25. He who would know correctly beforehand those that will recover, and those that will die, and in what cases the disease will be protracted for many days, and in what cases for a shorter time, must be able to form a judgment from having made himself acquainted with all the symptoms, and estimating their powers in comparison with one another, as has been described, with regard to the others, and the urine and sputa, as when the patient coughs up pus and bile together. One ought also to consider promptly the influx of epidemical diseases and the constitution of the season.[518] One should likewise be well acquainted with the particular signs and the other symptoms, and not be ignorant how that, in every year, and at every season, bad symptoms prognosticate ill, and favorable symptoms good, since the aforesaid symptoms appear to have held true in Libya, in Delos, and in Scythia;[519] from which it may be known that, in the same regions, there is no difficulty in attaining a knowledge of many more things than these; if having learned them, one knows also how to judge and reason correctly of them. But you should not complain because the name of any disease may happen not to be described here, for you may know all such as come to a crisis in the afore-mentioned times, by the same symptoms.[520]
APPENDIX
TO
THE BOOK OF PROGNOSTICS.
As announced in the Preliminary Discourse (Sect. II., 18), I shall now proceed to give an abstract of the principal matters contained in the Second Book of Prorrhetics, which appear to me to be highly interesting, and as they relate to the subjects treated of in the Prognostics, they may be more suitably introduced here than in any other place.
The author commences the treatise with expressing his disapproval of certain modes of making prognostics which he had seen practiced. He says he had heard of many and famous predictions having been made by physicians, such as he himself did not pretend that he could make. Such, for example, as for a physician to call in upon a patient who was looked upon as being in a desperate condition by another physician, and predict that he would not die, but would lose his sight. Or to predict with regard to another patient supposed to be in a bad way, that he will recover, but will become lame of a hand. And of a third who, to all appearance, cannot recover, to predict that he will get well, but that his toes will blacken and putrefy. Similar predictions are related under this class. Another mode of prediction is to prophecy to buyers and traders, to one death, to another madness, and to the rest diseases, and that from what is now occurring, or has occurred before, and all the predictions to turn out true. Another kind of predictions relates to Athletæ, and those who practice gymnastic and laborious exercises for the cure of diseases, where the practitioner pretends to so much exactness, that if the patient is guilty of any act of omission or commission in regard to food, drink, or venery, the physician will detect it. He himself makes no pretensions to any such skill in divination, but announces it as his object to describe the symptoms by which it may be known whether a man will die or live, and whether his disease will be of short or of long duration. With regard to the predictions of abscesses, lameness, death, or madness, the author holds that they can only be made after the morbid conditions leading to them have fairly set in. He strongly disapproves of all ostentatious modes of making predictions, and gives it as his advice that in all such cases the greatest prudence and reserve should be observed, since if a man become an adept in this art of prognostications, he will gain great credit with his patient, whereas if he fall into mistakes, he will incur odium, and will be looked upon as being deranged.
With regard to the prognostics made by those who practice gymnastics, he recommends them not to be made in a charlatan manner, but with suitable caution, and directs minute attention to be paid to the circumstances of the patient, which one has superior advantages in observing under this system. He says, for example, that a physician who feels a patient’s belly and pulse, pays attention to the breathing at the nostrils, and listens to the speech, and sound of the respiration, will be less likely to be deceived in forming a prognostic on his patients than he who neglects these things. He expresses himself, however, as being incredulous as to the possibility of detecting any little transgressions of orders which a patient may commit, although greater departures from instructions may be suspected. After some general observations in respect to diet, and other matters relating to it, he proceeds to a more circumstantial description of the symptoms upon which a prognosis is to be founded. And first, with regard to the alvine dejections, those of persons who live a laborious life, and use food and drink sparingly, are small and hard, and are passed every day, every third day, or every fourth day, but if they pass the last period there is danger of the man’s being seized with fever or diarrhœa. When the stools are so liquid that they do not assume a shape, they are all of a worse character in these cases. The dejections of persons who lead an active life are less copious than those of the indolent, provided they use the same amount of food. Liquid dejections taking place on the seventh day, and quickly coming to a crisis, are beneficial, if they occur all at once, and are not repeated. But if accompanied with fever, or if the diarrhœa is prolonged, all such dejections are bad, whether bilious, pituitous, or of indigested matters, and require a particular regimen and mode of treatment.
With regard to the urine, it should be in proportion to the drink that is taken, and somewhat thicker than the fluid that is drunk. If it be more copious than natural, this indicates either that the patient has disobeyed orders as to the amount of his drink, or that his body is in a state of atrophy. If the urine is passed in deficient quantity, with a noise, it indicates either that the man stands in need of purging, or that the bladder is diseased. A small quantity of blood passed without fever and pain does not indicate anything bad, but proves a solution to a state of lassitude. But if in large quantity, with the addition of any of these symptoms, it is to be dreaded. But if the urine be passed with pain, and if pus be passed along with the urine in a fever, the physician should announce that the patient will thus be relieved of his complaints.[521] Thick urine having a thin sediment indicates some pain and swelling about the joints. All the other sediments which occur in the urine of persons who practice exercises are connected with disease about the bladder; this will be clearly shown by the obstinate pains with which they are accompanied. The author, although he states that he had been conversant with the teachers of prognostics from urine, and their children and disciples, seems to express himself doubtful as to the possibility of acquiring a great degree of accuracy in regard to these matters.
Respecting dropsy, consumption, gout, and epilepsy, he states generally that if they are hereditary they are difficult to remove. A favorable prognosis is to be formed in dropsy when the patient’s viscera are sound, when his strength is firm, the digestion and respiration natural, when he is free of pain, the temperature of the body moderate, and when there is no wasting of the extremities. It is favorable when there is no cough, thirst, nor dryness of the tongue, when the bowels are easily moved by medicine, and when, at other times, the dejections are consistent. Dropsy, supervening, along with fever, upon a great discharge of blood, is of a most intractable nature, and the physician should intimate the danger to some other person beforehand. When great swellings suddenly subside and rise again, there is more hope in such a case than in dropsies connected with a discharge of blood. He concludes his observations on dropsies with the remark, that they are apt to deceive the patients, so that they desert their physicians and thus perish.
With regard to consumptive patients, he says, he has the same observations to make with regard to the sputa and cough as he had written with regard to empyema.[522] If the patient is to recover, the sputa should be white, equable, of one color, without phlegm; the defluxion from the head should be determined to the nose; there should be no fever, nor anorexia, nor thirst; the alvine discharges firm, proportionate to the ingesta, and the patient should not get thin. The best form of the chest is when it is quadrangular and hairy, and when the cartilage is small, and covered with flesh. Young persons, who become affected with empyema from determination (metastasis?), or fistula, or from any other similar cause, or from the retrocession of an abscess, do not recover unless many of the favorable symptoms combine in the case. They die, most commonly, in autumn, which proves peculiarly fatal in protracted diseases. Of all others, virgins, and women suffering from amenorrhœa, seldomest recover; and in their cases there is no hope unless menstruation be restored. All sexes, he seems to say (but the meaning appears to me rather ambiguous), have a better chance of recovery, when there is a discharge of blood, especially in those cases in which there are pains in the back and chest, connected with black bile; and if, after the evacuation, there be a remission of the pain; if the cough and fever do not set in; and if the thirst be tolerable. He seems to state (but the text is in an unsatisfactory condition), that relapses take place unless there be deposits in the place, the best of which are those which contain most blood; and that in those cases in which there are pains in the chest, if the patients get emaciated, and cough, and a dyspnœa supervenes, without fever or empyema, they should be asked whether, when they cough, and have difficulty of breathing, the sputa be compact, and attended with little smell.
With regard to persons affected with the gout, those who are aged, have tofi in their joints, who have led a hard life, and whose bowels are constipated, are beyond the power of medicine to cure. But, the best natural remedy for them is an attack of dysentery, or other determination to the bowels. Persons, under opposite circumstances, may be cured by a skilful physician.
The prognosis in epilepsy is unfavorable when the disease is congenital, and when it endures to manhood, and when it occurs to a grown person, and without any obvious cause. When connected with the head it is particularly to be apprehended, but least so when it seems to be derived from the hands or feet. The cure may be attempted in young persons, but not in old.