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                                     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 occu

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