the book of prognostics-第4章

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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　anticipa