if the eyelid
be
contracted, livid, or pale, or also the lip, or nose, along with
some
of the other symptoms, one may know for certain that death is
close
at hand. It is a mortal symptom, also, when the lips are
relaxed,
pendent, cold, and blanched.
3. It is well when the patient is found by
his physician reclining
upon
either his right or his left side, having his hands, neck, and
legs
slightly bent, and the whole body lying in a relaxed state, for
thus
the most of persons in health recline, and these are the best
of
postures which most resemble those of healthy persons. But to lie
upon
one's back, with the hands, neck, and the legs extended, is far
less
favorable. And if the patient incline forward, and sink down to
the
foot of the bed, it is a still more dangerous symptom; but if he
be
found with his feet naked and not sufficiently warm, and the hands,
neck,
and legs tossed about in a disorderly manner and naked, it is
bad,
for it indicates aberration of intellect. It is a deadly symptom,
also,
when the patient sleeps constantly with his mouth open, having
his
legs strongly bent and plaited together, while he lies upon his
back;
and to lie upon one's belly, when not habitual to the patient to
sleep
thus while in good health, indicates delirium, or pain in the
abdominal
regions. And for the patient to wish to sit erect at the
acme
of a disease is a bad symptom in all acute diseases, but
particularly
so in pneumonia. To grind the teeth in fevers, when
such
has not been the custom of the patient from childhood,
indicates
madness and death, both which dangers are to be announced
beforehand
as likely to happen; and if a person in delirium do this it
is
a very deadly symptom. And if the patient had an ulcer
previously,
or if one has occurred in the course of the disease, it is
to
be observed; for if the man be about to die the sore will become
livid
and dry, or yellow and dry before death.
4. Respecting the movement of the hands I have
these observations to
make:
When in acute fevers, pneumonia, phrenitis, or headache, the
hands
are waved before the face, hunting through empty space, as if
gathering
bits of straw, picking the nap from the coverlet, or tearing
chaff
from the wall- all such symptoms are bad and deadly.
5. Respiration, when frequent, indicates pain
or inflanunation in
the
parts above the diaphragm: a large respiration performed at a
great
interval announces delirium; but a cold respiration at nose or
mouth
is a very fatal symptom. Free respiration is to be looked upon
as
contributing much to the safety of the patient in all acute
diseases,
such as fevers, and those complaints which come to a
crisis
in forty days.
6. Those sweats are the best in all acute
diseases which occur on
the
critical days, and completely carry off the fever. Those are
favorable,
too, which taking place over the whole body, show that
the
man is bearing the disease better. But those that do not produce
this
effect are not beneficial. The worst are cold sweats, confined to
the
head, face, and neck; these in an acute fever prognosticate death,
or
in a milder one, a prolongation of the disease; and sweats which
occur
over the whole body, with the characters of those confined to
the
neck, are in like manner bad. Sweats attended with a miliary
eruption,
and taking place about the neck, are bad; sweats in the form
of
drops and of vapour are good. One ought to know the entire
character
of sweats, for some are connected with prostration of
strength
in the body, and some with intensity of the inflammation.
7. That state of the hypochondrium is best
when it is free from
pain,
soft, and of equal size on the right side and the left. But if
inflamed,
or painful, or distended; or when the right and left sides
are
of disproportionate sizes;- all these appearances are to be
dreaded.
And if there be also pulsation in the hypochondrium, it
indicates
perturbation or delirium; and the physician should examine
the
eyes of such persons; for if their pupils be in rapid motion, such
persons
may be expected to go mad. A swelling in the hypochondrium,
that
is hard and painful, is very bad, provided it occupy the whole
hypochondrium;
but if it be on either side, it is less dangerous
when
on the left. Such swellings at the commencement of the disease
prognosticate
speedy death; but if the fever has passed twenty days,
and
the swelling has not subsided, it turns to a suppuration. A
discharge
of blood from the nose occurs to such in the first period,
and
proves very useful; but inquiry should be made if they have
headache
or indistinct vision; for if there be such, the disease
will
be determined thither. The discharge of blood is rather to be
expected
in those who are younger than thirty-five years. Such
swellings
as are soft, free from pain, and yield to the finger,
occasion
more protracted crises, and are less dangerous than the
others.
But if the fever continue beyond sixty days, without any
subsidence
of the swelling, it indicates that empyema is about to take
place;
and a swelling in any other part of the cavity will terminate
in
like manner. Such, then, as are painful, hard, and large,
indicate
danger of speedy death; but such as are soft, free of pain,
and
yield when pressed with the finger, are more chronic than these.
Swellings
in the belly less frequently form abscesses than those in
the
hypochondrium; and seldomest of all, those below the navel are
converted
into suppuration; but you may rather expect a hemorrhage
from
the upper parts. But the suppuration of all protracted
swellings
about these parts is to be anticipated. The collections of
matter
there are to be thus judged of: such as are determined outwards
are
the best when they are small, when they protrude very much, and
swell
to a point; such as are large and broad, and which do not
swell
out to a sharp point, are the worst. Of such as break
internally,
the best are those which have no external communication,
but
are covered and indolent; and when the whole place is free from
discoloration.
That pus is best which is white, homogeneous, smooth,
and
not at all fetid; the contrary to this is the worst.
8. All dropsies arising from acute diseases
are bad; for they do not
remove
the fever, and are very painful and fatal. The most of them
commence
from the flanks and loins, but some from the liver; in
those
which derive their origin from the flanks and loins the feet
swell,
protracted diarrhoeas supervene, which neither remove the pains
in
the flanks and loins, nor soften the belly, but in dropsies which
are
connected with the liver there is a tickling cough, with
scarcely
any perceptible expectoration, and the feet swell; there
are
no evacuations from the bowels, unless such as are hard and
forced;
and there are swellings about the belly, sometimes on the
one
side and sometimes on the other, and these increase and diminish
by
turns.
9. It is a bad symptom when the head, hands,
and feet are cold,
while
the belly and sides are hot; but it is a very good symptom
when
the whole body is equally hot. The patient ought to be able to
turn
round easily, and to be agile when raised up; but if he appear
heavy
in the rest of his body as well as in his hands and feet, it
is
more dangerous; and if, in addition to the weight, his nails and
fingers
become livid, immediate death may be anticipated; and if the
hands
and feet be black it is less dangerous than if they be livid,
but
the other symptoms must be attended, to; for if he appear to
bear
the illness well, and if certain of the salutary symptoms
appear
along with these there may be hope that the disease will turn
to
a deposition, so that the man may recover; but the blackened
parts
of the body will drop off. When the testicles and members are
retracted
upwards, they indicate strong pains and danger of death.
10. With regard to sleep- as is usual with
us in health, the patient
should
wake during the day and sleep during the night. If this rule be
anywise
altered it is so far worse: but there will be little harm
provided
he sleep in the morning for the third part of the day; such
sleep
as takes place after this time is more unfavorable; but the
worst
of all is to get no sleep either night or day; for it follows
from
this symptom that the insomnolency is connected with sorrow and
pains,
or that he is about to become delirious.
11. The excrement is best which is soft and
consistent, is passed at
the
hour which was customary to the patient when in health, in
quantity
proportionate to the ingests; for when the passages are such,
the
lower belly is in a healthy state. But if the discharges be fluid,
it
is favorable that they are not accompanied with a noise, nor are
frequent,
nor in great quantity; for the man being oppressed by
frequently
getting up, must be deprived of sleep; and if the
evacuations
be both frequent and large, there is danger of his falling
into
deliquium animi. But in proportion to the ingesta he should
have
evacuations twice or thrice in the day, once at night and more
copiously
in the morning, as is customary with a person in health. The
faeces
should become thicker when the disease is tending to a
crisis;
they ought to be yellowish and not very fetid. It is favorable
that
round worms be passed with the discharges when the disease is
tending
to a crisis. The belly, too, through the whole disease, should
be
soft and moderately distended; but excrements that are very watery,
or
white, or green, or very red, or frothy, are all bad. It is also
bad
when the discharge is small, and viscid, and white, and
greenish,
and smooth; but still more deadly appearances are the black,
or
fatty, or livid, or verdigris-green, or fetid. Such as are of
varied
characters indicate greater duration of the complaint, but
are
no less dangerous; such as those which resemble scrapings, those
which
are bilious, those resembling leeks, and the black; these
being
sometimes passed together, and sometimes singly. It is best when
wind
passes without noise, but it is better that flatulence should
pass
even thus than that it should be retained; and when it does
pass
thus, it indicates either that the man is in pain or in delirium,
unless
he gives vent to the wind spontaneously. Pains in the
hypochondria,
and swellings, if recent, and not accompanied with
inflammation,
are relieved by borborygmi supervening in the
hypochondrium,
more especially if it pass off with faeces, urine,
and
wind; but even although not, it will do good by passing along, and
it
also does good by descending to the lower part of the belly.
12. The urine is best when the sediment is
white, smooth, and
consistent
during the whole time, until the disease come to a
crisis,
for it indicates freedom from danger, and an illness of
short
duration; but if deficient, and if it be sometimes passed clear,
and
sometimes with a white and smooth sediment, the disease will be
more
protracted, and not so void of danger. But if the urine be
reddish,
and the sediment consistent and smooth, the affection, in
this
case, will be more protracted than the former, but still not
fatal.
But farinaceous sediments in the urine are bad, and still worse
are
the leafy; the white and thin are very bad, but the furfuraceous
are
still worse than these. Clouds carried about in the urine are good
when
white, but bad if black. When the urine is yellow and thin, it
indicates
that the disease is unconcocted; and if it (the disease)
should
be protracted, there maybe danger lest the patient should not
hold
out until the urine be concocted. But the most deadly of all
kinds
of urine are the fetid, watery, black, and thick; in adult men
and
women the black is of all kinds of urine the worst, but in
children,
the watery. In those who pass thin and crude urine for a
length
of time, if they have otherwise symptoms of convalescence, an
abscess
may be expected to form in the parts below the diaphragm.
And
fatty substances floating on the surface are to be dreaded, for
they
are indications of melting. And one should consider respecting
the
kinds of urine, which have clouds, whether they tend upwards or
downwards,
and upwards or downwards, and the colors which they have
and
such as fall downwards, with the colors as described, are to be
reckoned
good and commended; but such as are carried upwards, with the
colors
as described, are to be held as bad, and are to be
distrusted.
But you must not allow yourself to be deceived if such
urine
be passed while the bladder is diseased; for then it is a
symptom
of the state, not of the general system, but of a particular
viscus.
13. That vomiting is of most service which
consists of phlegm and
bile
mixed together, and neither very thick nor in great quantity; but
those
vomitings which are more unmixed are worse. But if that which is
vomited
be of the color of leeks or livid, or black, whatever of these
colors
it be, it is to be reckoned bad; but if the same man vomit
all
these colors, it is to be reckoned a very fatal symptom. But of
all
the vomitings, the livid indicates the danger of death, provided
it
be of a fetid smell. But all the smells which are somewhat putrid
and
fetid, are bad in all vomitings.
14. The expectoration in all pains about the
lungs and sides, should
be
quickly and easily brought up, and a certain degree of yellowness
should
appear strongly mixed up with the sputum. But if brought up
long
after the commencement of the pain, and of a yellow or ruddy
color,
or if it occasions much cough, or be not strongly mixed, it
is
worse; for that which is intensely yellow is dangerous, but the
white,
and viscid, and round, do no good. But that which is very green
and
frothy is bad; but if so intense as to appear black, it is still
more
dangerous than these; it is dangerous than these; it is bad, if
nothing
is expectorated, and the lungs discharge nothing, but are
gorged
with matters which boil (as it were) in the air-passages. It is
bad
when coryza and sneezing either precede or follow affections of
the
lungs, but in all other affections, even the most deadly, sneezing
is
a salutary symptom. A yellow spittle mixed up with not much blood
in
cases of pneumonia, is salutary and very beneficial if spit up at
the
commencement of the disease, but if on the seventh day, or still
later,
it is less favorable. And all sputa are bad which do not remove
the
pain. But the worst is the black, as has been described. Of all
others
the sputa which remove the pain are the best.
15. When the pains in these regions do not
cease, either with the
discharge
of the sputa, nor with alvine evacuations, nor from
venesection,
purging with medicine, nor a suitable regimen, it is to
be
held that they will terminate in suppurations. Of empyemata such as
are
spit up while the sputum is still bilious, are very fatal, whether
the
bilious portion be expectorated separate, or along with the other;
but
more especially if the empyema begin to advance after this
sputum
on the seventh day of the disease. It is to be expected that
a
person with such an expectoration shall die on the fourteenth day,
unless
something favorable supervene. The following are favorable
symptoms:
to support the disease easily, to have free respiration,
to
be free from pain, to have the sputa readily brought up, the
whole
body to appear equally warm and soft, to have no thirst, the
urine,
and faeces, sleep, and sweats to be all favorable, as described
before;
when all these symptoms concur, the patient certainly will not
die;
but if some of these be present and some not, he will not survive
longer
than the fourteenth day. The bad symptoms are the opposite of
these,
namely, to bear the disease with difficulty, respiration
large
and dense, the pain not ceasing, the sputum scarcely coughed up,
strong
thirst, to have the body unequally affected by the febrile
heat,
the belly and sides intensely hot, the forehead, hands, and feet
cold;
the urine, and excrements, the sleep, and sweats, all bad,
agreeably
to the characters described above; if such a combination
of
symptoms accompany the expectoration, the man will certainly die
before
the fourteenth day, and either on the ninth or eleventh. Thus
then
one may conclude regarding this expectoration, that it is very
deadly,
and that the patient will not survive until the fourteenth
day.
It is by balancing the concomitant symptoms whether good or
bad,
that one is to form a prognosis; for thus it will most probably
prove
to be a true one. Most other suppurations burst, some on the
twentieth,
some on the thirtieth, some on the fortieth, and some as
late
as the sixtieth day.
16. One should estimate when the commencement
of the suppuration
will
take place, by calculating from the day on which the patient
was
first seized with fever, or if he had a rigor, and if he says,
that
there is a weight in the place where he had pain formerly, for
these
symptoms occur in the commencement of suppurations. One then may
expect
the rupture of the abscesses to take place from these times
according
to the periods formerly stated. But if the empyema be only
on
either side, one should turn him and inquire if he has pain on
the
other side; and if the one side be hotter than the other, and when
laid
upon the sound side, one should inquire if he has the feeling
of
a weight hanging from above, for if so, the empyema will be upon
the
opposite side to that on which the weight was felt.
17. Empyema may be recognized in all cases
by the following
symptoms:
In the first place, the fever does not go off, but is slight
during
the day, and increases at night, and copious sweats
supervene,
there is a desire to cough, and the patients expectorate
nothing
worth mentioning, the eyes become hollow, the cheeks have
red
spots on them, the nails of the hands are bent, the fingers are
hot
especially their extremities, there are swellings in the feet,
they
have no desire of food, and small blisters (phlyctaenae) occur
over
the body. These symptoms attend chronic empyemata, and may be
much
trusted to; and such as are of short standing are indicated by
the
same, provided they be accompanied by those signs which occur at
the
commencement, and if at the same time the patient has some
difficulty
of breathing. Whether they will break earlier or later
may
be determined by these symptoms; if there be pain at the
commencement,
and if the dyspnoea, cough, and ptyalism be severe,
the
rupture may be expected in the course of twenty days or still
earlier;
but if the pain be more mild, and all the other symptoms in
proportion,
you may expect from these the rupture to be later; but
pain,
dyspnoea, and ptyalism, must take place before the rupture of
the
abscess. Those patients recover most readily whom the fever leaves
the
same day that the abscess bursts,- when they recover their
appetite
speedily, and are freed from the thirst,- when the alvine
discharges
are small and consistent, the matter white, smooth, uniform
in
color, and free of phlegm, and if brought up without pain or strong
coughing.
Those die whom the fever does not leave, or when appearing
to
leave them it returns with an exacerbation; when they have
thirst,
but no desire of food, and there are watery discharges from
the
bowels; when the expectoration is green or livid, or pituitous and
frothy;
if all these occur they die, but if certain of these
symptoms
supervene, and others not, some patients die and some
recover,
after a long interval. But from all the symptoms taken
together
one should form a judgment, and so in all other cases.
18. When abscesses form about the ears, after
peripneumonic
affections,
or depositions of matter take place in the inferior
extremities
and end in fistula, such persons recover. The following
observations
are to be made upon them: if the fever persist, and the
pain
do not cease, if the expectoration be not normal, and if the
alvine
discharges be neither bilious, nor free and unmixed; and if the
urine
be neither copious nor have its proper sediment, but if, on
the
other hand, all the other salutary symptoms be present, in such
cases
abscesses may be expected to take place. They form in the
inferior
parts when there is a collection of phlegm about the
hypochondria;
and in the upper when the continue soft and free of
pain,
and when dyspnoea having been present for a certain time, ceases
without
any obvious cause. All deposits which take place in the legs
after
severe and dangerous attacks of pneumonia, are salutary, but the
best
are those which occur at the time when the sputa undergo a
change;
for if the swelling and pain take place while the sputa are
changing
from yellow and becoming of a purulent character, and are
expectorated
freely, under these circumstances the man will recover
most
favorably and the abscess becoming free of pain, will soon cease;
but
if the expectoration is not free, and the urine does not appear to
have
the proper sediment, there is danger lest the limb should be
maimed,
or that the case otherwise should give trouble. But if the
abscesses
disappear and go back, while expectoration does not take
place,
and fever prevails, it is a bad symptom; for there is danger
that
the man may get into a state of delirium and die. Of persons
having
empyema after peripneumonic affections, those that are advanced
in
life run the greatest risk of dying; but in the other kinds of
empyema
younger persons rather die. In cases of empyema treated by the
cautery
or incision, when the matter is pure, white, and not fetid,
the
patient recovers; but if of a bloody and dirty character, he dies.
19. Pains accompanied with fever which occur
about the loins and
lower
parts, if they attack the diaphragm, and leave the parts
below,
are very fatal. Wherefore one ought to pay attention to the
other
symptoms, since if any unfavorable one supervene, the case is
hopeless;
but if while the disease is determined to the diaphragm, the
other
symptoms are not bad, there is great reason to expect that it
will
end in empyema. When the bladder is hard and painful, it is an
extremely
bad and mortal symptom, more especially in cases attended
with
continued fever; for the pains proceeding from the bladder
alone
are to kill the patient; and at such a time the bowels are not
moved,
or the discharges are hard and forced. But urine of a
purulent
character, and having a white and smooth sediment, relieves
the
patient. But if no amendment takes place in the characters of
the
urine, nor the bladder become soft, and the fever is of the
continual
type, it may be expected that the patient will die in the
first
stages of the complaint. This form attacks children more
especially,
from their seventh to their fifteenth year.
20. Fevers come to a crisis on the same days
as to number on which
men
recover and die. For the mildest class of fevers, and those
originating
with the most favorable symptoms, cease on the fourth
day
or earlier; and the most malignant, and those setting in with
the
most dangerous symptoms, prove fatal on the fourth day or earlier.
The
first class of them as to violence ends thus: the second is
protracted
to the seventh day, the third to the eleventh, the fourth
to
the fourteenth, the fifth to the seventeenth, and the sixth to
the
twentieth. Thus these periods from the most acute disease ascend
by
fours up to twenty. But none of these can be truly calculated by
whole
days, for neither the year nor the months can be numbered by
entire
days. After these in the same manner, according to the same
progression,
the first period is of thirty-four days, the second of
forty
days, and the third of sixty days. In the commencement of
these
it is very difficult to determine those which will come to a
crisis
after a long interval; for these beginnings are very similar,
but
one should pay attention from the first day, and observe further
at
every additional tetrad, and then one cannot miss seeing how the
disease
will terminate. The constitution of quartans is agreeable to
the
same order. Those which will come to a crisis in the shortest
space
of time, are the easiest to be judged of; for the differences of
them
are greatest from the commencement, thus those who are going to
recover
breathe freely, and do not suffer pain, they sleep during
the
night, and have the other salutary symptoms, whereas those that
are
to die have difficult respiration, are delirious, troubled with
insomnolency,
and have other bad symptoms. Matters being thus, one may
conjecture,
according to the time, and each additional period of the
diseases,
as they proceed to a crisis. And in women, after
parturition,
the crises proceed agreeably to the same ratio.
21. Strong and continued headaches with fever,
if any of the
deadly
symptoms be joined to them, are very fatal. But if without such
symptoms
the pain be prolonged beyond twenty days, a discharge of
blood
from the nose or some abscess in the inferior parts may be
anticipated;
but while the pain is recent, we may expect in like
manner
a discharge of blood from the nose, or a suppuration,
especially
if the pain be seated above the temples and forehead; but
the
hemorrhage is rather to be looked for in persons younger than
thirty
years, and the suppuration in more elderly persons.
22. Acute pain of the ear, with continual and
strong fever, is to be
dreaded;
for there is danger that the man may become delirious and
die.
Since, then, this is a hazardous spot, one ought to pay
particular
attention to all these symptoms from the commencement.
Younger
persons die of this disease on the seventh day, or still
earlier,
but old persons much later; for the fevers and delirium
less
frequently supervene upon them, and on that account the ears
previously
come to a suppuration, but at these periods of life,
relapses
of the disease coming on generally prove fatal. Younger
persons
die before the ear suppurates; only if white matter run from
the
ear, there may be hope that a younger person will recover,
provided
any other favorable symptom be combined.
23. Ulceration of the throat with fever, is
a serious affection, and
if
any other of the symptoms formerly described as being bad, be
present,
the physician ought to announce that his patient is in
danger.
Those quinsies are most dangerous, and most quickly prove
fatal,
which make no appearance in the fauces, nor in the neck, but
occasion
very great pain and difficulty of breathing; these induce
suffocation
on the first day, or on the second, the third, or the
fourth.
Such as, in like manner, are attended with pain, are swelled
up,
and have redness (erythema) in the throat, are indeed very
fatal,
but more protracted than the former, provided the redness be
great.
Those cases in which both the throat and the neck are red,
are
more protracted, and certain persons recover from them, especially
if
the neck and breast be affected with erythema, and the erysipelas
be
not determined inwardly. If neither the erysipelas disappear on the
critical
day, nor any abscess form outwardly, nor any pus be spit
up,
and if the patient fancy himself well, and be free from pain,
death,
or a relapse of the erythema is to be apprehended. It is much
less
hazardous when the swelling and redness are determined outwardly;
but
if determined to the lungs, they superinduce delirium, and
frequently
some of these cases terminate in empyema. It is very
dangerous
to cut off or scarify enlarged uvulae while they and red and
large,
for inflammations and hemorrhages supervene; but one should try
to
reduce such swellings by some other means at this season. When
the
whole of it is converted into an abscess, which is called Uva,
or
when the extremity of the variety called Columella is larger and
round,
but the upper part thinner, at this time it will be safe to
operate.
But it will be better to open the bowels gently before
proceeding
to the operation, if time will permit, and the patient be
not
in danger of being suffocated.
24. When the fevers cease without any symptoms
of resolution
occurring,
and not on the critical days, in such cases a relapse may
be
anticipated. When any of the fevers is protracted, although the man
exhibits
symptoms of recovery, and there is no longer pain from any
inflammation,
nor from any other visible cause, in such a case a
deposit,
with swelling and pain, may be expected in some one of the
joints,
and not improbably in those below. Such deposits occur more
readily
and in less time to persons under thirty years of age; and one
should
immediately suspect the formation of such a deposit, if the
fever
be protracted beyond twenty days; but to aged persons these less
seldom
happen, and not until the fever be much longer protracted. Such
a
deposit may be expected, when the fever is of a continual type,
and
that it will pass into a quartan, if it become intermittent, and
its
paroxysms come on in an irregular manner, and if in this form it
approach
autumn. As deposits form most readily in persons below thirty
years
of age, so quartans most commonly occur to persons beyond that
age.
It is proper to know that deposits occur most readily in
winter,
that then they are most protracted, but are less given to
return.
Whoever, in a fever that is not of a fatal character, says
that
he has pain in his head, and that something dark appears to be
before
his eyes, and that he has pain at the stomach, will be seized
with
vomiting of bile; but if rigor also attack him, and the
inferior
parts of the hypochondrium are cold, vomiting is still nearer
at
hand; and if he eat or drink anything at such a season, it will
be
quickly vomited. In these cases, when the pain commences on the
first
day, they are particularly oppressed on the fourth and the
fifth;
and they are relieved on the seventh, but the greater part of
them
begin to have pain on the third day, and are most especially
tossed
on the fifth, but are relieved on the ninth or eleventh; but in
those
who begin to have pains on the fifth day, and other matters
proceed
properly with them, the disease comes to a crisis on the
fourteenth
day. But when in such a fever persons affected with
headache,
instead of having a dark appearance before their eyes,
have
dimness of vision, or flashes of light appear before their
eyes,
and instead of pain at the pit of the stomach, they have in
their
hypochondrium a fullness stretching either to the right or
left
side, without either pain or inflammation, a hemorrhage from
the
nose is to be expected in such a case, rather than a vomiting. But
it
is in young persons particularly that the hemorrhage is to be
expected,
for in persons beyond the age of thirty-five, vomitings
are
rather to be anticipated. Convulsions occur to children if acute
fever
be present, and the belly be they cannot sleep, are agitated,
and
moan, and change color, and become green, livid, or ruddy. These
complaints
occur most readily to children which are very young up to
their
seventh year; older children and adults are not equally liable
to
be seized with convulsions in fevers, unless some of the
strongest
and worst symptoms precede, such as those which occur in
frenzy.
One must judge of children as of others, which will die and
which
recover, from the whole of the symptoms, as they have been
specially
described. These things I say respecting acute diseases, and
the
affections which spring from them.
25. He who would correctly beforehand those
that will recover, and
those
that will die, and in what cases the disease will be
protracted
for many days, and in what cases for a shorter time, must
be
able to form a judgment from having made himself acquainted with
all
the symptoms, and estimating their powers in comparison with one
another,
as has been described, with regard to the others, and the
urine
and sputa, as when the patient coughs up pus and pus and bile
together.
One ought also to consider promptly the influx of epidemical
diseases
and the constitution of the season. One should likewise be
well
acquainted with the particular signs and the other symptoms,
and
not be ignorant how that, in every year, and at every season,
bad
symptoms prognosticate ill, and favorable symptoms good, since the
aforesaid
symptoms appear to have held true in Libya, in Delos, and in
Scythia,
from which it may be known that, in the same regions, there
is
no difficulty in attaining a knowledge of many more things than
these;
if having learned them, one knows also how to judge and
reason
correctly of them. But you should not complain because the name
of
any disease may happen not to be described here, for you may know
all
such as come to a crisis in the aforementioned times, by the
same
symptoms.
-THE END-
