the book of prognostics-第3章

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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　tak