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Full text of "Ancient Classic Texts before 400 B.C."

The Book of Prognostics 
By Hippocrates 



Translated by Francis Adams 



PART 1 

It ppears 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. 



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. 



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. 



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. 



PART 5 

Respiration, when frequent, indicates pain or inf lanunation 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 . 



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. 



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. 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. 



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. 



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. 



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. 



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. 



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 . 



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. 



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 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. 



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. 



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. 



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. 



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 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. 



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. 



PART 2 

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. 



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 . 



PART 2 2 

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. 



PART 2 3 

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. 



PART 2 4 

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. 



PART 2 5 

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