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Using this evidence he must examine the several problems that arise. For if a physician know these things well, by preference all of them, but at any rate most, he will not, on arrival at a town with which he is unfamiliar, be ignorant of the local diseases, or of the nature of those that commonly prevail; so that he will not be at a loss in the treatment of diseases, or make blunders, as is likely to be the case if he have not this knowledge before he consider his several problems. As time and the year passes he will be able to tell what epidemic diseases will attack the city either in summer or in winter, as well as those peculiar to the individual which are likely to occur through change in mode of life. For knowing the changes of the seasons, and the risings and settings of the stars, with the circumstances of each of these phenomena, he will know beforehand the nature of the year that is coming. Through these considerations and by learning the times beforehand, he will have full knowledge of each particular case, will succeed best in securing health, and will achieve the greatest triumphs in the practice of his art. If it be thought that all this belongs to meteorology, he will find out, on second thoughts, that the contribution of astronomy to medicine is not a very small one but a very great one indeed. For with the seasons men’s diseases, like their digestive organs, suffer change.

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I will now set forth clearly how each of the foregoing questions ought to be investigated, and the tests to be applied. A city that lies exposed to the hot winds--these are those between the winter rising of the sun and its winter setting--when subject to these and sheltered from the north winds, the waters here are plentiful and brackish, and must be near the surface,μετέωρος elevated, both here and in Chapter XXIV, seems, when applied to springs, to mean the opposite of Deep, i. e. rising from a point near the surface of the soil. Contrast Chapter VII, where water ἐκ βαθυτάτων πηγέων is said to be warm in winter and cool in summer. hot in summer and cold in winter. The heads of the inhabitants are moist and full of phlegm, and their digestive organs are frequently deranged from the phlegm that runs down into them from the head. Most of them have a rather flabby physique, and they are poor eaters and poor drinkers. For men with weak heads will be poor drinkers, as the after-effects are more distressing to them. The endemic diseases are these. In the first place, the women are unhealthy and subject to excessive fluxes. Then many are barren through disease and not by nature, while abortions are frequent. Children are liable to convulsions and asthma, and to what they think causes the disease of childhood, and to be a sacred disease.That is, epilepsy. Coray’s reading means, that affection which they think is caused by Heaven, and to be sacred. Men suffer from dysentery, diarrhoea, ague, chronic fevers in winter, many attacksOr forms. of eczema, and from hemorrhoids. Cases of pleurisy, pneumonia, ardent fever, and of diseases considered acute, rarely occur. These diseases cannot prevail where the bowels are loose. Inflammations of the eyes occur with running, but are not serious; they are of short duration, unless a general epidemic take place after a violent change. When they are more than fifty years old, they are paralyzed by catarrhs supervening from the brain, when the sun suddenly strikes their head or they are chilled. These are their endemic diseases, but besides, they are liable to any epidemic disease that prevails through the change of the seasons.

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I will now set forth clearly how each of the foregoing questions ought to be investigated, and the tests to be applied. A city that lies exposed to the hot winds—these are those between the winter rising of the sun and its winter setting—when subject to these and sheltered from the north winds, the waters here are plentiful and brackish, and must be near the surface,μετέωρος elevated, both here and in Chapter XXIV, seems, when applied to springs, to mean the opposite of Deep, i. e. rising from a point near the surface of the soil. Contrast Chapter VII, where water ἐκ βαθυτάτων πηγέων is said to be warm in winter and cool in summer. hot in summer and cold in winter. The heads of the inhabitants are moist and full of phlegm, and their digestive organs are frequently deranged from the phlegm that runs down into them from the head. Most of them have a rather flabby physique, and they are poor eaters and poor drinkers. For men with weak heads will be poor drinkers, as the after-effects are more distressing to them. The endemic diseases are these. In the first place, the women are unhealthy and subject to excessive fluxes. Then many are barren through disease and not by nature, while abortions are frequent. Children are liable to convulsions and asthma, and to what they think causes the disease of childhood, and to be a sacred disease.That is, epilepsy. Coray’s reading means, that affection which they think is caused by Heaven, and to be sacred. Men suffer from dysentery, diarrhoea, ague, chronic fevers in winter, many attacksOr forms. of eczema, and from hemorrhoids. Cases of pleurisy, pneumonia, ardent fever, and of diseases considered acute, rarely occur. These diseases cannot prevail where the bowels are loose. Inflammations of the eyes occur with running, but are not serious; they are of short duration, unless a general epidemic take place after a violent change. When they are more than fifty years old, they are paralyzed by catarrhs supervening from the brain, when the sun suddenly strikes their head or they are chilled. These are their endemic diseases, but besides, they are liable to any epidemic disease that prevails through the change of the seasons.

But the following is the condition of cities with the opposite situation, facing the cold winds that blow from between the summer setting and the summer rising of the sun, being habitually exposed to these winds, but sheltered from the hot winds and from the south. First, the waters of the region are generally hard and cold. The natives must be sinewy and spare, and in most cases their digestive organs are costive and hard in their lower parts, but more relaxed in the upper. They must be bilious rather than phlegmatic. Their heads are healthy and hard, but they have in most cases a tendency to internal lacerations. Their endemic diseases are as follow. Pleurisies are common, likewise those diseases which are accounted acute. It must be so, since their digestive organs are hard, and the slightest cause inevitably produces in many patients abscesses, the result of a stiff body and hard digestive organs. For their dryness, combined with the coldness of the water, makes them liable to internal lacerations. Such constitutions necessarily make men eat much and drink little; for one cannot be both a great eater and a great drinker. Inflammations of the eyes occur at last; they are hard and violent, and rapidly cause rupture of the eyes. Men under thirty suffer from violent bleedings at the nose in summer. Instances of the disease called sacred are rare but violent. These men are more likely to be long-lived than are others. Their sores become neither phlegmaticSuppurating. nor malignant, but their characters incline to fierceness, not to mildness. For men these diseases are endemic, besides there are epidemic diseases which may prevail through the change of the seasons. As to the women, firstly many become barren through the waters being hard, indigestible and cold. Their menstrual discharges are not healthy, but are scanty and bad. Then childbirth is difficult, although abortion is rare. After bearing children they cannot rear them, for their milk is dried up through the hardness and indigestibility of the waters, while cases of phthisis are frequent after parturition, for the violence of it causes ruptures and strains. Children suffer from dropsies in the testicles while they are little, which disappear as they grow older. In such a city puberty is late.

The effects of hot winds and of cold winds on these cities are such as I have described; the following are the effects of winds on cities lying exposed to those between the summer and winter risings of the sun, and to those opposite to these. Those that lie towards the risings of the sun are likely to be healthier than those facing the north and those exposed to the hot winds, even though they be but a furlong apart. In the first place, the heat and the cold are more moderate. Then the waters that face the risings of the sun must be clear, sweet-smelling, soft and delightful, in such a city. For the sun, shining down upon them when it rises, purifies them. The persons of the inhabitants are of better complexion and more blooming than elsewhere, unless some disease prevents this. They are clear-voiced, and with better temper and intelligence than those who are exposed to the north, just as all things growing there are better. A city so situated is just like spring, because the heat and the cold are tempered; the diseases, while resembling those which we said occur in cities facing the hot winds, are both fewer and less severe. The women there very readily conceive and have easy deliveries.

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Such are the conditions in these cities. Those that lie towards the settings of the sun, and are sheltered from the east winds, while the hot winds and the cold north winds blow past them--these cities must have a most unhealthy situation. In the first place, the waters are not clear, the reason being that in the morning mist is generally prevalent, which dissolves in the water and destroys its clearness, as the sun does not shine upon it before it is high on the horizon. In the summer cold breezes blow in the morning and there are heavy dews; for the rest of the day the sun as it advances towards the west thoroughly scorches the inhabitants, so that they are likely to be pale and sickly, subject to all the diseases aforesaid, for none are peculiar to them.αὐτοῖς may be either a dative of advantage or one of disadvantage. There can thus be two meanings:— (1) for none are isolated to their advantage, i. e. they are exempt from none; (2) for none are isolated to their disadvantage, i. e. they have no disease peculiar to themselves. I have taken the latter meaning, with Littré, but a good case could be made out for the former. They are likely to have deep, hoarse voices, because of the atmosphere, since it is usually impure and unhealthy in such places. For while it is not clarified much by the north winds, which are not prevalent there, the winds that do prevail insistently are very rainy, such being the nature of westerly winds. Such a situation for a city is precisely like autumn in respect of the changes of the day, seeing that the difference between sunrise and afternoon is great.

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Such are the conditions in these cities. Those that lie towards the settings of the sun, and are sheltered from the east winds, while the hot winds and the cold north winds blow past them—these cities must have a most unhealthy situation. In the first place, the waters are not clear, the reason being that in the morning mist is generally prevalent, which dissolves in the water and destroys its clearness, as the sun does not shine upon it before it is high on the horizon. In the summer cold breezes blow in the morning and there are heavy dews; for the rest of the day the sun as it advances towards the west thoroughly scorches the inhabitants, so that they are likely to be pale and sickly, subject to all the diseases aforesaid, for none are peculiar to them.αὐτοῖς may be either a dative of advantage or one of disadvantage. There can thus be two meanings:— (1) for none are isolated to their advantage, i. e. they are exempt from none; (2) for none are isolated to their disadvantage, i. e. they have no disease peculiar to themselves. I have taken the latter meaning, with Littré, but a good case could be made out for the former. They are likely to have deep, hoarse voices, because of the atmosphere, since it is usually impure and unhealthy in such places. For while it is not clarified much by the north winds, which are not prevalent there, the winds that do prevail insistently are very rainy, such being the nature of westerly winds. Such a situation for a city is precisely like autumn in respect of the changes of the day, seeing that the difference between sunrise and afternoon is great.

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So much for winds, healthy and unhealthy. I wish now to treat of waters, those that bring disease or very good health, and of the ill or good that is likely to arise from water. For the influence of water upon health is very great. Such as are marshy, standing and stagnant must in summer be hot, thick and stinking, because there is no outflow; and as fresh rain-water is always flowing in and the sun heats them, they must be of bad colour, unhealthy and bilious. In winter they must be frosty, cold and turbid through the snow and frosts, so as to be very conducive to phlegm and sore throats. Those who drink it have always large, stiff spleens, and hard, thin, hot stomachs, while their shoulders, collar-bones and faces are emaciated; the fact is that their flesh dissolves to feed the spleen, so that they are lean. With such a constitution they eat and drink heavily. Their digestive organs, upper and lower, are very dry and very hot, so that they need more powerful drugs. This malady is endemic both in summer and in winter. In addition the dropsies that occur are very numerous and very fatal. For in the summer there are epidemics of dysentery, diarrhoea and long quartan fever, which diseases when prolonged cause constitutions such as I have described to develop dropsies that result in death. These are their maladies in summer. In winter young people suffer from pneumonia and illnesses attended by delirium, the older, through the hardness of their digestive organs, from ardent fever. Among the women occur swellings and leucophlegmasia; they conceive hardly and are delivered with difficulty. The babies are big and swollen, and then, as they are nursed, they oecome emaciatedOr consumptive. and miserable. The discharge after childbirth is bad. Children are very subject to hernia and men to enlarged veins and to ulcers on the legs, so that such constitutions cannot be long-lived but must grow prematurely old. Moreover, the women appear to be with child, yet, when the time of delivery comes, the fullness of the womb disappears, this being caused by dropsy in that organ. Such waters I hold to be absolutely bad. The next worst will be those whose springs are from rocks--for they must be hard--or from earth where there are hot waters, or iron is to be found, or copper, or silver, or gold, or sulphur, or alum, or bitumen, or soda. For all these result from the violence of the heat. So from such earth good waters cannot come, but hard, heating waters, difficult to pass and causing constipation. The best are those that flow from high places and earthy hills. By themselves they are sweet and clear, and the wine they can stand is but little. In winter they are warm, in summer cold. They would naturally be so, coming from very deep springs. I commend especially those whose flow breaks forth towards the rising--by preference the summer rising--of the sun. For they must be brighter, sweet-smelling and light; while all that are salt, harsh and hard are not good to drink, though there are some constitutions and some diseases which are benefited by drinking such waters, concerning which I will speak presently. Aspect affects spring waters thus. Those whose sources face the risings of the sun are the very best. Second in excellence come those between the summer risings and the summer settings, by preference in the direction of the risings. Third best are those between the summer and winter settings. The worst are those that face the south, and those between the winter rising and setting. These are very bad indeed when the winds are in the south, less bad when they are in the north. Spring waters should be used thus. A man in health and strength can drink any water that is at hand without distinction, but he who because of disease wishes to drink the most suitable can best attain health in the following way. Those whose digestive organs are hard and easily heated will gain benefit from the sweetest, lightest and most sparkling waters. But those whose bellies are soft, moist, and phlegmatic, benefit from the hardest, most harsh and saltish waters, for these are the best to dry them up. For waters that are best for cooking and most solvent naturally loosen the digestive organs the most and relax them; but harsh waters, hard and very bad for cooking, contract most these organs and dry them up. In fact the public are mistaken about saline waters through inexperience, in that they are generally considered to be laxative. The truth is that they are just the reverse; they are harsh and bad for cooking, so that the digestive organs too are stiffened by them rather than loosened.

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So much for winds, healthy and unhealthy. I wish now to treat of waters, those that bring disease or very good health, and of the ill or good that is likely to arise from water. For the influence of water upon health is very great. Such as are marshy, standing and stagnant must in summer be hot, thick and stinking, because there is no outflow; and as fresh rain-water is always flowing in and the sun heats them, they must be of bad colour, unhealthy and bilious. In winter they must be frosty, cold and turbid through the snow and frosts, so as to be very conducive to phlegm and sore throats. Those who drink it have always large, stiff spleens, and hard, thin, hot stomachs, while their shoulders, collar-bones and faces are emaciated; the fact is that their flesh dissolves to feed the spleen, so that they are lean. With such a constitution they eat and drink heavily. Their digestive organs, upper and lower, are very dry and very hot, so that they need more powerful drugs. This malady is endemic both in summer and in winter. In addition the dropsies that occur are very numerous and very fatal. For in the summer there are epidemics of dysentery, diarrhoea and long quartan fever, which diseases when prolonged cause constitutions such as I have described to develop dropsies that result in death. These are their maladies in summer. In winter young people suffer from pneumonia and illnesses attended by delirium, the older, through the hardness of their digestive organs, from ardent fever. Among the women occur swellings and leucophlegmasia; they conceive hardly and are delivered with difficulty. The babies are big and swollen, and then, as they are nursed, they oecome emaciatedOr consumptive. and miserable. The discharge after childbirth is bad. Children are very subject to hernia and men to enlarged veins and to ulcers on the legs, so that such constitutions cannot be long-lived but must grow prematurely old. Moreover, the women appear to be with child, yet, when the time of delivery comes, the fullness of the womb disappears, this being caused by dropsy in that organ. Such waters I hold to be absolutely bad. The next worst will be those whose springs are from rocks—for they must be hard—or from earth where there are hot waters, or iron is to be found, or copper, or silver, or gold, or sulphur, or alum, or bitumen, or soda. For all these result from the violence of the heat. So from such earth good waters cannot come, but hard, heating waters, difficult to pass and causing constipation. The best are those that flow from high places and earthy hills. By themselves they are sweet and clear, and the wine they can stand is but little. In winter they are warm, in summer cold. They would naturally be so, coming from very deep springs. I commend especially those whose flow breaks forth towards the rising—by preference the summer rising—of the sun. For they must be brighter, sweet-smelling and light; while all that are salt, harsh and hard are not good to drink, though there are some constitutions and some diseases which are benefited by drinking such waters, concerning which I will speak presently. Aspect affects spring waters thus. Those whose sources face the risings of the sun are the very best. Second in excellence come those between the summer risings and the summer settings, by preference in the direction of the risings. Third best are those between the summer and winter settings. The worst are those that face the south, and those between the winter rising and setting. These are very bad indeed when the winds are in the south, less bad when they are in the north. Spring waters should be used thus. A man in health and strength can drink any water that is at hand without distinction, but he who because of disease wishes to drink the most suitable can best attain health in the following way. Those whose digestive organs are hard and easily heated will gain benefit from the sweetest, lightest and most sparkling waters. But those whose bellies are soft, moist, and phlegmatic, benefit from the hardest, most harsh and saltish waters, for these are the best to dry them up. For waters that are best for cooking and most solvent naturally loosen the digestive organs the most and relax them; but harsh waters, hard and very bad for cooking, contract most these organs and dry them up. In fact the public are mistaken about saline waters through inexperience, in that they are generally considered to be laxative. The truth is that they are just the reverse; they are harsh and bad for cooking, so that the digestive organs too are stiffened by them rather than loosened.

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Such are the facts about spring waters. I will now proceed to speak of rain water and snow water. Rain waters are the lightest, sweetest, finest and clearest. To begin with, the sun raises and draws up the finest and lightest part of water, as is proved by the formation of salt. The brine, owing to its coarseness and weight, is left behind and becomes salt; the finest part, owing to its lightness, is drawn up by the sun. Not only from pools does the sun raise this part, but also from the sea and from whatever has moisture in it--and there is moisture in everything. Even from men it raises the finest and lightest part of their juices. The plainest evidence thereof is that when a man walks or sits in the sun wearing a cloak, the parts of his skin reached by the sun will not sweat, for it draws up each layer of sweat as it appears. But those parts sweat which are covered by his cloak or by anything else. For the sweat drawn forcibly out by the sun is prevented by the covering from disappearing through the sun’s power. But when the man has come into a shady place, his whole body sweats alike, as the sun no longer shines upon it. For this reason too rain-water grows foul quicker than any other, and has a bad smell; being a mixture gathered from very many sources it grows foul very quickly. Furthermore, when it has been carried away aloft, and has combined with the atmosphere as it circles round, the turbid, dark part of it separates out, changes and becomes mist and fog, while the clearest and lightest part of it remains, and is sweetened as the heat of the sun produces coction, just as all other things always become sweeter through coction. Now as long as it is scattered and uncondensed, it travels about aloft, but as soon as it collects anywhere and is compressed into one place owing to sudden, contrary winds, then it bursts wherever the most compression happens to take place. For this is more likely to occur when the clouds, set in motion and carried along by a wind that allows them no rest, are suddenly encountered by a contrary blast and by other clouds.The reading of Kéhlewein means, condensed, set in motion and carried along by a wind, are suddenly, etc. In such cases the front is compressed, the rear comes on and is thus thickened, darkened and compressed into one place, so that the weight bursts it and causes rain. Such waters are naturally the best. But they need to be boiled and purifiedOr, with the reading of Coray, filtered. from foulness if they are not to have a bad smell, and give sore throat, coughs and hoarseness to those who drink them.

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Such are the facts about spring waters. I will now proceed to speak of rain water and snow water. Rain waters are the lightest, sweetest, finest and clearest. To begin with, the sun raises and draws up the finest and lightest part of water, as is proved by the formation of salt. The brine, owing to its coarseness and weight, is left behind and becomes salt; the finest part, owing to its lightness, is drawn up by the sun. Not only from pools does the sun raise this part, but also from the sea and from whatever has moisture in it—and there is moisture in everything. Even from men it raises the finest and lightest part of their juices. The plainest evidence thereof is that when a man walks or sits in the sun wearing a cloak, the parts of his skin reached by the sun will not sweat, for it draws up each layer of sweat as it appears. But those parts sweat which are covered by his cloak or by anything else. For the sweat drawn forcibly out by the sun is prevented by the covering from disappearing through the sun’s power. But when the man has come into a shady place, his whole body sweats alike, as the sun no longer shines upon it. For this reason too rain-water grows foul quicker than any other, and has a bad smell; being a mixture gathered from very many sources it grows foul very quickly. Furthermore, when it has been carried away aloft, and has combined with the atmosphere as it circles round, the turbid, dark part of it separates out, changes and becomes mist and fog, while the clearest and lightest part of it remains, and is sweetened as the heat of the sun produces coction, just as all other things always become sweeter through coction. Now as long as it is scattered and uncondensed, it travels about aloft, but as soon as it collects anywhere and is compressed into one place owing to sudden, contrary winds, then it bursts wherever the most compression happens to take place. For this is more likely to occur when the clouds, set in motion and carried along by a wind that allows them no rest, are suddenly encountered by a contrary blast and by other clouds.The reading of Kéhlewein means, condensed, set in motion and carried along by a wind, are suddenly, etc. In such cases the front is compressed, the rear comes on and is thus thickened, darkened and compressed into one place, so that the weight bursts it and causes rain. Such waters are naturally the best. But they need to be boiled and purifiedOr, with the reading of Coray, filtered. from foulness if they are not to have a bad smell, and give sore throat, coughs and hoarseness to those who drink them.

Waters from snow and ice are all bad. For, once frozen, water never recovers its original nature, but the clear, light, sweet part is separated out and disappears, while the muddiest and heaviest part remains. The following experiment will prove it. Pour by measure, in winter, water into a vessel and set it in the open, where it will freeze best; then on the next day bring it under cover, where the ice will melt best; if, when it is dissolved, you measure it again you will find it much diminished. This shows that freezing dries up and causes to disappear the lightest and finest part, not the heaviest and coarsest, to do which it has no power. In this way, therefore, I am of opinion that such waters, derived from snow or ice, and waters similar to these, are the worst for all purposes.

Such are the properties of rain waters, and of those from snow and ice. Stone, kidney disease, strangury and sciatica are very apt to attack people, and ruptures occur, when they drink water of very many different kinds, or from large rivers, into which other rivers flow, or from a lake fed by many streams of various sorts, and whenever they use foreign waters coming from a great, not a short, distance. For one water cannot be like another; some are sweet, others are impregnated with salt and alum, others flow from hot springs. These when mixed up together disagree, and the strongest always prevails. But the strongest is not always the same; sometimes it is one, sometimes another, according to the winds. One has its strength from a north wind, another from the south wind, and similarly with the others. Such waters then must leave a sediment of mud and sand in the vessels, and drinking them causes the diseases mentioned before. That there are exceptions I will proceed to set forth.

Those whose bowels are loose and healthy, whose bladder is not feverish, and the mouth of whose bladder is not over narrow, pass water easily, and no solid matter forms in their bladder. But feverishness of the bowels must be accompanied by feverishness of the bladder. For when it is abnormally heated its mouth is inflamed. In this condition it does not expel the urine, but concocts and heats it within itself. The finest part is separated off, and the clearest passes out as urine, while the thickest and muddiest part forms solid matter, which, though at first small, grows in course of time. For as it rolls about in the urine it coalesces with whatever solid matter forms, and so it grows and hardens. When the patient makes water, it is forced by the urine to fall against the mouth of the bladder, and staying the flow of the urine causes violent pain. So that boys that suffer from stone rub and pull at their privy parts, under the impression that there lies the cause of their making water.Coray’s emendation would mean, the cause of the stoppage, an attractive alteration. That my account is correct is shown by the fact that sufferers from stone emit urine that is very clear, as the thickest and muddiest part of it remains and solidifies. This in most cases is the cause of stone. Children get stone also from the milk, if it be unhealthy, too hot and bilious. For it heats the bowels and the bladder, so that the urine is heated and affected as I have described. And my opinion is that we should give to young children only very diluted wine, which heats and parches the veins less. Females suffer less from stone. For their urethra is short and broad, so that the urine is easily expelled. Nor do they rub the privy parts as do males, nor handle the urethra. For it opens directly into the privy parts, which is not so with males, nor is their urethra wide. And they drink more than boys do.

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This, or something very like this, is the truth concerning these matters. As to the seasons, a consideration of the following points will make it possible to decide whether the year will prove unhealthy or healthy. If the signs prove normal when the stars set and rise; if there be rains in autumn, if the winter be moderate, neither too mild nor unseasonably cold, and if the rains be seasonable in spring and in summer, the year is likely to be very healthy. If, on the other hand, the winter prove dry and northerly, the spring rainy and southerly, the summer cannot fail to be feverladen, causing ophthalmia and dysenteries. For whenever the great heat comes on suddenly while the earth is soaked by reason of the spring rains and the south wind, the heat cannot fail to be doubled, coming from the hot, sodden earth and the burning sun; men’s bowels not being braced nor their brain dried--for when spring is such the body and its flesh must necessarily be flabby--the fevers that attack are of the acutest type in all cases, especially among the phlegmatic. Dysenteries are also likely to come upon women and the most humid constitutions. If at the rising of the Dog Star stormy rain occurs and the Etesian winds blow, there is hope that the distempers will cease and that the autumn will be healthy. Otherwise there is danger lest deaths occur among the women and children, and least of all among the old men; and lest those that get better lapse into quartans, and from quartans into dropsies. But if the winter be southerly, rainy and mild, and the spring be northerly, dry and wintry, in the first place women with child whose delivery is due by spring suffer abortion; and if they do bring forth, their children are weak and sickly, so that either they die at once, or live puny, weak and sickly. Such is the fate of the women. The others have dysenteries and dry ophthalmia, and in some cases catarrhs descend from the head to the lungs. Phlegmatics are liable to dysenteries, and women also, phlegm running down from the brain because of the humidity of their constitution. The bilious have dry ophthalmia because of the warm dryness of their flesh. Old men have catarrhs because of their flabbiness and the wasting of their veins, so that some die suddenly, while others become paralyzed on the right side or the left. For whenever, owing to the winter being southerly and the body warm, neither brain nor veins are hardened, a northerly, dry, cold spring supervening, the brain, just at the time when it ought to have been relaxed along with spring and purged by cold in the head and hoarseness, congeals and hardens, so that the heat of summer having suddenly supervened and the change supervening, these diseases befall. Such cities as are well situated with regard to sun and winds, and use good waters, are less affected by such changes; but if they use marshy or standing waters, and are not well situated with regard to winds and sun, they are more affected. If the summer prove dry, the diseases cease more quickly; if it be rainy, they are protracted. Sores are apt to fester from the slightest cause. Lienteries and dropsies supervene on the conclusion of the diseases, as the bowels do not readily dry up. If the summer and the autumn be rainy and southerly, the winter must be unhealthy; phlegmatics and men over forty are likely to suffer from ardent fevers, bilious people from pleurisy and pneumonia. If the summer prove dry and northerly, and the autumn rainy and southerly, it is likely that in winter headaches occur and mortifications of the brain,See Littré V. 581 foll. and in addition hoarseness, colds in the head, coughs, and in some cases consumption as well. But if the weather be northerly and dry, with no rain either during the Dog Star or at Arcturus, it is very beneficial to those who have a phlegmatic or humid constitution, and to women, but it is very harmful to the bilious. For these dry up overmuch, and are attacked by dry ophthalmia and by acute, protracted fevers, in some cases too by melancholies. For the most humid and watery part of the bile is dried up and is spent, while the thickest and most acrid part is left, and similarly with the blood. Consequently these diseases come upon them. But all these conditions are helpful to the phlegmatic, for they dry up and reach winter dried up and not flabby.

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This, or something very like this, is the truth concerning these matters. As to the seasons, a consideration of the following points will make it possible to decide whether the year will prove unhealthy or healthy. If the signs prove normal when the stars set and rise; if there be rains in autumn, if the winter be moderate, neither too mild nor unseasonably cold, and if the rains be seasonable in spring and in summer, the year is likely to be very healthy. If, on the other hand, the winter prove dry and northerly, the spring rainy and southerly, the summer cannot fail to be feverladen, causing ophthalmia and dysenteries. For whenever the great heat comes on suddenly while the earth is soaked by reason of the spring rains and the south wind, the heat cannot fail to be doubled, coming from the hot, sodden earth and the burning sun; men’s bowels not being braced nor their brain dried—for when spring is such the body and its flesh must necessarily be flabby—the fevers that attack are of the acutest type in all cases, especially among the phlegmatic. Dysenteries are also likely to come upon women and the most humid constitutions. If at the rising of the Dog Star stormy rain occurs and the Etesian winds blow, there is hope that the distempers will cease and that the autumn will be healthy. Otherwise there is danger lest deaths occur among the women and children, and least of all among the old men; and lest those that get better lapse into quartans, and from quartans into dropsies. But if the winter be southerly, rainy and mild, and the spring be northerly, dry and wintry, in the first place women with child whose delivery is due by spring suffer abortion; and if they do bring forth, their children are weak and sickly, so that either they die at once, or live puny, weak and sickly. Such is the fate of the women. The others have dysenteries and dry ophthalmia, and in some cases catarrhs descend from the head to the lungs. Phlegmatics are liable to dysenteries, and women also, phlegm running down from the brain because of the humidity of their constitution. The bilious have dry ophthalmia because of the warm dryness of their flesh. Old men have catarrhs because of their flabbiness and the wasting of their veins, so that some die suddenly, while others become paralyzed on the right side or the left. For whenever, owing to the winter being southerly and the body warm, neither brain nor veins are hardened, a northerly, dry, cold spring supervening, the brain, just at the time when it ought to have been relaxed along with spring and purged by cold in the head and hoarseness, congeals and hardens, so that the heat of summer having suddenly supervened and the change supervening, these diseases befall. Such cities as are well situated with regard to sun and winds, and use good waters, are less affected by such changes; but if they use marshy or standing waters, and are not well situated with regard to winds and sun, they are more affected. If the summer prove dry, the diseases cease more quickly; if it be rainy, they are protracted. Sores are apt to fester from the slightest cause. Lienteries and dropsies supervene on the conclusion of the diseases, as the bowels do not readily dry up. If the summer and the autumn be rainy and southerly, the winter must be unhealthy; phlegmatics and men over forty are likely to suffer from ardent fevers, bilious people from pleurisy and pneumonia. If the summer prove dry and northerly, and the autumn rainy and southerly, it is likely that in winter headaches occur and mortifications of the brain,See Littré V. 581 foll. and in addition hoarseness, colds in the head, coughs, and in some cases consumption as well. But if the weather be northerly and dry, with no rain either during the Dog Star or at Arcturus, it is very beneficial to those who have a phlegmatic or humid constitution, and to women, but it is very harmful to the bilious. For these dry up overmuch, and are attacked by dry ophthalmia and by acute, protracted fevers, in some cases too by melancholies. For the most humid and watery part of the bile is dried up and is spent, while the thickest and most acrid part is left, and similarly with the blood. Consequently these diseases come upon them. But all these conditions are helpful to the phlegmatic, for they dry up and reach winter dried up and not flabby.

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By studying and observing after this fashion one may foresee most of the consequences of the changes. One should be especially on one’s guard against the most violent changes of the seasons, and unless compelled one should neither purge, nor apply cautery or knife to the bowels, before at least ten days are past. The following are the four most violent changes and the most dangerous :--both solstices, especially the summer solstice, both the equinoxes, so reckoned, especially the autumnal. One must also guard against the risings of the stars, especially of the Dog Star, then of Arcturus, and also of the setting of the Pleiades. For it is especially at these times that diseases come to a crisis. Some prove fatal, some come to an end, all others change to another form and another constitution.

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By studying and observing after this fashion one may foresee most of the consequences of the changes. One should be especially on one’s guard against the most violent changes of the seasons, and unless compelled one should neither purge, nor apply cautery or knife to the bowels, before at least ten days are past. The following are the four most violent changes and the most dangerous :—both solstices, especially the summer solstice, both the equinoxes, so reckoned, especially the autumnal. One must also guard against the risings of the stars, especially of the Dog Star, then of Arcturus, and also of the setting of the Pleiades. For it is especially at these times that diseases come to a crisis. Some prove fatal, some come to an end, all others change to another form and another constitution.

So much for the changes of the seasons. Now I intend to compare AsiaThat is, Asia Minor. and Europe, and to show how they differ in every respect, and how the nations of the one differ entirely in physique from those of the other. It would take too long to describe them all, so I will set forth my views about the most important and the greatest differences. I hold that Asia differs very widely from Europe in the nature of all its inhabitants and of all its vegetation. For everything in Asia grows to far greater beauty and size; the one region is less wild than the other, the character of the inhabitants is milder and more gentle. The cause of this is the temperate climate, because it lies towards the east midway between the risingsThat is, the winter rising and the summer rising. of the sun, and farther away than is Europe from the cold. Growth and freedom from wildness are most fostered when nothing is forcibly predominant, but equality in every respect prevails. Asia, however, is not everywhere uniform; the region, however, situated midway between the heat and the cold is very fruitful, very wooded and very mild; it has splendid water, whether from rain or from springs. While it is not burnt up with the heat nor dried up by drought and want of water, it is not oppressed with cold, nor yet damp and wet with excessive rains and snow. Here the harvests are likely to be plentiful, both those from seed and those which the earth bestows of her own accord, the fruit of which men use, turning wild to cultivated and transplanting them to a suitable soil. The cattle too reared there are likely to flourish, and especially to bring forth the sturdiest young and rear them to be very fine creatures.Or, if πυκνότατα and κάλλιδτα be adverbs, they are very prolific and the best of mothers. The men will be well nourished, of very fine physique and very tall, differing from one another but little either in physique or stature. This region, both in character and in the mildness of its seasons, might fairly be said to bear a close resemblance to spring Courage, endurance, industry and high spirit could not arise in such conditions either among the natives or among immigrants,The writer is thinking of Asiatic natives and the Greek colonists on the coast of Asia Minor. but pleasure must be supreme . . .There is a gap in the text here dealing with the Egyptians and Libyans. wherefore in the beasts they are of many shapes.

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A constitution of this kind prevents fertility. The men have no great desire for intercourse because of the moistness of their constitution and the softness and chill of their abdomen, which are the greatest checks on venery. Moreover, the constant jolting on their horses unfits them for intercourse. Such are the causes of barrenness in the men; in the women they are the fatness and moistness of their flesh, which are such that the womb cannot absorb the seed. For neither is their monthly purging as it should be, but scanty and late, while the mouth of the womb is closed by fat and does not admit the seed. They are personally fat and lazy, and their abdomen is cold and soft. These are the causes which make the Scythian race unfertile. A clear proof is afforded by their slave-girls. These, because of their activity and leanness of body, no sooner go to a man than they are with child.

Moreover, the great majority among the Scythians become impotent, do women’s work, live like women and converse accordingly. Such men they call Anaries. Now the natives put the blame on to Heaven, and respect and worship these creatures, each fearing for himself. I too think that these diseases are divine, and so are all others, no one being more divine or more human than any other; all are alike, and all divine. Each of them has a nature of its own, and none arises without its natural cause. How, in my opinion, this disease arises I will explain. The habit of riding causes swellings at the joints,For this difficult word see Littré V. 320 and VIII. xxxix foll. because they are always astride their horses; in severe cases follow lameness and sores on the hips. They cure themselves in the following way. At the beginning of the disease they cut the vein behind each ear. When the blood has ceased to flow faintness comes over them and they sleep. Afterwards they get up, some cured and some not. Now, in my opinion, by this treatment the seed is destroyed. For by the side of the ear are veins, to cut which causes impotence, and I believe that these are the veins which they cut. After this treatment, when the Scythians approach a woman but cannot have intercourse, at first they take no notice and think no more about it. But when two, three or even more attempts are attended with no better success, thinking that they have sinned against Heaven they attribute thereto the cause, and put on women’s clothes, holding that they have lost their manhood. So they play the woman, and with the women do the same work as women do.

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This affliction affects the rich Scythians because of their riding, not the lower classes but the upper, who possess the most strength; the poor, who do not ride, suffer less. But, if we suppose this disease to be more divine than any other, it ought to have attacked, not the highest and richest classes only of the Scythians, but all classes equally--or rather the poor especially, if indeed the gods are pleased to receive from men respect and worship, and repay these with favours. For naturally the rich, having great wealth, make many sacrifices to the gods, and offer many votive offerings, and honour them, all of which things the poor, owing to their poverty, are less able to do; besides, they blame the gods for not giving them wealth, so that the penalties for such sins are likely to be paid by the poor rather than by the rich. But the truth is, as I said above, these affections are neither more nor less divine than any others, and all and each are natural. Such a disease arises among the Scythians for such a reason as I have stated, and other men too are equally liable to it, for wherever men ride very much and very frequently, there the majority are attacked by swellings at the joints, sciatica and gout, and are sexually very weak. These complaints come upon the Scythians, and they are the most impotent of men, for the reasons I have given, and also because they always wear trousers and spend most of their time on their horses, so that they do not handle the parts, but owing to cold and fatigue forget about sexual passion, losing their virility before any impulse is felt.

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This affliction affects the rich Scythians because of their riding, not the lower classes but the upper, who possess the most strength; the poor, who do not ride, suffer less. But, if we suppose this disease to be more divine than any other, it ought to have attacked, not the highest and richest classes only of the Scythians, but all classes equally—or rather the poor especially, if indeed the gods are pleased to receive from men respect and worship, and repay these with favours. For naturally the rich, having great wealth, make many sacrifices to the gods, and offer many votive offerings, and honour them, all of which things the poor, owing to their poverty, are less able to do; besides, they blame the gods for not giving them wealth, so that the penalties for such sins are likely to be paid by the poor rather than by the rich. But the truth is, as I said above, these affections are neither more nor less divine than any others, and all and each are natural. Such a disease arises among the Scythians for such a reason as I have stated, and other men too are equally liable to it, for wherever men ride very much and very frequently, there the majority are attacked by swellings at the joints, sciatica and gout, and are sexually very weak. These complaints come upon the Scythians, and they are the most impotent of men, for the reasons I have given, and also because they always wear trousers and spend most of their time on their horses, so that they do not handle the parts, but owing to cold and fatigue forget about sexual passion, losing their virility before any impulse is felt.

Such is the condition of the Scythians. The other people of Europe differ from one another both in stature and in shape, because of the changes of the seasons, which are violent and frequent, while there are severe heat waves, severe winters, copious rains and then long droughts, and winds, causing many changes of various kinds. Wherefore it is natural to realize that generation too varies in the coagulation of the seed,I. e. in the formation of the foetus. and is not the same for the same seed in summer as in winter nor in rain as in drought. It is for this reason, I think, that the physique of Europeans varies more than that of Asiatics, and that their stature differs very widely in each city. For there arise more corruptions in the coagulation of the seed when the changes of the seasons are frequent than when they are similar or alike. The same reasoning applies also to character. In such a climate arise wildness, unsociability and spirit. For the frequent shocks to the mind impart wildness, destroying tameness and gentleness. For this reason, I think, Europeans are also more courageous than Asiatics. For uniformity engenders slackness, while variation fosters endurance in both body and soul; rest and slackness are food for cowardice, endurance and exertion for bravery. Wherefore Europeans are more warlike, and also because of their institutions, not being under kings as are Asiatics. For, as I said above, where there are kings, there must be the greatest cowards. For men’s souls are enslaved, and refuse to run risks readily and recklessly to increase the power of somebody else. But independent people, taking risks on their own behalf and not on behalf of others, are willing and eager to go into danger, for they themselves enjoy the prize of victory. So institutions contribute a great deal to the formation of courageousness.

diff --git a/data/tlg0627/tlg003/__cts__.xml b/data/tlg0627/tlg003/__cts__.xml index 5e2a50160..dddab0b46 100644 --- a/data/tlg0627/tlg003/__cts__.xml +++ b/data/tlg0627/tlg003/__cts__.xml @@ -5,4 +5,8 @@ Προγνωστικόν Hippocrates. Oeuvres complètes d'Hippocrate, Vol. 2. Littré, Émile, editor. Adolf M. Hakkert: Amsterdam, 1961 (printing). + + Of the Prognostics + Hippocrates, The Genuine Works of Hippocrates, Vol. 1. Adams, Francis, translator. New York: William Wood and Company, 1886. + diff --git a/data/tlg0627/tlg003/tlg0627.tlg003.perseus-eng1.xml b/data/tlg0627/tlg003/tlg0627.tlg003.perseus-eng1.xml index a0bb42fed..686a044d0 100644 --- a/data/tlg0627/tlg003/tlg0627.tlg003.perseus-eng1.xml +++ b/data/tlg0627/tlg003/tlg0627.tlg003.perseus-eng1.xml @@ -1,18 +1,36 @@ + - + The Book of Prognostics Hippocrates Francis Adams + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division - Cultural Heritage Langauge Technologies + Cultural Heritage Language Technologies Kansas City Missouri - February 20, 2003 + February 20, 2003 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0627.tlg003.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + @@ -21,646 +39,98 @@ Francis Adams New York - William Wood & Company + William Wood and Company 1886 + 1 + Internet Archive +

Data Entry

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This pointer pattern extracts section.

+ + - English + English + + CTS and EpiDoc conversion. + - - - -
- PART 1 -

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,Galen, in his Commentary on this clause of the - sentence, acutely remarks that patients are justly disposed to form a high - opinion of a physician who points out to them symptoms of their complaint - which they themselves had omitted to mention to him. And Staphanus further - remarks that the patient naturally estimates highly the acumen of the - physician who detects any errors in regimen which he has been guilty of, - such as drinking water, or eating fruit when forbidden; (Ed. Dietz, p. 54;) - or when he has some disease about him, such as bubo or inflammation, which - he wishes to conceal. (Ibid., p. 63.) 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.The author evidently alluded to hepatitis ending in abscess. - This would seem to have been a very common termination of inflammation of - the liver in Greece, as it is often described in the ancient medical works. - Se PAULUS AEGINETA, B. III., 46, and the authorities quoted there in the - Sydenham Society's edition. 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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 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.

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- PART 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.The observations of Andral have in some - measure confirmed the opinion of Hippoc-rates and other authors, ancient and - modern, that there are certain days in the duration of the disease in which - there is a greater tendency to amelioration. Of ninety-three cases, he found - twenty-three give way on the seventh, thirteen on the eleventh, eleven on - the fourteenth, and nine on the twentieth days. The recoveries in the - remaining cases commenced on twelve out of forty-two non-critical days, as - many as eleven being ascribed to the tenth day. Thus the recoveries on - critical days averaged as high as four-teen, while those on non-critical - scarcely exceeded three." (Dr. C. J. B. Williams on Pneumonia, Cyclop. of - Pract. Med., vol. iii., p. 405.) See also Andral, Clin. Med., c. ii., p. - 365.

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- PART 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.

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- PART 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.

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- PART 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 hypochondria 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.

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- PART 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.Our author here and elsewhere - impresses it upon his readers that it is from the tout - ensemble of the symptoms that a judgment is to be formed in every - case. This is evidently a remark of the most vital importance in forming a - prognosis. These things I say respecting acute diseases, and the - affections which spring from them.

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- PART 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 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,It has excited a great deal of discussion and - difference of opinion to determine what our author means by specifying these - three places; but the explanation given by Galen in his Commentary seems to - me quite satisfactory. According to him, the meaning of our author is that - good and bad symptoms tell the same in all places, in the hot regions of - Libya, the cold of Scythia, and the temperate of Delos. It is further to be - borne in mind that Odessus in Scythia, and Cyrene in Libya, were the - extremities of the Grecian world, whilst Delos may be regarded as its - centre. It is proper to remark, however, that by the three places mentioned, - Erotian understands the three quarters of the earth-Africa, Asia, and - Europe. 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 meaning of this last - sentence has been supposed to be somewhat ambiguous; but to me it appears - evidently to be this, that the rules of prognosis, as laid down above, apply - to all diseases of an acute character, whether their names happen to be - mentioned in the course of this work or not, so that it should not be - considered a defect in the work that any one is omitted.

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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,Galen, in his Commentary on this clause of the sentence, acutely remarks that patients are justly disposed to form a high opinion of a physician who points out to them symptoms of their complaint which they themselves had omitted to mention to him. And Staphanus further remarks that the patient naturally estimates highly the acumen of the physician who detects any errors in regimen which he has been guilty of, such as drinking water, or eating fruit when forbidden; (Ed. Dietz, p. 54;) or when he has some disease about him, such as bubo or inflammation, which he wishes to conceal. (Ibid., p. 63.) 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.

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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.

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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.

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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.

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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.

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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.

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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.The author evidently alluded to hepatitis ending in abscess. This would seem to have been a very common termination of inflammation of the liver in Greece, as it is often described in the ancient medical works. Se PAULUS AEGINETA, B. III., 46, and the authorities quoted there in the Sydenham Society’s edition. 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 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.

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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.The observations of Andral have in some measure confirmed the opinion of Hippocrates and other authors, ancient and modern, that there are certain days in the duration of the disease in which there is a greater tendency to amelioration. Of ninety-three cases, he found twenty-three give way on the seventh, thirteen on the eleventh, eleven on the fourteenth, and nine on the twentieth days. The recoveries in the remaining cases commenced on twelve out of forty-two non-critical days, as many as eleven being ascribed to the tenth day. Thus the recoveries on critical days averaged as high as fourteen, while those on non-critical scarcely exceeded three. (Dr. C. J. B. Williams on Pneumonia, Cyclop. of Pract. Med., vol. iii., p. 405.) See also Andral, Clin. Med., c. ii., p. 365.

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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.

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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.

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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 hypochondria 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.

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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.

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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.

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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.

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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.

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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.

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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.Our author here and elsewhere impresses it upon his readers that it is from the tout ensemble of the symptoms that a judgment is to be formed in every case. This is evidently a remark of the most vital importance in forming a prognosis. These things I say respecting acute diseases, and the affections which spring from them.

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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 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,It has excited a great deal of discussion and difference of opinion to determine what our author means by specifying these three places; but the explanation given by Galen in his Commentary seems to me quite satisfactory. According to him, the meaning of our author is that good and bad symptoms tell the same in all places, in the hot regions of Libya, the cold of Scythia, and the temperate of Delos. It is further to be borne in mind that Odessus in Scythia, and Cyrene in Libya, were the extremities of the Grecian world, whilst Delos may be regarded as its centre. It is proper to remark, however, that by the three places mentioned, Erotian understands the three quarters of the earth—Africa, Asia, and Europe. 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 meaning of this last sentence has been supposed to be somewhat ambiguous; but to me it appears evidently to be this, that the rules of prognosis, as laid down above, apply to all diseases of an acute character, whether their names happen to be mentioned in the course of this work or not, so that it should not be considered a defect in the work that any one is omitted.

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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,Galen, in his Commentary on this clause of the sentence, acutely remarks that patients are justly disposed to form a high opinion of a physician who points out to them symptoms of their complaint which they themselves had omitted to mention to him. And Staphanus further remarks that the patient naturally estimates highly the acumen of the physician who detects any errors in regimen which he has been guilty of, such as drinking water, or eating fruit when forbidden; (Ed. Dietz, p. 54;) or when he has some disease about him, such as bubo or inflammation, which he wishes to conceal. (Ibid., p. 63.) 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.

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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.

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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.

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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.

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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.

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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.

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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.The author evidently alluded to hepatitis ending in abscess. This would seem to have been a very common termination of inflammation of the liver in Greece, as it is often described in the ancient medical works. Se PAULUS AEGINETA, B. III., 46, and the authorities quoted there in the Sydenham Society’s edition. 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 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.

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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.The observations of Andral have in some measure confirmed the opinion of Hippocrates and other authors, ancient and modern, that there are certain days in the duration of the disease in which there is a greater tendency to amelioration. Of ninety-three cases, he found twenty-three give way on the seventh, thirteen on the eleventh, eleven on the fourteenth, and nine on the twentieth days. The recoveries in the remaining cases commenced on twelve out of forty-two non-critical days, as many as eleven being ascribed to the tenth day. Thus the recoveries on critical days averaged as high as fourteen, while those on non-critical scarcely exceeded three. (Dr. C. J. B. Williams on Pneumonia, Cyclop. of Pract. Med., vol. iii., p. 405.) See also Andral, Clin. Med., c. ii., p. 365.

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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.

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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.

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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 hypochondria 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.

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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.

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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.

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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.

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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.

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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.

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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.Our author here and elsewhere impresses it upon his readers that it is from the tout ensemble of the symptoms that a judgment is to be formed in every case. This is evidently a remark of the most vital importance in forming a prognosis. These things I say respecting acute diseases, and the affections which spring from them.

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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 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,It has excited a great deal of discussion and difference of opinion to determine what our author means by specifying these three places; but the explanation given by Galen in his Commentary seems to me quite satisfactory. According to him, the meaning of our author is that good and bad symptoms tell the same in all places, in the hot regions of Libya, the cold of Scythia, and the temperate of Delos. It is further to be borne in mind that Odessus in Scythia, and Cyrene in Libya, were the extremities of the Grecian world, whilst Delos may be regarded as its centre. It is proper to remark, however, that by the three places mentioned, Erotian understands the three quarters of the earth—Africa, Asia, and Europe. 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 meaning of this last sentence has been supposed to be somewhat ambiguous; but to me it appears evidently to be this, that the rules of prognosis, as laid down above, apply to all diseases of an acute character, whether their names happen to be mentioned in the course of this work or not, so that it should not be considered a defect in the work that any one is omitted.

+ + diff --git a/manifest.txt b/manifest.txt index 77b667d51..e43a67c56 100644 --- a/manifest.txt +++ b/manifest.txt @@ -2332,6 +2332,7 @@ /data/tlg0627/tlg002/tlg0627.tlg002.perseus-eng4.xml /data/tlg0627/tlg002/tlg0627.tlg002.perseus-grc2.xml /data/tlg0627/tlg003/__cts__.xml +/data/tlg0627/tlg003/tlg0627.tlg003.perseus-eng2.xml /data/tlg0627/tlg003/tlg0627.tlg003.perseus-grc2.xml /data/tlg0627/tlg004/__cts__.xml /data/tlg0627/tlg004/tlg0627.tlg004.perseus-grc2.xml