SECT. IV.—HOW TO KNOW WHETHER THE DISEASE WILL PROVE FATAL OR NOT.
These are fatal symptoms: A deathlike countenance, sharp nose, hollow eyes, and the other symptoms described by Hippocrates, when they do not proceed from watchfulness, or evacuation, or want of food; also, intolerance of the light, shedding tears from no external cause, there being no particular affection of the eyes; or the one eye appearing less than the other; or the white of the eyes becoming red, or livid, or black, or having a muddiness in them; and the white of the eyes appearing during sleep, the eyelids not being closed, unless this symptom proceed from a great evacuation, or from habit. Likewise grinding the teeth, a state of delirium, picking at flocks of wool, or bits of chaff, are not favorable. Attention should also be paid to the patient’s mode of lying. To lie on one’s back, as it were, in a relaxed state, and to sink downwards in bed, are indications of extreme debility. It is still worse to have a cold respiration at the mouth and nostrils; and a pulse obscure, dense, and intermitting, and profuse sweatings with syncope are most mortal symptoms. If all the symptoms we have mentioned, or even more appear, or if they be fewer in number but strong, and if they be without any of the favorable ones, death is inevitable. The breathing free, pulse natural, soundness of intellect, being well disposed to take whatever is offered, the appearance of countenance and mode of reclining like those of persons in health,—all these symptoms are favorable and prognosticate recovery; and, in general, whatever symptom is contrary to the natural state indicates an unfavorable, whereas, what is correspondent, indicates a favorable termination. Concerning the prognosis from the urine, alvine discharges, and sputa, we will speak soon.
Commentary. The great master of prognostics is Hippocrates, whose system of medicine was entirely based on the observation of the favorable and unfavorable symptoms of disease. It would appear that the first advances in this art were made in the temples of the gods, and especially of Æsculapius, which the sick were in the practice of resorting to in order to ascertain the issue of their maladies. See a very ingenious and learned disquisition, ‘de Hippocratis Doctrina a Prognostice oriunda,’ by F. Z. Ermerins, M.D. The works of Hippocrates, especially the ‘Prorrhetica and Coacæ,’ contain a rich treasure of observations which cannot be too much explored by the student of medicine. His prognostics are founded upon the appearances of the face, eyes, tongue, the voice, hearing, the state of the hypochondriac region, the abdomen, the general system, sleep, respiration, and the excretions. We can do little more, in this place, than express our high sense of the value of the ‘Hippocratic Treatises on Prognostics,’ and recommend the study of them to all members of the profession who would wish to learn the true inductive system of cultivating medicine. We shall give as a specimen of Hippocrates’ and Galen’s labours, in this department, a few of Galen’s remarks on the causes of the symptoms, as described by Hippocrates. It is one of the prognostics of Hippocrates, that profuse perspiration in acute fevers is unfavorable; and, in explanation of this, Galen states that a critical sweat may indeed be favorable; but that such as are profuse and continued indicate a complete prostration of the vital powers. A fixedness of the eyes is said by Hippocrates to be a fatal symptom; the reason of which, according to Galen, is, that it proceeds from paralysis, or insensibility of the muscles of the eye. Hippocrates mentions it as an unfavorable symptom when the patient lies with his mouth open; and Galen attributes this symptom to the origin of the nerves, that is to say, the brain, undergoing pressure. Hippocrates states, that involuntary discharges from the bowels are an unfavorable symptom; and Galen justly remarks that they indicate great insensibility.
The Prognostics and Aphorisms of Hippocrates are further illustrated by the learned and interesting Commentaries of Stephanus Sophista, Theophilus, and Damascius, which were published a few years ago by Dietz. From the nature of their works, it is impossible to give any satisfactory outline of their contents within our narrow limits. We shall merely give one specimen of them. It is stated in one of the Aphorisms of Hippocrates, that dyspnœa and delirium occurring together in fever, indicate a fatal termination. Upon which Theophilus and Damascius remark, that the one symptom implies disease of the heart and the other of the brain. (Ed. Dietz. T. H., p. 415.)
Celsus gives an elegant translation of this part of the works of Hippocrates. The following is his version of the description of the Facies Hippocratica: “Ad ultima jam ventum esse testantur, nares acutæ, collapsa tempora, concavi oculi, frigidæ languidæque aures et imis partibus leniter versæ, cutis circa frontem dura et intenta, color aut niger aut perpallidus.” Other unfavorable symptoms are also strikingly portrayed: “Mali morbi testimonium est vehementer et crebro spirare: a sexto die cepisse inhorrescere; pus expuere; vix excreare; dolorem habere continuum; difficulter ferre morbum; jactare brachia et crura; sine voluntate lachrimare; habere humorem glutinosum dentibus inhærentem; cutem circa umbilicum et pubem macram, præcordia inflammata, dolentia, dura, tumida, intenta, magisque si hæc dextra parte, quam sinistra est; periculosissimum tamen est, si venæ quoque ibi vehementer agituntur.”
Aëtius and Oribasius, like our author, borrow almost every thing from Hippocrates and Galen.
Rhases and Avicenna, particularly the latter, treat of the prognostics in fever very fully. Avicenna, like Hippocrates, sets down deafness as an unfavorable symptom. Hippocrates had stated, that jaundice coming on before the seventh day is unfavorable; but Averrhoes affirms, that all the Indian and Persian physicians reckoned it a favorable symptom. Rhases considers yellowness of the skin an unfavorable symptom, unless the fever be of a bilious nature. Alsaharavius says it is an unfavorable complication when it does not prove critical. It is proper to mention here that Hippocrates modifies the above prognostic by stating in one of his aphorisms, that jaundice coming on on the 7th, 9th, 11th, or 14th day is favorable. (iv. 64.) Alsaharavius states it as a dangerous symptom, when the patient lies on his back with his legs drawn up. This agrees with the prognostic of Celsus “Mors denuntiatur ubi æger supinus cubat, eique genua contracta sunt.” Avicenna and Averrhoes state it as a fatal symptom when the patient sinks down in bed and exposes his hands and feet. (Averrhoes, Comment. in Cant. Avicennæ.)
According to Rhases it is a bad symptom when the patient has lost his modesty, so as to expose freely those parts of the body that should be covered. He holds also that it is a bad symptom when the vomitings resemble verdigris. (Ad Mansor. x, 21.)
Prosper Alpinus gives an admirable account of the prognostics in diseases. See his work, ‘De Præsagiendâ Morte et Vitâ ægrotantium,’ passim. He agrees with the ancients, that deafness is an unfavorable symptom, unless it occur at the time of a crisis. Like the ancients, he considers the absence of thirst an unfavorable symptom in ardent diseases, as indicating that the system is insensible of its wants.