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PREDICTIONS OR PROGNOSTICS. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
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PREDICTIONS OR PROGNOSTICS.
Fœsius has a preface to this treatise and its immediate successor, (the second book of Predictions,) explanatory of the two, but too long to be here inserted, and indeed not forming a part of my plan, viz., that of giving a brief view of the different treatises, without troubling either myself or reader with any extensive research as to the real author of each. It is perhaps sufficient, as in the preceding treatises, to give the short exposition of Haller, serving as a preface or head-piece, and which is to the following effect, viz.: that Galen considered this treatise as the production of one of Hippocrates’ children, but that although initiated in the art of prediction, yet it was in a degree vastly inferior to Hippocrates himself. He knew not how to deduce general axioms from particular events, and not unfrequently has given particular observations for axioms. He has not sufficiently discriminated the symptoms depending on the cause of disease, and too often exhibits as symptoms different and incoherent events. He oftentimes mentions the names of the sick, from whose diseases he derives his axioms; among them some of Cos, from which island Hippocrates is supposed to have removed at an early period. He likewise makes use of obsolete words, or else employs them in an unaccustomed sense. Nearly half the treatise is taken up with delirium and the symptoms of soporose diseases. A third part is taken up with convulsions, and the remainder with hemorrhages and abscesses, especially of those occurring behind the ears. On this treatise Galen has written a commentary. As the general argument of the treatise, Haller adds, that it consists of the enunciation of what is salutary or injurious in diseases, and of what portends good or evil; as also, what the peculiar occurrences are, which in almost all diseases happen to the sick.
It is divided into eleven chapters by Haller, and under one hundred and seventy short sentences by Fœsius. This treatise, together with Fœsius’s comments, has been very ably translated by Dr. Moffat, under the title of Prorrhetics, (πϱοϱϱητιχον, Hipp.; implying vaticinium, prædictio,) Lond. 1788, together with the Prognostics, and will compensate the reader for its full perusal. As this can be readily obtained, I have deemed it less necessary to give more than a very brief outline of the contents, although I have translated the whole.—Ed.
Presages respecting those who are attacked with coma, phrenitis, madness, melancholia, their various signs, and symptoms;—of what throbbing pains about the navel, leg, and thigh, portend; presages from pains of the loins; from the voice, thirst, mode of reply, the eyes, teeth, respiration, countenance, alvine and urinary discharges, in acute and bilious diseases; vomiting, forgetfulness, imperception, rigors and heat in the side, redness of the face, distortion of the eyes,—all of which are bad. In what circumstances purging is improper; pains in the cardia, neck, and with tumid præcordia, &c.; soporose fevers, and their concomitants; vomiting, variety of; non-discharge of puerperal lochia; apoplexy; lumbar pains, and translation of, to the stomach; pains of the fauces without swellings, but with difficult breathing, extreme danger of; various soporose and spasmodic affections, their danger; singultus; pains of the neck with sopor, sweat, tension of the abdomen; ulcerated mouth, &c.; lumbar pains, their fatal metastasis to the præcordia and head; rigors; pervigilium, involuntary discharge of urine in sleep; headache, with sopor, &c., in pregnancy; fatal signs of some anginose and other affections of the fauces; signs of convulsions; variety of alvine discharges; good, bad, indicative of convulsions, &c.; what convulsions indicate in fever and mental affections; of various convulsive states and mental emotions, especially in females; their causes and symptoms; of hemorrhages, &c., how to estimate them; presages from epistaxis; nasal stillicidium; of tumours and abscesses about the ears, &c.; suppression of urine; alvine discharges; various pains, &c., deafness, &c., all connected with parotid swellings; danger from, in various diseases; convulsions from hemorrhages from different parts, and their association and connexion with abscesses of and about the ears.
This book, (says Haller,) the genuine production of a great man as we may readily perceive, from the weight, modesty, method, and continued succession of observations it evinces, is far superior to the first book.—It commences with a notice of the ostentatious predictions of some of the physicians of his time. It then speaks of the predictions in a healthy state, derived from the discharges, and from the respiration. This is followed by a notice of several diseases; dropsy, phthisis, empyema, gout, epilepsy, ulcers, wounds in general, and particularly of those of the head, the cubit, and spinal marrow; of sanguineous angina, diseases of the eyes, dysentery, diarrhœa, lientery; of easy or difficult conception, of headache, of chlorosis, nyctalopia, epistaxis, enlarged spleen, a disease closely allied to scurvy; of sciatica, leprosy, lichen, and morphew. It points out the principal events and symptoms of each, and I cannot think the first book of Predictions can possibly be referred to the same class of genuine writings. The book may be considered as adverting to the ancient modes of prediction; to the predictions of most importance in the art, together with the good and bad symptoms, from which such predictions are derived.
Hippocrates in this treatise, (says Gardeil,) seems to have principally had in view the exposure of the vanity of the diagnostics and prognostics of the gymnastic physicians, and to establish firmly the foundation of a true science of prognostics, by a copious detail in many instances.—Ed.a
We hear much of numerous surprising and wonderful predictions made by physicians, such as I must confess I have never made myself, nor seen made by others. Some of them I will here relate.
A man in the last extremity, was so considered by all around him; another physician being called in, exclaims, “This man will not die, but he will lose his sight.” In another case of equal danger he predicted that the patient would survive, but that he would lose the use of his hand. In a third, not expected to live, he declared that he would recover, but that his toe-nails would become black, and fall off from putrefaction. Many others are related of a similar nature.
Another method, in predicting to such as are engaged in business, is to announce death to some, or mania, or other disease; which they pretend to know from past events, and declare they have never been deceived. In the gymnasia, among the athletæ and others who go there for exercise and to strengthen their system, they profess to determine accurately whether any deviation has been made in their accustomary and prescribed regimen or drinks, or in their stated exercise, or if venery has been indulged in. Nothing of all this can be hidden from us, say they, however slight the fault, so perfect is our art. And all this foolery is dignified by the name of prediction.
For my part, I pretend not to such predictions; I describe merely the symptoms by which we may judge if health or death will follow; of the continuance of the disease, and whether future health or death may be expected. Elsewhere I have treated of abscesses that occur, and how to judge of each by their respective appearance. I think that those persons who have predicted lameness and such events, have made the assertion after the disease was confirmed, and when it was evident that the abscess could not be restrained; for I cannot persuade myself that their prediction could have preceded its formation; and I think the same as to their other asserted predictions. Their proceedings are by no means difficult to such as choose to follow them. Thus, who is so ignorant as not to know a dropsy, or phthisis? and as for insanity, it is easily known if a predisposition to it exists, or if they have previously suffered from it. Such persons, by excess in drinking or in eating, or privation of rest, or by imprudent exposure to the vicissitudes of temperature, are assuredly very likely to be thus attacked. So in those affected with hemorrhoids; if in winter we notice them with a high colour, and drinking freely, is it not easy to predict what so often is observed to follow, viz., that in the spring a copious hemorrhage will take place, followed by pallid countenance and dropsical effusions in the summer? He, however, who desires to excel in this kind of quackery, will do well to attend to these particulars, and also consider if he will gather laurels from it. From works already in our hands, we are enabled oftentimes to foretell both death, delirium, and recovery. Much more might be added, but I have determined to write only what is most easily to be attained; at the same time advising every one to be very prudent and reserved, not only as to their predictions, but also in every part of their profession; being well assured that, by just predictions, they will be esteemed and regarded by every intelligent person, whilst deception or failure in prediction, will cause their discredit, and very soon lead others to consider them fools. I recommend, therefore, the utmost prudence in advancing predictions or other assertions, for I daily see and hear persons of but little judgment, who erroneously relate every thing that is done, said, or written, in relation to medicine.
With respect to the predictions affirmed to have been made to those who frequent the gymnasium as a means of improvement of health, I have no faith in the statements as they have been related; yet if any one thinks fit to believe them, he has my full consent. Opinion will scarcely be set aside by probability, good or bad, or be deemed sufficient by an individual who has pinned his faith on the subject asserted; for such faith has not been the result of a strict examination. I leave every one therefore to believe as he chooses. If nevertheless there is any truth in the assertions made, or in those things which the physicians of the gymnasium profess to affirm, relative to the omissions in the regimen they may have directed; still, he who has made such divination, must have founded it on some symptom, and have spoken of it doubtfully at first, though by subsequent extension it assumes a marvellous character. It is not easily ascertained in diseases, when errors are committed in regimen; although here, the patient is confined to his bed, and his treatment is simple, so that inquiries are necessarily very limited. Many are restricted to mere liquids, others in addition employ broths, or solid food of a stronger nature. Now, in such cases, if the simple drinks are too largely taken, respiration will be impeded, and the discharge of urine increased. If broths are taken beyond due amount, or a stronger nourishment, thirst and fever are superadded, and the belly becomes distended and hard. The physician can readily by examination convince himself of these changes and of any others, by means of daily observation. By the use of his reason and of sight, when visiting a person who ought to have remained quietly at home, under a particular regimen, it is easily ascertained if any deviation has taken place; as for instance if he had been moving about, or had eaten different articles; and by the aid of his own hands, he can discover the state of the belly or of the pulse. The sense of smell, in fevers, affords him much assistance, for the odour varies greatly in them, which is not the case in health if accompanied with an appropriate diet. Even our ears enable us to judge of the voice and of respiration in diseases, differing as they do from what is perceived in health. Suppose a physician to be acquainted with the nature of diseases and the habits of the sick, yet he is not thereby qualified to form a prediction; for if the disease is as yet unsettled, the above symptoms do not authorize it, and we must await its further progress before we can safely judge of what is to follow. If the symptoms above mentioned are the mere results of some error in regimen, they will probably disappear in twenty-four hours, and if such an event is announced, it will no doubt prove true. So far I cheerfully acknowledge that we may determine wherein a patient thus confined at home, may have proved disobedient; but as to those persons who frequent the gymnasia, and commit errors in diet, &c., I listen to the reports respecting them, and laugh at the narration. When only trifling errors are committed, I know no means of assuring myself about them; but if they are considerable, I will state how we may be led to their detection.
We must, in the first place, carefully observe the individual for at least a day, in the same place and at the same hour, especially at sunrise; at that time, fasting, and empty from his evacuations, he has had nothing to tire him, save perhaps a short walk, of no injurious tendency. He who follows a good regimen, will necessarily, at this time, be of his natural standard, both as to his complexion and his whole system; whilst the observer is also then more acute in mind and in vision. He ought to consider the character, habits, and powers of the person; for some more readily than others conform to directions. If one on a restricted diet should go considerably beyond it, it will be evident from an increase of fulness of the body and of its colour, except indeed the excretions are increased in due proportion. Labour is moreover better supported; we may inquire also if wind is discharged up or down, as is usually the case from such excess in eating and drinking. If the regimen requires frequent meals, and hard work, and the proper quantity is not taken, or drunkenness is indulged in; or if, after a hearty supper, exercise is pretermitted, this state of disobedience may be thus discovered. If, after omission of his supper, his usual exercise renders him more active, agile, and fit for work. If the exercise after supper is omitted, eructations, and flatulence ab ano take place, with little or no relief of a sense of fulness. Sweating, from work is more easily induced, respiration is difficult and oppressed, and the alvine discharges are more copious and less consistent. If both supper and exercise are omitted, languor and flatulent extension are increased. Should he have been inebriated, sweating is more profuse, with a difficulty of respiration, a sense of weight, abundant urine, and, unless headache exists, an augmented gayety. If venereal desire attends, and be moderately indulged in, it is useful; but if in excess, lassitude follows, the skin becomes rigid, and of an unhealthy colour.
As to the predictions from the alvine discharges, it may be remarked, that people who work hard, with little sustenance, have such evacuations, small and hard, daily, or every three or four days, or even at longer intervals, when there is danger of an attack of fever or diarrhœa; but liquid dejections, not moulded in passing, are of a worse character. Those who work hard and eat copiously should have easy discharges, the amount of food being proportioned to their labour; hence, with equal quantity of food, in health, if the work is great, the discharge will be small; whilst if the work is inconsiderable the discharges will be greater, and this is a rule of general standing. Liquid dejections or diarrhœa without fever, and ending on the seventh day or sooner, are advantageous, provided the discharge is made at once and not repeated; but if fever attends, or the diarrhœa is frequently renewed and obstinate, they are altogether bad, whether bilious, watery, or crude. Each of these varieties requires its own particular regimen and remedies.
The urine ought to be proportioned to the fluids taken in, pass off in an equable stream and with ease emptying the bladder, having a rather greater density than the drink taken. If less so in this particular, and at the same time more abundant than the prescribed drink, it indicates that more was taken, or that the nutriment was carried off by this channel. If discharged with a slight hissing sound, purgation is indicated, or may denote the existence of some affection of the bladder. A slight discharge of blood, without pain or fever, is of little importance, and may arise from fatigue; but if it is of frequent occurrence, and is accompanied by pain and fever, it is unfavourable, and we may predict a subsequent discharge of pus with relief to the pain. A thick urine, depositing a lightish sediment, denotes tumour or pain in some of the joints. All the other sediments in the urine of those who labour, arise from vesical affections, as manifested by pains not readily removed. All this, and similar, I have noticed, and have judged it proper to detail. I have associated with those who have talked of the exact predictions elsewhere made, I have conversed with their children, and with their disciples, and have read their writings, and having thus made myself fully master of their opinions, but finding no solid grounds for them, I was thence determined to commit my own to writing.
With respect to dropsy, phthisis, gout, and epilepsy, I shall remark that this is common to them all, viz., their extreme difficulty of cure when congenital. And now of each in particular.
For the cure of dropsy, sound viscera and adequate strength, with good digestion, are very essential; good breathing, freedom from pain, equable temperature of the whole body, no emaciation of the limbs, but rather a fulness, although the absence of both is best, with natural softness and size, and the belly soft to the touch. There should be neither cough, thirst, nor dry tongue, whether after sleep, or at other times, as often is the case. The appetite should be good, and after eating no uneasiness. Purgatives should operate promptly, and at other times the stools should be soft and figured. The urine should correspond with the regimen, and with the changes of wines. Labour should be readily supported without feeling fatigued. Such is the best state for an hydropic person, to give the expectation of recovery. In proportion as it deviates therefrom are our hopes to be less sanguine; but they must entirely cease when the reverse of what is above stated is the actual condition; or only be maintained according to the existing state of things.
It is much to be feared that dropsy will succeed large discharges of blood from the stomach and bowels; when connected with fever it will be of a brief character, and few recover. A prediction to this effect may be safely made to the friends of the patient. Large œdematous swellings, disappearing, and recurring again, are more readily cured than in the preceding case. They are, however, very deceptive, inducing the patient to dismiss his physician, and thus dying without assistance.
Of phthisis, advanced to the state of cough and suppuration, I shall refer to what I have already said of empyema. If likely to recover, the expectoration is easy, and should appear white, uniform in colour and in consistence, and free from pituita. Humours from the head should flow freely by the nose; fever should be absent, so that nourishment need not be interdicted, and no thirst should attend. A daily evacuation of healthy fæces, in amount proportioned to the food taken, should take place; emaciation ought not to occur; the chest should be square and hairy; and the sternum, small and well covered with flesh, should not project. With such accompaniments, there is little danger; without them, death is not remote. In youth, when suppuration forms from congestion, or from previous ulceration, or any similar cause, or from a repetition of an abscess, a recovery is not to be looked for, unless there is a combination of nearly all the above favourable signs. Such persons commonly die in the autumn, as is usually the case in all other chronic affections. Women and girls, in whom phthisis occurs from suppressed menstruation, rarely escape. If it occasionally happens, besides the presence of the above symptoms, a perfect and regular return of the catamenia must follow, or there is no hope to be entertained. No less fatal in man, woman, and girls, is the suppuration succeeding to a profuse hæmoptysis. It is by duly attending to all the symptoms mentioned, that a prediction can be given of health or death in phthisis accompanied with suppuration. Those who after hæmoptysis experience less pain in their back and breast, are most likely to recover; for their cough is less frequent, and though fever attends, it is accompanied with but trifling thirst. Nevertheless, the hemorrhage is often renewed, or an abscess is induced with a discharge of blood. When, with pains of the breast, emaciation slowly advances, with cough, and difficult breathing, but unaccompanied by fever or discharge of pus, we must inquire if something of a compact nature and of an offensive odour is not discharged by coughing.
As to gout, my sentiments are as follows:—Old people who have tophaceous concretions of the joints, with continual suffering, and habitual costiveness, are incurable, at least by any measures known to me. They are relieved by pain in the intestines (dysentery, Hal.), and by the humours tending to the inferior parts. When the patient is young, and not affected with articular nodosities, if he leads an active life, and is very regular in his evacuations, and in a duly adapted regimen, he may hope for a cure.
Epilepsy is very difficult to cure, when arising in childhood; and it strengthens by age. Next to this, when it arises in manhood from twenty-five to forty-five years. Then those, who have a sudden attack without any previous symptoms in any part. Such as have it springing from the head, or sides, or hands, or feet, are more readily cured. Even here there is much diversity; for if arising from the head, it is most difficult, and next from the sides: it is much more easy to cure, when its origin is in the feet, or hands. The cure is to be attempted by the same means which are useful in young, vigorous, and laborious people, unless the mind is affected, or an apoplectic tendency exists; for all vehement emotions of the mind are very bad: other emotions tending downwards are useful on whatever organ they may fix, especially if a sanguineous discharge is promoted. As to epilepsy occurring in old age, it is mostly fatal; if not soon destructive, they recover spontaneously, and without any medical assistance. When children suddenly squint, or are still more changed as to their vision; if tubercles of the neck occur, or stammering in speech, or long-continued dry cough;—or, if rather older, tormina take place without discharge, and contortions in the sides, with varicose vessels on the belly, or a hernia of the omentum, swelled testicles, wasting of the hands or feet, or their complete impotency, without any apparent cause—be assured that in all such cases, there has been an attack of epilepsy. This will often be admitted by those who have the care of them. Some however have not observed it, and therefore deny that such an event has taken place.
In order to predict the termination of ulcers, it is essential previously to study carefully the constitution of the individual; for in some they readily heal up, in others they do not. Age likewise is to be had in view, for each advance of life has its peculiar ulcers, of more or less easy removal. The parts of the body are equally different in this respect. Especially is it necessary to be well informed as to the good or bad in all these cases;—and he who has made himself fully master of them, is alone qualified to predict their events; for how is it possible, if this is not the case? Now a good state of the body consists in its agility, good proportion, a healthy state of the viscera, and being neither too fat nor too meagre. The skin should be fair, brown, or of a light fleshy tint. All of these separately are good; but if intermixed with a greenish hue, or if pale or livid, this is unhealthy: in fine, every deviation from the three colours above mentioned, may be reckoned to be bad. As to the connexion of age with ulcers, children are liable to tumours, which suppurate, and to struma, which for the most part readily heal. If older, such also occur, and are less easily cured. Men are not so liable to them, but they are to tumours of an encysted, or cancerous nature, often concealed, and of a high degree of danger; sometimes to pustular eruptions and creeping ulcers, up to sixty years of age. A still more advanced period brings with it a disposition to cancers of the internal organs, or of the extremities, scarcely ceasing but by death. The most difficult of these to cure, are seated in the axilla, in the loins, and thighs, to which parts the humours are most abundantly directed, and a return of them is very usual. In affections of the joints, the thumb and great toe are the parts most liable to be attacked, especially the latter. The tongue is not unfrequently ulcerated by some adjoining decayed tooth.
Wounds are mostly fatal that are made in the large vessels; likewise in those of the neck and groins, or in the brain and liver, intestines and bladder; the danger is proportioned in a measure to the extent of the wound, as well as to its direction: the constitution is also to be considered;—in some persons, little or no fever or inflammation take place after wounds, whilst others are promptly affected thereby. If the patient becomes delirious, whilst the wound appears otherwise trifling, every attention must be paid to it that art can bestow, seeing that death occurs from all description of wounds. There are an immense number of vessels, both great and small, from which a spontaneous hemorrhage might prove fatal, but which on other occasions might be opened with advantage. Many wounds occur in parts of little importance, and which apparently have nothing formidable in them, which are, however, attended with such severe pain as to impede respiration. At times, instead of this, the pain induces delirium and fever, with death. If subject to these symptoms, it is less alarming when they occur. Nor is this surprising, considering the difference between men, both as to mind and body, and of what resistance they are capable. Should wounds happen under these circumstances of mind and body, whilst there seems from the irritation and violence of the injury, but little hope of restoration to his senses and to health, every thing must be abstained from, save only what is absolutely required to restrain the frequent faintings. As to all other wounds, especially if recent, their cure should be undertaken and persevered in, until all fever subsides, or danger of hemorrhage, or of a degeneration into eating ulcers. Always be watchful to guard against accidents, for it is of much importance. Eating ulcers, with great depth, blackness, and dryness, are fatal. The state of such as afford a blackish sanies is very dangerous. When the discharge is white and mucous, they are less fatal, but more frequent, and of longer continuance. Tetters, of all the eating ulcers, are the least fatal, but they are, like occult cancers, difficult of cure. In all these cases a fever for twenty-four hours affords relief, especially if the suppuration is white and thick. The exfoliation of a tendon or of a bone, or of both, is useful in deep and black suppurations, for it then happens that the pus improves and the putrefaction ceases.
As to wounds of the head, such are the most to be dreaded that reach the brain. All are dangerous, if accompanied by denudation of the bone, by compression, or by fracture. If the wound is small, but with extensive fissure of the bone, the danger is greater; and yet more so, if it be near the sutures and the upper part of the head. In all cases of wounds of the head deserving attention, if recent and fresh, we should inquire if the person fell from the blow at once, and became drowsy. If so, greater care is requisite, as there is reason to presume the brain is interested. Should the injury be of longer standing, other symptoms must be regarded and carefully considered. Now, it is very favourable if there be an absence of fever, hemorrhage, and inflammation, and no pain has succeeded. If any of these attend, it is better that it should have taken place immediately, and been of short duration. If pain attends, an inflammation of the edges of the wound is favourable, and after the hemorrhage, that pus should make its appearance; if fever, that the favourable signs elsewhere described in treating of acute fevers should attend; the reverse of which is unpropitious. But when the fever begins on the fourth, seventh, or eleventh day, it is a fatal symptom. It commonly has a crisis on the eleventh day, if its commencement was on the fourth; on the fourteenth or seventeenth, if it began the seventh; and on the twentieth, if it began on the eleventh, conformably to what is written on fevers arising without any manifest cause. If, at the commencement of the fever, delirium takes place, or paralysis of any part, the person will die, unless some very favourable symptom is present, or his constitution is very strong. This must be particularly attended to, for in some cases there is a hope of recovery, yet with the continued loss of the limb that had been affected, if he should survive.
In wounds of the limbs, if large, and the tendons are divided that are connected with the joints, it is evident that the use of them will be destroyed. If any doubt as to this exists, that is, of the wound of the tendons, when pierced by a dart, a direct wound is more favourable than if oblique. If the weapon inflicting the injury be heavy and blunt, the danger is equally great, and is to be estimated by the depth of the wound and other symptoms. Among these are, whether suppuration extends to the joint, which is very dangerous; whether obstinate tumours continue, producing induration of the parts, of long duration, even after the wound is healed; in which case the motion of the joint will be long in restoration, especially if the limb has been suffered to remain in a state of extension during the cure. When the probability is that the tendon will exfoliate, it is correct to predict lameness of the part, especially if in the lower extremities. The destruction of the tendon may be known by the long-continued discharge of a white, thick, purulent matter, with pain and inflammation of the joint from the onset. The same is the case when the bone separates. In fractures of the elbow, with inflammation, and ending in suppuration, incisions and cautery are required. In affections of the spinal marrow from falls or other cause, or if spontaneous, the use of the legs is lost; if the hand is placed on the belly or bladder, no sensation is felt. At the commencement, neither fæces nor urine are discharged except by medicine; but if of longer standing, they pass off involuntarily, and death soon follows.
When the fauces are filled with blood, by day and by night, unaccompanied by headache or cough, or vomiting, fever, or pain in the breast or back; the fauces and nostrils should be examined, to ascertain whether it may not arise from ulceration or from a leech.
Watery eyes are easily cured, when the swelling, tears, and sordes all commence at once; if the tears and sordes are intermixed, without much heat, if the sordes be white and soft, and the swelling light and extended, and the lids agglutinated, but without pain, little danger is to be dreaded, and the disease will be of short duration. But if the tears are abundant, hot, with a small discharge, and swelling in one eye only, it is of longer continuance, although not dangerous, and without pain. Here, it is highly necessary to attend to the crisis, which may be expected on the twentieth day; if it extends beyond this period, it occurs on the fortieth, or even proceeds to the sixtieth. During all which time the discharge should be examined, whether it is mixed with the tears, if white and soft, and this especially at the time of the crisis, as such will be the case if the disease is about to terminate. If both eyes are affected equally, there is more hazard of ulceration, and the crisis will be less prolonged. Ophthalmia, if dry, is very painful; it is not of long continuance unless ulceration ensues. If the swelling is large, dry, and without pain, it is not dangerous; but if it is painful and dry, an ulceration of the eye may be feared, and accretion of the lids. There is danger when the pain is accompanied with tears, for from such hot and salt humours ulceration of the pupil or lids may be apprehended. If the swelling continues, with discharge of tears and sordes for a long time, an eversion of the lids is to be expected in men; and the same, together with ulceration, in women and children. Should the sordes be of a greenish or livid tinge, the tears abundant and scalding, with heat of the head, and pain extending from the temples and fixed in the eye, preventing sleep, ulceration will ensue in the eye, with danger of its bursting. A fever supervening is favourable, as is also a pain about the loins. To predict in such a case, the time of the complaint must be kept in view, as well as the nature of the discharge from the eye, the pains, and the insomnia. When enabled to examine the eye, if any part is found ruptured, and through the opening any part should project, this is very unfavourable, for it is difficult to replace it. Should it be in a state of putrefaction, there is no hope of its recovery; the sight is entirely lost. The results of other ulcerations may be predicted from a consideration of their locality, and the extent and depth of the ulcer, for the cicatrix that ensues will be in proportion thereto. When the eye is ruptured and the pupil is thereby displaced, there is no further hope of the recovery of sight, either from time or from remedial means. Slight displacements may indeed be relieved in young subjects, provided nothing bad supervenes. We may anticipate in youth, if no further evil ensues, that the cicatrices, if recent, may be removed by time or by art. As to the part wounded, the most dangerous is that in which the pupil is interested,—next, when it is above the supercilia, and then according to the proximity to them. When the pupil assumes a grayish, argentine, or bluish tint, it is a bad sign. If it contracts, it is more favourable; or if it enlarges and contracts, or even assumes an angular appearance, whether spontaneously, or from some obvious cause. Obscurity of vision, clouds, and white spots, diminish and disappear, unless an ulcer should attack the part, or a previous cicatrix or pterygion had existed. If a cicatrix of the black of the eye should occur, giving to the part a whitish appearance, and in time becoming thick and rough, it will leave behind it evidence of its existence not easily eradicated.
The crises as described in fevers, are similar in these cases. In order to predict them, we must be master of the symptoms, know well the diseases of the eyes, and their differences. The greater the number of the unfavourable signs, the disease will be in the same ratio prolonged, as is explained in writings on the subject. If the symptoms are good, in the like ratio will be the period of the disease, and a crisis may be looked for on the seventh day, or shortly after, and all danger considered as past. Relapses are to be guarded against, when such changes for the better occur on non-critical days, and without the accompaniment of good symptoms. In all affections of the eyes, the urine should be inspected, and the fleeting nature of opportunity should be kept in constant remembrance.
Pains in the bowels, attended with fever, and a variety of alvine dejections, with inflammation of the liver, of the præcordia or belly, with nausea and thirst, are always bad; and the more of these there are, in the same degree are they dangerous. If few in number, the hope is the greater. The greatest danger is at about five years of age, and thus up to that of ten, after which it is much lessened. Such pains as are beneficial are unattended by the above symptoms. When accompanied with bloody stools, and such as resemble the washings of flesh, they terminate on the seventh or fourteenth, the twentieth or fortieth day, or at some intermediate period. Such discharges often give relief to other diseases. If of a chronic nature, that relief is more slow, but quicker if they are recent. Women, during pregnancy, are subject to them up to, and even after delivery. The discharges of blood and matters resembling the scraping of the bowels, and that for months, are not always the source of abortion, unless conjoined with pain and other of the enumerated symptoms of dysentery. If so, they prove fatal to the fœtus, and of great danger to the mother, until parturition and the discharge of the secundines; and afterwards, if then the dysentery does not at once cease, or soon after.
Frequent and long-continued lientery, coming on at all hours, both by day and night, with or without strepitus, with a discharge of crude and undigested or dark-coloured matters, and unformed, of offensive smell, are uniformly bad. They excite thirst, but the fluid is not conveyed away by urine. The mouth becomes ulcerated, blotches and spots of different colours appear in the face, similar to what are called freckles, and the skin of the belly becomes rough, like dough in fermentation. The appetite entirely fails, and all exercise or work is out of the question. This disease is most severe in old age; in middle life, less so; but much less so in early life. In all cases, except the two first mentioned, when the above formidable symptoms are not in great amount, it is less to be dreaded. It requires to be carefully attended to, until the urine is discharged in due amount to the drink taken in, and the system appears to derive nourishment from the food, and the skin to be liberated from its mottled appearance. The other profluvia, unaccompanied with fever, are of short duration, and generally of a mild character; they commonly cease spontaneously, or yield to lotions. We may announce the evacuations about to cease, when on applying the hand to the belly, no motion is felt, and when flatus is discharged at the close of an evacuation. Diarrhœa, in men afflicted with the hemorrhoids, occasions a prolapsus ani; and dysentery induces the same in children with calculus, and in old people who with difficulty evacuate their mucous accretions.
We may estimate the facility or difficulty of conception in the manner following. First, as to the exterior. Small women are more apt to conceive than large ones; thin women than fat; brown than pallid; white than florid; such as have prominent veins, than those in whom they are deep-seated. Excessive fleshiness is unfavourable to conception at an advanced age. Large and turgid breasts are favourable; all of which signs are apparent to view. With respect to the interior, it is necessary to know the state of the uterus, as to its health, its dryness, and softness; neither retracted nor too low down; its orifice should not be awry, nor compressed, nor too extended; for in all such cases pregnancy is impossible. So likewise we must ascertain the state of menstruation; if it duly takes place every month, in adequate quantity, and of a proper colour; at regular and equal times in a month. If so, the circumstances are favourable. When therefore conception does not occur, if the woman is pallid, free from fever, and no apparent fault of the bowels; if she complains of headache, of painful and ill-conditioned catamenia, in small amount, and at distant and irregular periods, the uterus requires to be evacuated. If the woman has a good complexion, with much flesh and fat, so that the vessels are unseen; if free from pain, and menstruation is entirely absent, or trifling and ill-conditioned, it is very difficult to promote conception. On the contrary, if the body is vigorous, the menses superabundant, and pregnancy does not occur, there is some fault of the womb; it is retracted, or too open. Other affections of that organ are connected with pain, and a bad complexion, together with emaciation. Should there be an ulcer in the womb, the result of parturition, or of some tumour or other cause, fever is the consequence, with swellings and pains in the groins: and if to this an interruption of the lochia be added, the evil is rendered worse and more obstinate; and there are, moreover, superadded, headache and pains of the præcordia. When the ulcer heals, the part is left in an indurated state, and the aptitude to conceive is diminished. When the ulcer is in the left side only, and whilst continuing, conception takes place; or if it has healed, and the state of health is otherwise good, it is most probable that the child is a male; but if it is the right side that has been affected, the probability is greater of its being a female. If pregnancy cannot take place, and fever and a cough oppress her, it is necessary to ascertain whether an ulcer of the womb exists, or any of the affections I have mentioned; and if there is not, a vomiting of blood may be anticipated, presuming that the menses have necessarily disappeared: but if they return, and the fever leaves her after the hemorrhage, pregnancy may ensue. If the bowels are greatly disordered previous to the hemorrhage, there is danger of dying before the vomiting up of the blood. Some persons imagine themselves pregnant when it is not the case, and persevere in the mistake for many months. The menses disappear, the belly enlarges, motions are felt, headache and pains of the neck and hypochondria attend; but little or no milk in the breasts, or if any, of an aqueous nature. When the belly subsides and becomes soft, if nothing else prevents, conception may occur; for such a state is calculated to promote a change in the uterus favourable thereto. All the above-mentioned pains are not felt in true pregnancy, unless from being previously accustomed to them. Headache exists and milk is secreted. In long-continued uterine fluxes, we should inquire if headache, and pains of the loins and pelvis are present; and also if there are toothache, dimness of sight, and humming of the ears. Whenever, fasting, bilious matters are vomited for many successive days, without being in a pregnant state, or having fever, ascertain whether lumbrici are not also voided at the same time. If the answer is in the negative, we may announce their probable occurrence; for it is by no means uncommon with women and virgins, but less the case with men.
They who suffer pains without fever are not in danger of death, but of a long continuance, together with metastases and relapses. Of these pains are headache, sometimes trifling, at others severe. We must notice if there is dizziness, with redness of the eyes and itching of the forehead, in which case bleeding, or a spontaneous discharge of blood, will afford relief; it is a simple case. But when headache and pain in the forehead arise from exposure to winds and cold, whilst much heated, a catarrh sometimes dissipates it. Sternutatories are useful, producing a copious discharge of mucous pituita from the nose. Catarrhs very naturally are followed by cough, and if the accompanying sneezing does not give relief, swellings and changes of complexion succeed. Where obstinate and universal headache occur, with apparent cause, if the patient is thin and exhausted, a more severe disease is to be feared. If the pains fly from the head to the neck or back, and then return, it is worse; and still more so, if at the same time all the three parts mentioned are suffering from it. An abscess occurring any where affords relief, so does a purulent expectoration, a hemorrhoidal discharge, or a crop of pustular eruptions over the body. A scaldhead sometimes cures it.
In case of drowsiness, with intolerable itching of the whole head, or some particular part, with a sense of coldness over the head at times, we should inquire if the itching extends to the end of the tongue. If so, some disease of difficult cure is forming; otherwise the cure is easy. Its mode of termination may be deduced from what has heretofore been said respecting abscesses, which however are less frequent in these cases. Should vertigo be conjoined with the pains, the disease will prove obstinate and threatens mania. Old people are more subject to this. Other affections of the head, which often attack both men and women, are less dangerous, though violent and of long duration. Boys and girls often suffer from them, particularly the latter, at the approach of menstruation. The headache of women in most particulars is similar to that of men, but with less itching and bilious affections, unless after the cessation of the menses.
All those who in early life have a bad complexion for a long continuance, not however icteritious, whether men or women, are subject to headache; they devour earth and gravel, and are affected with hemorrhoids. A bilious complexion, of an obstinate character, but not of a strongly marked icteritious nature, is accompanied with similar complaints; but in place of the unnatural appetite mentioned, they have much more pain in the præcordia. Long-continued paleness with tumid face, is accompanied with headache or pain in the bowels, or they have some disease of the rectum. In other respects the disorders mentioned are seldom single, but often remain latent and subsequently appear.
Nyctalopia is an affection indicated by seeing in the dark. It occurs in youth, both in childhood and adults; it disappears spontaneously, sometimes in forty days, at times in seven months, or even continues a year. The period of its cessation may be judged of from the degree of the affection and the age of the patient. A cure follows a formation of abscesses on the lower extremities, which is not however common in early life. Women are exempt from it, and girls also when menstruation appears. If the disease follows a long-continued flow of the tears, inquiry should be made if previously headache was common.
If without fever or an unhealthy complexion, headache and pains in the temples are customary, when no tendency to eruption in the face exists, nor hoarseness of the voice, nor toothache, we may anticipate a hemorrhage from the nose. In such cases, although apparently enjoying good health, we shall find the spleen enlarged, and headache, or sparks flying before the eyes. In most cases, affections of the spleen are accompanied with headache.
Ulceration of the gums and fetid breath are frequent attendants on enlarged spleen. When with enlarged spleen there is neither hemorrhage nor offensive breath, it will be found that there exist ill-conditioned ulcerations of the legs and livid scars. If, moreover, eruptions of the face attend, hoarse voice, and toothache, epistaxis may be looked for. The spleen is enlarged also in such as have the lower lids tumefied. If the feet swell, and appear to be anasarcous, the belly and the loins should be carefully examined.
Twitchings of the face, without the rest of the body suffering, soon disappear, either alone or by some slight remedy; otherwise there is a chance of apoplexy. And if to the loss of motion, atrophy of the limb is united, its restoration to health is not to be expected; but if it still continues to receive its nutrition, motion will be restored. In order to estimate the period of its restoration, regard must be had to the extent of the complaint, its period of commencement, the age of the patient, and the season of the year; always bearing in mind that the older the disease the more obstinate and dangerous it is, as well as more frequent in recurrence, and more particularly in old age. Autumn and winter are less favourable for its removal than spring or summer. Pains in the shoulders descending to the hands, and there inducing numbness, are not followed by abscesses, but are relieved by vomiting up black bilious matters. When the pains remain fixed in the shoulders, or extend to the back, a discharge of pus or of black bile restores health. The issue of each of the above may be conjectured by the respiration being free or difficult; if free, and the patient is thin, the presumption is in favour of the bilious vomiting; if difficult, and the countenance is florid beyond what is usual, and differing from its common hue, the probability is that pus will be discharged. We should ascertain if the feet are swelled, as this is a confirmatory symptom. This disease is more usual and violent from forty to sixty years of age, which is likewise the period at which sciatica is most prevalent.
With respect to sciatica, the following observations demand attention. In age, if subject to cramps, with coldness of the loins and legs, the penis torpid, the intestines moved only by medicine, and then principally of mucosities, the disease will be very obstinate. It may be predicted to continue for a year at least, unless relieved by spring and summer. In young people, the disease is to the full as painful, but it is of less duration; forty days will usually bring it to a termination. The cramps are less severe with them, as is likewise the coldness of the loins and legs. When the pains of the loins and thighs are not sufficiently great to keep them lying down, we must examine if in the sciatic region there is any swelling, and if the pain extends to the groin; for if either of these be the case, the disease will be of long continuance. Inquire also if there be numbness of the thigh and of the ham. If the answer is affirmative, ask if it extends to the leg and tarsus. When this is the case, it may be foretold that the thigh will have alternate accessions of heat and cold. Should the disease quit the loins for the inferior parts, we may give encouragement to the patient; but if it continues in the loins and sciatic region, and extends upwards, it may be considered as very serious.
In all intermitting pains and swellings of the joints, not having a gouty character, the viscera will be found enlarged, and a white deposit takes place in the urine. If in such cases there is tumefaction of the temples, there will likewise be much pain and night sweats. But if a white deposit does not take place in the urine, and there are no sweats, there is danger of lameness of some joint, or a formation of the kind of tumour denominated meliceris. Such occur in those persons who in childhood and youth were subject to bleeding from the nose, which had been arrested. Inquire, therefore, if such had been the case, and whether sharp itching and heat of the back and breast are present, and if also there is a sharp and constant pain of the bowels, or hemorrhoidal tumours; for these are commonly the source of the complaint. If the complexion alters, inquire if headache exists, and such will be found to be the case.
When the pain of the belly is confined to the right side, it is more severe than if on the left, particularly in those in whom the pain extends from the hypochondrium to the liver. Such pains are sometimes relieved by the discharge of wind, which is followed soon after with that of much pale urine. This disease is not fatal, but of long duration; and if very inveterate, is apt to affect the sight. We should make inquiry respecting any hemorrhages in youth, or defect of vision, respecting the colour of the urine, and of the discharge of flatus, and whether benefited thereby.
Impetigines, and vitiligo, and morphew, occurring in infancy or in youth, apparently trifling at first, ultimately augment; the abscesses and eruptions attending are not the consequence of, but constitute a part of the disease itself. In fact, when a tumour forms here suddenly, and is large, it becomes a real abscess. A species of white leprosy, called elephantiasis, is one of the most fatal diseases. All these affections arise from atrabilis. The more recent they are, the more readily are they cured in early life, and when confined to the most soft and fleshy parts.
[a ]Clifton has given a translation of this treatise under the head of “Hippocrates on Prognostics.” Haller has divided it under nineteen chapters, but I have followed Clifton in making no distinct parts.—Ed.