the book of prognostics-第3节

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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　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　violenc