                                     400 BC
                            THE BOOK OF PROGNOSTICS
                                 by Hippocrates
                          Translated by Francis Adams
                    THE BOOK OF PROGNOSTICS

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

                           -THE END-
