XIV.—Pus that has a whitish color and a uniform consistency, that is smooth and free from clumps, and the odor of which is only slightly unpleasant, is the least harmful. On the other hand, a pus which possesses the opposite characteristics is very dangerous.
XL.—Severe pain in the ear, if associated with a persistent fever is dangerous, for the patient may become delirious and die.
[There are 47 chapters in the Book of Prognoses; in addition, there are 740 separate sections in the Coan Prognoses (Praenotiones Coacae).]
The Epidemic Diseases.—VI.—4. The wife of Agasis had already as a young girl been troubled with shortness of breath. After she had reached womanhood, and soon after she had given birth to a child, she lifted a heavy weight. Immediately she heard, as she believed, a noise in her chest, and on the following day she experienced some difficulty in breathing and a certain amount of pain in her right hip. These two symptoms were so related to each other that, whenever the pain in the hip made its appearance, she immediately became conscious that she was short of breath, and, vice versa, whenever the pain ceased, she found that her breathing became easier. Her expectoration was of a foamy character and of a rather bright color, but, after it had been allowed to stand for a short time, it looked like diluted biliary matter that had been vomited. The pain in the hip troubled her chiefly when she performed manual work. She was advised to abstain from eating garlic, pork, mutton, and beef, and not to call loudly or to get excited while she was engaged in work.
VII.—7. The wife of Polycrates became feverish during the summer season, and about the time of the dog star. In the morning her breathing was somewhat embarrassed, but after mid-day it became more difficult and at the same time more rapid. From the very beginning of the illness she had a cough and expectorated purulent masses. In the throat and along the course of the trachea one could hear a hoarse whistling sound. The patient’s face had a healthy color, and over the two halves of the jaw there was some redness, not of a deep hue but rather fresh and bright. A little later her voice also became hoarse, she began to show some emaciation, raw spots developed over the fleshy parts of her hips, and the surface of the body grew more moist than it had been before. On the seventieth day the outward evidences of fever became much less noticeable, but the respiration grew more rapid; and from that day to the time of her death, five or six days later, she was obliged to remain in a sitting posture. Toward the end the tracheal râle grew louder, and dangerous sweats occurred, but the patient never lost her expression of intelligence.
Fractures.—II.—9. In the human body the foot, like the hand, is composed of a number of small bones. As they are not easily broken it may safely be assumed, when such a case of fracture comes under observation, that some pointed or unusually heavy object had caused the lesion, and that the surrounding soft parts must necessarily have been injured at the same time. (Injuries of this nature will be discussed in a later section.) But if any part of this bony framework is pushed out of its natural position—whether this take place in one of the toes, or in one of the tarsal bones, it makes no difference—the dislocated part should be forced back into position in the manner recommended in section XXIV. In its essential features the treatment consists in the employment of wax plaster, compresses, and bandages, exactly the same as is done in the treatment of fractures of the long bones, but without splints. The same rules hold good with regard to the degree of pressure to be applied, and every third day the dressings should be renewed. On each occasion of such renewal the patient should be questioned with regard to the sensations which he feels after the bandages have been applied, and if necessary they should be readjusted in accordance with the nature of the answers which he gives. The great majority of these injuries heal completely in twenty days. The exceptional cases are those in which the fracture] involves a bone that stands in immediate relation with the bones of the leg. It is advisable, however, that the patient should remain in bed during the period mentioned; for, in not a few instances, the persons thus affected, failing to appreciate the gravity of the injury, walk about before the parts have really healed; and then, for an indefinite period of time, they are frequently reminded in a painful manner of the injury which they received. There is nothing astonishing in this when the fact is recalled to mind that the feet support the entire weight of the body.
[Forty-eight chapters or sections, some of them of considerable length, are devoted to the subject of fractures. The authorities are almost unanimous in stating that this portion of the so-called Hippocratic writings was written by Hippocrates himself. Malgaigne and Petrequin, two of the most competent French writers on questions relating to surgery, declare that the treatises written by Hippocrates on fractures and dislocations (the two forming in reality one continuous treatise) are the best and most complete books ever written by a physician.]
Wounds of the Head.—10. The physician should, first of all, before touching the patient’s head, inspect carefully the wound and surrounding parts. After noting whether the injury has been inflicted upon a strong or a weak portion of the head, he should ascertain whether the hair has been cut by the fall or the blow, and whether portions of it have penetrated into the wound. In the latter event he should express his fear that the skull at this point has been laid bare and has perhaps even received some material injury. He should make this statement before he has touched or probed the wound. Then afterward he should proceed to a physical examination of the injured parts, in order that he may learn positively whether the overlying soft tissues have or have not been separated from the bone. If simple inspection reveals the fact that the skull has been laid bare, well and good; but, if the real condition is not thus revealed, he should not hesitate to employ the probe. If he finds that the soft parts have been separated from the bone and that the latter has been more or less injured, he should continue this more minute exploration until he shall have ascertained to just what extent and in what manner the skull has been injured, and what measures are required to remedy the damage; in brief, he should make the diagnosis. At the same time, however, he should not neglect to question the patient very closely about the manner in which the wound was inflicted, for in this way he may be able to infer the existence of a contusion, or even a fracture of the skull, of which no material evidences are discoverable. Important information may also be gathered by passing the hand over the seat of injury in the bone,—information which the employment of the probe is not competent to convey.
[Twenty-one additional chapters are devoted to wounds of the head, every possible phase of the subject being handled by Hippocrates in the most careful and thorough manner.]