the book of prognostics-第3部分

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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　s