Chapter XI: Preface (1)

Of the approach of a disorder there are many signs. In the explication of which, I shall, without hesitation, make use of the authority of the ancients, and more especially that of Hippocrates; as even the more modern physicians, although they have made alterations in the method of curing, nevertheless confess, that he has delivered the best prognostics from these signs. But before I speak of those antecedents, which give cause to apprehend distempers ensuing; it seems not improper to explain, what seasons of the year, what kinds of weather, what times of life, what constitutions are most safe from, or most obnoxious to dangers, and what kinds of disorders are most to be feared in each of these. Not but in any weather(1), men of all ages and all habits, fall into all kinds of distempers, and die of them too; but because some events are more frequent than others. And therefore it is useful for every person to know, against what, and when, he should be most upon his guard.

CHAP. I.

OF THE DIFFERENT SEASONS, WEATHER, AGES, CONSTITUTIONS, AND THE DISEASES PECULIAR TO EACH.

The most healthful season then is the spring, next to that the winter, the summer is more dangerous than either, the autumn by far the most dangerous of all. With regard to the weather, that is best, which is equal, whether it be cold or hot: that, which varies most, is the worst. For this reason it is, that the autumn destroys the greatest number. For generally in the middle of the day it is hot, the nights, mornings, and evenings too, are cold: thus the body relaxed by the _preceding_ summer, and by the frequent meridian heats _of autumn_, is exposed to sudden cold. But as this is most common in this season, so it is hurtful, whenever it happens. When the weather is equal, serene days are most healthful: rainy are better than those that are only misty or cloudy: and in winter those days are best, that have no wind at all; in summer, that have the westerly breezes. If the winds blow from any of the other quarters, the northerly are more salutary than the easterly or southerly. Nevertheless these sometimes differ according to the situation of countries. For generally in every place a wind, that comes from the inland parts, is healthful; one from the sea is sickly. And not only health is more certain in a good temperature of the weather, but even the more malignant distempers, which happen to come on then, are more mild and sooner removed. That air is the worst for a sick person, which has occasioned his distemper; insomuch that in such a case, a change for weather in it’s own nature worse is favourable.

The middle age is safest, because it is neither endangered by the heat of youth, nor the coldness of old age. Old age is more liable to chronical diseases, and youth to acute ones. The body most promising for health is the square, neither over slender, nor over fat. For a tall stature, as it is comely in youth, so it quickly wears out by age. A slender body is weak, a corpulent heavy.

Whatever disorders arise from the motion of the humours, are generally to be most apprehended in the spring(2); so that, at this season, lippitudes, pimples, hæmorrhages, abscesses of the body, which the Greeks call apostemata[AF], atrabilis, which they name melancholia[AG], madness, epilepsy, angina, gravedoes, and catarrhs, usually occur. Also those distempers in the joints and nerves, which sometimes are troublesome, and sometimes easy, at this time of the year are the most apt both to begin and return. Neither is the summer altogether free from most of the above-mentioned distempers; but adds moreover fevers, either ardent, or tertian, vomitings, purgings, ear-achs, ulcers of the mouth, gangrenes, both in the other parts of the body, and chiefly in the private parts; and all these disorders that waste a man by sweat. There is hardly any of these, that is not found in the autumn; but there arise then, besides irregular fevers, pain of the spleen, dropsical disorders(3), consumption, which the Greeks call phthisis[AH]; difficulty of urine, which they term stranguria[AI]; the distemper of the smaller intestine which they name ileos[AJ], there happens also what the Greeks call lienteria[AK]; pains of the hips, epileptic disorders. And the same season is mortal to those that are worn out with long diseases, and such, as have been oppressed by the preceding summer; and it dispatches some by new distempers, and involves others in very tedious ones, especially quartan agues, which may even continue through the winter. Nor is any season more liable to the plague, of whatever kind it be, however various in its manner of hurting. The winter provokes pains of the head, the cough, and whatever disorder is contracted in the fauces, sides, or bowels.

[AF] ἀποστήματα.

[AG] μελαγχολία.

[AH] φθίσις.

[AI] στραγγουρία.

[AJ] εἰλεος.

[AK] λειεντερία.

With regard to the varieties of weather, the north wind raises a cough, exasperates the fauces, binds the belly, suppresses urine, excites shudderings, also pain of the side and breast; yet it braces a sound body(4), and renders it more mobile and brisk. The south wind causes dulness of hearing, blunts the senses, raises a pain of the head, opens the belly, and renders the whole body heavy, moist, and languid. The other winds, by how much they approach more nearly to either of these, produce effects the more similar to each of them. All heat inflames the liver and spleen, enervates the mind, and occasions faintings, and hæmorrhages. Cold causes sometimes convulsions, and sometimes a tetanus, the Greek name for the first is spasmos[AL], and for the other tetanos[AM]: it produces blackness in ulcers, and a shuddering in fevers. In dry weather we meet with acute fevers, lippitudes, dysenteries, stranguries, pains of the joints; in rainy, tedious fevers, diarrhœas, angina, gangrenes, epilepsies, palsy, which the Greeks call paralysis[AN]. Nor is the present weather only to be considered, but also what has been its course for some time. If a dry winter has been attended with northerly winds, and the spring with southerly, and rains, there most commonly ensue lippitudes, dysenteries, fevers, and these chiefly in more delicate bodies, particularly women. But if southerly winds and rains have prevailed in the winter, and the spring be cold and dry, then indeed pregnant women, whose time is near, are in danger of a miscarriage; and those, that go their full time, bring forth weakly children, not likely to live. Other people are attacked with dry lippitudes, and if they are old, with bad gravedoes and catarrhs. But if the southerly winds have continued from the beginning of winter to the end of spring, people are very quickly taken off by pleurisies, and fevers attended with a delirium, which is called phrenitis[AO]. But when the heat begins with the spring, and continues through the summer, profuse sweating in fevers necessarily follows. But if a dry summer has been attended with northerly winds, and the autumn with rains, and southerly, all the following winter we find coughs, catarrhs, hoarseness, and in some a consumption. But if the autumn too is equally dry, and the same northerly winds blow, all the more delicate bodies, amongst which I placed women, enjoy a good state of health: and for the more robust, they may possibly be attacked with dry lippitudes, and fevers either acute, or tedious, and atrabiliary disorders.

[AL] σπασμὸς.

[AM] τέτανος.

[AN] παράλυσις.

[AO] φρεν̃ιτιϛ.̃

As to the different ages, children, and those a little more advanced, have their health best in the spring, and are most safe in the beginning of summer; old men in the summer, and beginning of autumn; young and middle aged men in the winter. The winter is more hurtful to old men, and the summer to youths. For the peculiar weaknesses, that appear at different times of life, first of all infants and young children will be troubled with spreading ulcers of the mouth, which the Greeks call aphthæ[AP], vomitings, nightly watching, humour in the ears, and inflammations about the navel. The peculiar complaints of such as are teething, are exulcerations in the gums, convulsions, slight fevers, purgings, and these are chiefly troublesome about the cutting of the canine teeth. Infants of the fullest habit, and whose bellies are very much bound, are most liable to these dangers. But when they have grown up a little, there appear disorders of the glands, and different inclinations of the vertebræ, which compose the spine, scrophulous swellings, some painful kinds of warts, by the Greeks called acrochordones[AQ], and many other tubercles. In the beginning of puberty, many of the above-named, and long fevers, and hæmorrhages from the nose. And generally all children are most in danger first about the fortieth day, then the seventh month, then the seventh year, after these at the time of puberty. Moreover any distempers, which commence in infancy, and are terminated neither by puberty, nor in men by their first commerce with women, nor in women by the appearance of their menses, commonly continue long: yet more frequently these puerile disorders of long standing are removed by these means. Youth is most subject to acute disorders, and epileptic, and to a consumption: and they are commonly young men, who spit blood. After this age, come on pleurisies and peripneumonies, lethargy, cholera, madness, and discharges of blood from certain mouths, as it were, of the veins, by the Greeks called hæmorrhoides[AR]. In old age, difficulty of breathing, and making urine, gravedo, pains of the joints and kidneys, palsies, bad habit of body, which the Greeks call cachexia[AS], nightly watchings, tedious disorders of the ears, of the eyes, and nose, and especially a loose belly, and its consequences a dysentery, or lientery, and other indispositions incident to that habit. Besides these the slender are distressed with consumptions, purgings, catarrhs, and pains of the bowels, and sides. The corpulent generally are oppressed with acute diseases, and difficulty of breathing, and often die suddenly, which seldom happens in a more slender body.

[AP] ἄφθαι.

[AQ] ἀκροχορδ́ονες.

[AR] αἱμοῤῥοίδες.

[AS] καχεξία.

CHAP. II.

OF THE SIGNS OF AN APPROACHING ILLNESS.

Before an illness, as I mentioned above, there appear some signs of its approach. All of them have this in common, that the body alters from its ordinary state; and not only for the worse, but even for the better. For this reason, if one has become more plump, and looks better, and of a more florid complexion than usual, he ought to hold these advantages suspected. For because these things can neither continue at a stay, nor admit further improvement, they generally run backward very fast, like some heavy body tumbling down. But it is a worse sign, when one is emaciated contrary to his natural habit, and has lost his colour and comeliness: because bodies redundant can allow something to be carried off by a distemper; the deficient have not wherewithal to bear the force of the distemper itself. Besides there is cause to be presently alarmed, if the limbs are heavy; if frequent ulcers break out; if the body has grown hotter than common; if sleep be too heavy; if the dreams are tumultuous; if one awakes oftner than usual, and then falls asleep again; if the body of a person asleep sweats in some parts contrary to custom, especially if that be about the breast, or neck, or legs, or knees, or hips; also if the mind is languid; if there is a reluctance to speaking and motion; if the body be indisposed to action; if the præcordia are pained, or the whole breast, or which happens in most people, the head; if the mouth is filled with saliva; if the eyes feel pain in turning; if the temples be strait bound(5): if the limbs have shudderings; if the breathing is difficult; if the arteries in the forehead are dilated and beat strong; if there be frequent yawnings; if the knees feel tired, or the whole body be afflicted with a lassitude. Several of these things often, some of them always, precede a fever. This, however, ought to be first considered, whether any of these happen frequently to a person without any consequent uneasiness. For there are some peculiarities in the constitutions of particular persons, without the knowledge of which, it is not easy to prognosticate what is to happen. With reason therefore a man is free from apprehensions about those things, which he has often escaped without danger: he only is justly uneasy, to whom these appearances are new, or who has never been secured from their bad effects without proper precautions.

CHAP. III.

GOOD SYMPTOMS IN SICK PEOPLE.

When any person is seized with a fever, it is certain he is not in danger, if he lies either upon his right or left side, as may have been usual with him, with his legs a little drawn up, which by the way is commonly the lying posture of a person in health; if he turns himself with ease; if he sleeps in the night-time, and keeps awake in the day; if he breathes easily; if he does not struggle; if the skin about the navel and pubes be full(6); if his præcordia be equally soft on both sides, without any sense of pain; or although they are a little swelled, yet yield to the impression of the fingers, and are not pained. This illness, though it will continue some time, yet will be safe. The body also, which is every where soft, and in the same degree of heat, and which sweats all over equally, and whose fever is removed by that sweat, is in a fair way of doing well. When the body is recovering its health, sneezing also is amongst the good signs, and an appetite, either continued from the beginning, or even coming after a nausea. Nor should that fever alarm, which terminates in one day; nor indeed that, which though it has prevailed for a longer time, yet has totally intermitted betwixt paroxysms, so as the body became free from all complaint, which the Greeks call eilicrines[AT]. If any thing happens to be discharged by vomiting, it ought to be a mixture of bile and phlegm: and the sediment of the urine white, smooth, equal; so that, if there is any thing like small clouds swimming in it, that subsides to the bottom. And the stools in one, who is safe from danger, are soft, figured, and evacuated at nearly the same intervals, as was usual in health, and in quantity duly proportioned to the nourishment, that is taken. A loose belly is worse: but even this should not immediately be esteemed dangerous, if the discharge be of a harder consistence in the morning, or gradually turn less liquid, and the excrements be reddish, and their offensive smell don’t exceed that of the like discharge of a healthy man. And there is nothing bad in voiding some worms at the end of the distemper(7). If a flatulency has occasioned a pain and swelling in the upper parts without an inflammation, a rumbling of the belly from thence to the lower parts is a good sign; and more so, if it has found an easy passage with the excrements.

[AT] Εἱλικρινὲς, sincere, or unmixed; so that it is explained
naturally enough by our author _integrum_, _sound_, which I chuse to
render by _free from all complaint_, because we never apply the term
_sound_ to a body, that has any distemper hanging about it.

CHAP. IV.

BAD SYMPTOMS IN SICK PEOPLE.

On the other hand there is hazard of a dangerous distemper, when the patient lies supine, with his arms and legs extended: when he inclines to sit up during the greatest violence of an acute distemper, especially in a peripneumony: when he is distressed with wakefulness in the night, even although he sleep in the day time. Now sleep, which happens betwixt the fourth hour(8) and night, is worse than that, which is betwixt morning and the same hour. But it is worst of all, if he neither sleep in the night, nor the day time: for that cannot well happen without a constant delirium. Neither is it a good sign to be oppressed with sleep beyond measure: and the worse, the nearer the sleep comes to being continued day and night. It is also a sign of a dangerous distemper to breathe quickly, and with vehemence; for shudderings to have come on after the sixth day; to spit matter; to expectorate with difficulty; to have constant pain; to be much distressed with the distemper; to toss the arms and legs about; to weep involuntarily; to have a glutinous humour sticking to the teeth; for the skin about the navel and pubes to be emaciated; for the praecordia to be inflamed, painful, hard, swelled, tense: the case is worse, if these appearances be more on the right side than on the left: but the danger is still greatly increased, if at the same time the pulsation of the arteries there be violent. Again, it indicates a bad distemper to be too quickly emaciated; to have the head, feet, and hands cold, with the belly and sides hot; or for the extremities to be cold during the violence of an acute distemper; or to shudder after sweating; or after vomiting to have the hiccough, or the eyes to be red; or after having an appetite for food, or at the end of long fevers, to loath it; to sweat much, and especially a cold sweat; or to have sweats not equally diffused over the whole body, and such as do not terminate the fever. They are also bad fevers, which return every day at the same time; or those, that always have paroxysms equally violent, and which do not remit every third day; or those, that continue so as to increase in their paroxysms, and only remit in their intervals, but never leave the body quite free from disorder. It is worst of all, if the fever does not at all remit, but continues with equal violence. It is dangerous too for a fever to come after a jaundice, especially if the praecordia have continued hard on the right side; or on the left, if attended with pain there. Every acute fever ought to give us no small apprehensions: and always in such a fever, or after sleep, convulsions are terrible. It is also a sign of a bad distemper to wake with a fright, and likewise in the beginning of a fever for the mind to be presently disordered, or any limb to become paralytic. In that case, though the patient escape with life, yet for the most part that limb is debilitated. A vomiting also of pure phlegm or bile is dangerous; and if it be green, or black, it is worse. Urine is bad, where the sediment is reddish or livid; and worse, in which there is a kind of small and white threads: and worst of all, that, which bears the resemblance of small clouds, composed as it were of particles of bran. Thin and white urine is bad, but especially in phrenitic patients. It is bad to have the belly entirely bound. And a purging too in fevers is dangerous, where it will not allow a man to rest in his bed; especially if the discharge be very liquid, or whitish, or pale, or frothy. Besides these it portends danger, if the excretion be small in quantity, glutinous, smooth, white, and at the same time of a palish colour; or if it is either livid, or bilious, or bloody, or of a more offensive smell than common. An unmixed discharge also, which comes after long fevers, is bad.

CHAP. V.

SIGNS OF LONG SICKNESS.

After the foregoing symptoms have appeared, ’tis known, that a distemper will become tedious: for it must necessarily be so, unless it be mortal. And there is no other hope in violent diseases, than that the patient may escape by eluding the first shock of the distemper, that there may be room for the application of proper methods of cure. But some signs appear in the beginning of a distemper, from which we may gather, that although it does not prove mortal, yet it will last for a considerable time. In fevers not violent, when a cold sweat comes on only about the head or neck; or when the body sweats without the fever intermitting; or when the body is sometimes cold, and sometimes hot, and the colour changes; or when in fevers an abscess, which has been formed in some part, does not prove salutary; or when the patient, considering the time of his illness, is but little emaciated. Also, if the urine at some times is thin and limpid, and at other times has some sediment; and if what subsides be smooth, and white, or red; or if it have the appearance of motes; or if it send up air bubbles.

CHAP. VI.

THE SYMPTOMS OF DEATH.

But though in such circumstances there is reason to fear, yet there remains some hope. But we are sure a person is come to the last stage, when the nose is sharp, the temples shrivelled, the eyes hollow, the ears cold, and languid, and slightly inverted at their extremities, the skin about the forehead hard and tense, the colour either black or very pale; and much more so, if these things happen without any preceding wakefulness, or purging, or fasting: from which causes this appearance sometimes arises, but then it vanishes in one day. So that if it continues longer, it is a forerunner of death. And if it remains the same for three days in a tedious distemper, death is very near: and more especially if besides the eyes can’t bear the light and shed tears; and the white part of them grows red; and their small vessels are pale; and humour floating in them at last sticks to the angles; and one eye is less than the other; and they are either very much sunk, or much swelled; and when the eye-lids in sleep are not closed, but betwixt them there appears some part of the white of the eye; provided it be not occasioned by a flux; when the eye-lids also are pale, and the same paleness discolours the lips and nose; and also when the lips, and nose, and eyes, and eye-lids, and eye-brows, or some of these, are distorted, and the patient from pure weakness loses his hearing, or sight.

Death is also to be expected, when the patient lies supine, and his knees are contracted; when he slides downward now and then towards his feet; when he lays bare his arms and legs, and tosses them about irregularly, and there is no heat in them; when he gapes with his mouth; when he sleeps constantly; when being insensible, he grinds his teeth, and had not that custom in health; when an ulcer, which broke out either before, or in the time of his sickness, has grown dry, and turned either pale or livid, The following symptoms are also deadly; pale-coloured nails, and fingers; a cold breath; or if one in a fever, and acute disease, or madness, or peripneumony, or pain of the head, gathers the wool off the cloaths with his hands, or draws out and smooths their edges, or catches at any small prominences in an adjoining wall. Pains also, that have begun in the hips and lower parts, if they have been translated to the bowels, and suddenly ceased, are sure prognostics of approaching death; and more so, if any of the other symptoms have also concurred. And it is impossible to save that person, who labouring under a fever without any tumour, is suddenly, _as it were_, strangled, or cannot swallow his spittle; or one, whose neck, while the fever and habit of body remain the same, is turned aside, so that it is equally impossible for him to swallow any thing; or him, who at the same time has a continued fever, and extreme weakness of body; or when, without an abatement of the fever, the external surface of his body is cold, and the internal parts so hot as to produce thirst; or one, who, the fever continuing as in the former case, is distressed at once with a delirium and difficulty of breathing; or one, who, after drinking hellebore, has been seized with convulsions; or one, that has lost his speech after being intoxicated with liquor, for he is commonly carried off by convulsions, unless either a fever has supervened, or he has begun to speak at the time, when the effects of the liquor shall be over. A pregnant woman is also easily destroyed by an acute distemper. And likewise any person, whose disorder is increased by sleep; and one, who in the beginning of a recent disorder, vomits, or voids by stool, atrabilis; and the event is the same, where this has been discharged in either of these ways, when the body has been already extenuated, and wasted by a long illness. A bilious spitting, and purulent, whether they come up separately, or mixed, shew that there is danger of death. And if this appearance has commenced about the seventh day of a disease, the consequence is, that the patient will die about the fourteenth, unless some other symptoms more benign, or malignant, come on: and these after symptoms, the more gentle or violent they are, signify that death will happen so much the later, or sooner. A cold sweat likewise in an acute fever is mortal; and in every disease, a vomiting variegated with different colours; and especially if it be fetid. And it is also extremely bad to vomit blood in a fever. The urine is commonly of a bright yellow colour and thin in great crudity; and often before it has time to concoct, kills the patient. Upon this account, if it continue so for any time, it prognosticates danger of death. But the worst of all and most deadly is the black, thick, and fetid. And such as this is the worst in men and women; but in children that, which is thin and watery. A variegated discharge also by the belly is very bad; and such as contains strigments(9), blood, bile, and something green, and these either at different times, or all together in a kind of mixture, but so as each of them appear distinctly. Yet ’tis possible for one to endure this somewhat longer. But a speedy death is denoted, when the discharge is liquid, and withal either black, or pale, or fat; especially if besides it have an intolerable stench.

I am sensible I may be asked, how it happens, if the signs of future death are infallible, that some, who are entirely given over by physicians, should recover, and that some are reported to have come to life again, even when they were carried out to be buried? Nay, the justly famed Democritus maintained, that even the marks that life was gone, which physicians had trusted, were not certain: so far was he from allowing, that there could be any certain prognostics of death. In answer to which I shall not insist, that some marks, which bear a great resemblance to each other, often deceive not the able, but the unskilful physicians, (which Asclepiades knowing, when he met a funeral, cried out, that the person, whom they were about to bury, was alive) and that the art is not to be charged with the faults of any of its professors. But I will answer with more moderation; that medicine is a conjectural art, and that the nature of conjecture is such, that although it answers for the most part, yet sometimes it fails. And if a _prognostic_ may deceive a person, perhaps in one of a thousand instances, it must not therefore be denied credit, since it answers in innumerable others. And this I say not only with regard to the mortal, but also to the salutary _symptoms_. For hope too is sometimes disappointed, and one dies, whom at first the physician thought in no danger. And those things, which have been contrived for curing, sometimes occasion a change for the worse. Nor is it possible for human weakness to avoid this, in so great a variety of constitutions. But medicine however deserves credit, which most frequently, and in the greatest number of sick people by far, is of service. Nevertheless we ought not to be ignorant, that the prognostics both of recovery and death are more fallacious in acute distempers.

CHAP. VII.

OF THE SIGNS IN PARTICULAR DISEASES.

Having then mentioned those signs, which belong to diseases in general, I shall now proceed to point out those marks, which may attend the particular kinds of them. Now there are some of these, which happen before, and others in the time of fevers, which discover either the state of the internal parts, or what is likely to follow. Before fevers, if the head be heavy, or there be a dimness in the eyes after sleep, or there be frequent sneezings, some disorder from phlegm about the head may be feared. If a person abound with blood, or be very hot, the consequence is, that there may be an hæmorrhage from some part. If any person is emaciated without an evident cause, he is in danger of falling into a bad habit of body. If the præcordia are pained, or there is a troublesome flatulency, or if the urine is discharged the whole day unconcocted, ’tis plain there is a crudity. Such as have a bad colour for a long time without a jaundice, are either distressed with pains of the head, or labour under a malacia. Those, whose faces long continue pale and swelled, have disorders either of the head, or bowels, or belly. If a boy in a continued fever has no passage in his belly, and his colour is changed and he is deprived of sleep, and is constantly bemoaning, himself, convulsions are to be apprehended. A frequent catarrh in a slender body and tall, gives ground to fear a consumption. When for several days there is no stool, it portends either a sudden purging, or a slight fever. When the feet swell, and there is a long continued purging, or pain in the bottom of the belly and hips, a dropsical disorder is impending: but this kind of distemper commonly arises from the ilia. Those also are exposed to the same danger, whose belly, discharges nothing, when they have a stimulus, unless with difficulty, and the excrements hard. When there is a swelling in the feet, and when the like tumour, sometimes in the right, sometimes in the left side of the belly alternately rises and falls, that disorder seems to arise from the liver. It is a mark of the same distemper, when the intestines about the navel are pained, which the Greeks call strophos[AU], and pains of the hip continue without being relieved either by time or remedies. If a pain of the joints, for instance in the feet or hands, or in any other part, be attended with a contraction of the nerves there; or if any limb fatigued by slight exercise, is equally distressed by heat and cold, we may expect the gout either in the feet or hands, or that there will be a disease in that joint, where the pain is felt. Such as have had hæmorrhages from the nose, while they were children, which afterwards ceased, must either be afflicted with pains of the head, or have some troublesome exulcerations in their joints, or fall into some languishing distemper. Women, whose menses are suppressed, will be subject to excruciating pains of the head, or a disorder in some other part. And those are liable to the same dangers, who have complaints in their joints, such as pains and swellings coming and going, without the gout, and such-like distempers. Particularly if their temples are often pained, and their body sweats in the night-time, and their forehead itches, there is fear of a lippitude. If a woman after delivery has violent pains, with no other bad symptoms, about the twentieth day there will either be an eruption of blood from the nose, or some abscess in the lower parts. And _in general_ in any person, a violent pain about the temples and forehead, will be removed in one of these two ways: more probably by an hæmorrhage, if the person be young; if somewhat more advanced, by a suppuration. A fever, which goes off suddenly without any apparent reason, without good signs, commonly returns. A person, whose fauces are filled with blood, both in the day-time, and in the night, will be found to have an ulcer there, if neither pains of the head, nor of the præcordia, nor a cough, nor vomiting, nor slight fever have preceded. If a woman is attacked with a slight fever from a disorder in the groin, and the cause does not appear, there is an ulcer in the womb. Thick urine, in which there is a white sediment, implies that there is a pain about the joints, or the bowels, and fear of some impending distemper. When it is green, it shows, that the bowels will be pained, or that there will be a swelling attended with some danger; or at least, that the body is not sound. But if there is blood or pus in the urine, either the bladder or kidneys are ulcerated. If it be thick, and contain in it some small caruncles, or something like hairs; or if it be frothy, or fetid; or sometimes bring off something like sand, and sometimes like blood; and the hips be pained, and those parts, which lie between them, and above the pubes; and besides these if there be frequent eructations, sometimes a bilious vomiting, and the extremities be cold, and there is a frequent inclination to make water, but great difficulty in it, and what comes away be limpid, or reddish, or pale, and gives some small relief, and the belly be discharged with much wind; in such circumstances the distemper lies in the kidneys. But if the urine drops away slowly, or if blood is discharged with it, and in that some bloody concretions, and it is made with difficulty, and the internal parts about the pubes are pained, the fault is in the bladder. Those, that have calculous concretions, are known by these symptoms. The urine is made with difficulty, and comes away slowly, and by drops, and sometimes involuntarily, is sandy; sometimes blood, or bloody concretions, or something purulent is discharged with it. Some make it more readily standing upright, others lying upon their back: especially those, that have large stones; some even in an inclined posture, and these by drawing out the penis, alleviate their pain. There is also a sensation of weight in that part, which is increased by running, and every kind of motion. Some also in the paroxysm of the pain, cross their feet over one another, often changing them. But women are often obliged to rub the external orifice of their pudenda with their hands: sometimes applying their finger to that part, when it presses upon the neck of the bladder, they feel the stone. But where any expectorate frothy blood, their disorder is in the lungs. A pregnant woman, whose belly is very loose, may possibly miscarry. If the milk flows from her breast, the fœtus is weak. Hard breasts shew the child to be sound. A frequent hiccough, and of longer continuance than ordinary, is a sign of an inflammation of the liver. If tumours upon ulcers have suddenly disappeared, and this has happened in the back, we may be apprehensive either of convulsions, or a tetanus: but if in the fore part of the body, either a pleurisy or madness is to be expected. Sometimes also a purging, which is the safest of them all, follows such an accident. If the hæmorrhoidal veins, in one used to a discharge of blood from them, suddenly stop, either a dropsical disorder or a consumption ensues. A consumption also comes on, if suppurated matter derived from a pleurisy cannot be carried off within forty days. But where there is a long continued grief attended with long fear and watching, the atrabiliary distemper is the consequence. Those, who have frequent hæmorrhages from the nose, labour under a swelling of the spleen, or pains of the head: and they commonly see imaginary objects floating before their eyes. But those, whose spleens are large, have their gums diseased and a stinking mouth, or an hæmorrhage in some part. If none of these happen, bad ulcers will be formed in their legs, and black cicatrices from them. Where there is a cause of pain and no sense of it, the mind is disordered. If blood has been collected in the abdomen, it is there converted into pus. If a pain removes from the hips and the lower parts into the breast, and no bad symptom has supervened, there is danger of a suppuration in that place. Those, that without a fever have a pain, or itching, with redness and heat, in any part, will have a suppuration there. Limpid urine also in a valetudinary person portends some suppuration about the ears.

[AU] στρόφος.

Now as these appearances, even without a fever, contain indications of what is latent or future, they are much more certain when accompanied with a fever; and then symptoms of other disorders also shew themselves. Wherefore when a person speaks more quickly than he used to do in health, and of a sudden talks much, and that with greater confidence than ordinary; or when one breathes slow, and with great force, and the pulse beats high, with hard and swelled præcordia, then there is a fear of approaching madness. Frequent motion of the eyes also, and a darkness arising before them, together with head-ach; or loss of sleep without any pain, and a continual watching day and night; or lying upon the belly contrary to custom, if that is not occasioned by a pain of the belly itself; also an unusual grinding of the teeth, while the body continues strong, are signs of madness. If an abscess has been formed, and subsides before a discharge by spitting comes on, the usual fever still continuing, there will be danger first of madness, and then of death. An acute pain also of the ear, with a continued and strong fever, often disorders the mind: and of this malady younger people sometimes die in seven days; those that are older hold out something longer: because their fevers are not equally violent, nor their distraction so great; so that they last till the distemper is resolved into pus. A suffusion of blood in the breasts of a woman betokens approaching madness. Those, that have long fevers, will either have an abscess formed somewhere, or pains of the joints. Those, whose breath is greatly straitened in passing through the fauces in fevers, will soon fall into convulsions. If an angina suddenly disappears, the distemper is removing into the lungs; and that is often fatal before the seventh day: and if that does not happen, the consequence is a suppuration in some part. Lastly, after long purgings come dysenteries; after these a lientery; after violent catarrhs a consumption; after pleurisies diseases of the lungs; after which madness; after great heats of the body a tetanus or convulsion; after a wound of the head a delirium; after great torment for want of sleep, convulsions; when the blood vessels above ulcers are in strong motion, there will be an hæmorrhage.

A suppuration is produced many ways(10); for if fevers unattended with pain continue long without any manifest cause, the disorder is transferred upon some particular part: but this happens only in younger people; for in the elderly, a quartan ague is the common consequence of such a disease. A suppuration also happens, if the præcordia being hard and pained have neither carried off the patient before the twentieth day, nor an hæmorrhage from the nose has ensued; and this holds chiefly in youths, especially if in the beginning of the distemper they had dimness of the eyes, or pains of the head: but then the abscess forms in the lower parts _of the body_. But if there be a soft tumour in the præcordia, and it has not ceased within sixty days, and the fever continues all that time, then the abscess forms in the superior parts: and if there is not a discharge of blood from the nose(11) in the beginning, it breaks out about the ears. And as every tumour of long standing generally tends to suppuration, so one, that is seated in the præcordia is more likely to have that issue, than one that is in the belly: and one, that is above the navel, than one, that is below it. Also if there is a sense of lassitude in a fever, an abscess is formed either in the jaws, or the joints. Sometimes too the urine continues long and thin, and crude, and the other symptoms are good: in this case for the most part an abscess is formed below the transverse septum (which the Greeks call diaphragma). If a peripneumony is removed neither by expectoration, nor by cupping, nor bleeding, nor a proper regimen, it sometimes gives rise to some vomicæ, either about the twentieth day, or thirtieth, or fortieth, and even sometimes about the sixtieth. Now we must date our reckoning from that day, in which the person was first taken with the fever, or seized with a horror, or felt a weight in the part. But these vomicæ are generated sometimes in the lungs, sometimes about the ribs. Where the suppuration is seated, it raises a pain and inflammation, and there is a greater heat there: and if one has lain down upon the sound side, he imagines it loaded with some weight. And every suppuration, that is not yet visible, may be known by the following signs: the fever does not wholly intermit, but is more mild in the day-time, and increases at night, there is plentiful sweating, an inclination to cough, and hardly any thing brought up by it, the eyes are hollow, cheeks red, the veins under the tongue white, the nails of the hands crooked, the fingers, especially their extremities, hot; there are swellings in the feet, difficulty in breathing, loathing of food, pimples breaking out over the whole body. But if the pain, cough, and difficulty of breathing have come on immediately at the beginning, the vomica will break before, or about the twentieth day. If these have begun later, they must of course increase; but the less quickly they have appeared, the more slowly will they be removed. It is common also in a severe distemper for the feet, hands, and nails to turn black: and if death has not followed, and the other parts of the body are restored, yet the feet fall off.

CHAP. VIII.

WHAT SYMPTOMS ARE DANGEROUS, OR HOPEFUL IN PARTICULAR DISEASES.

Our next business is to explain the particular marks in every kind of distemper, which either afford hope, or indicate danger. If the bladder be pained, and there be a discharge of purulent urine, and also a smooth and white sediment in it, there is no danger. In a peripneumony, if the pain is mitigated by the spitting, although that be purulent, yet if the patient breathes easily, expectorates freely, and is not much distressed with the distemper, he may possibly recover his health. Nor need we immediately give way to fears, if the spittle is mixed with some reddish blood, provided that presently ceases. Pleurisies, that suppurate, when the matter is carried off within forty days, are thereby terminated. If there is a vomica in the liver, and the matter discharged from it be unmixed and white, the patient easily recovers, for that disorder is seated in the membrane. Now these kinds of suppurated tumours are tolerable, which are directed towards the external parts, and rise to a point. But of those, which point inward, the more mild are such, as while close, don’t affect the skin, and suffer it to remain without pain, and of the same colour with the other parts. Also pus from whatever part it is discharged, if it be smooth, white, and uniform, is not at all dangerous; and if after the evacuation of it the fever has presently abated, and the nausea and thirst have ceased to be troublesome. If at any time also a suppuration falls into the legs, and the patient’s discharge by spitting becomes purulent instead of reddish, the danger is less. But in a consumption, he that is to recover, will have his spitting white, uniform, and of the same colour, with out phlegm: and whatever falls down from the head by the nostrils, should be of a like nature. ’Tis far best to be altogether free from a fever: next to this, that it be so gentle, as neither to prevent the taking of food, nor occasion a frequent thirst. In this distemper that state of the belly is safe, in which every day consistent excrements are evacuated, in quantity proportioned to the food; and so is that body, which is least slender, and has the broadest and most hairy chest, and whose cartilage is small and fleshy. In a consumption too, if a woman has had her menses suppressed, and while the pain still remains about her breast, and shoulders, and the blood has of a sudden made its way, the distemper is commonly mitigated: for both the cough is lessened, and the thirst and febricula cease. But in the same patients, if their menses do not return, for the most part the vomica breaks: and the more bloody the discharge from it is, so much the better. A dropsical disorder is the least to be feared, which has begun without any preceding distemper. Of the next favourable sort is that, which succeeds a long distemper, if at the same time the bowels be firm; if the breathing be easy; if there is no pain; if the body is not hot; and is equally lean in its extremities; if the belly is soft; if there be no cough, no thirst; if the tongue even in sleep does grow dry; if there is an appetite for meat; if the belly yields to purging medicines; if spontaneously it discharges excrements soft and figured; if it grows less(12); if the urine is altered by the change of wine, and by drinking certain medicinal potions; if the body is free from lassitude, and easily bears motion: for where one has all these symptoms, he is altogether safe; where most of them appear, the patient is in a hopeful way. Diseases of the joints, as the gout in the feet or hands, if they have attacked the patients young, and have not brought on a callus, may be removed; and they are most of all allayed by a dysentery, and when by any means the belly becomes loose. Also an epilepsy, that begins before puberty, is easily removed; and where a person sensibly feels the approaching fit first affecting some part of the body. It is best, that it begin at the hands or feet; next to them, at the sides; but worst of all, when it begins at the head. And in these patients also, excretions by the belly are of the greatest service. Now a purging is not in the least hurtful, which is without a fever, if it quickly, ceases; if upon feeling the belly, there is no motion perceived; if wind is discharged at the end of a stool. Nay even a dysentery is not dangerous, if blood and strigments are discharged, provided the patient is without a fever, and the other concomitants of this distemper: insomuch, that a pregnant woman may not only be cured, but her fœtus also preserved. And it is an advantage in this disorder, if the patient has come to some age. On the contrary, a lientery is more easily cured in tender age: especially if the urine begins to be excreted, and the body to be nourished with food. The same age is most favourable in pains of the hip, and arms, and in every paralytic disorder. Amongst these, the hip, if it be without numbness, if its coldness be slight, although it be greatly pained, yet it is easily and quickly cured; and a paralytic limb, if it continue to be nourished, may be recovered. A palsy of the mouth also is cured by a loose belly. And all purging does good to one labouring under a lippitude. Madness is removed by the appearance of a varicous swelling, or sudden eruption of blood from the hæmorrhoidal veins, or a dysentery. Pains of the arms, which are propagated either to the shoulders, or hands, are cured by vomiting of atrabilis. And whatever pain moves downward, is more easily cured. A hiccough is cured by sneezing. A vomiting stops long purgings. A woman, that vomits blood, is relieved by the flux of her menses. She, whose menses are deficient, if there has been an hæmorrhage from the nose, is free from all danger. And one, that is hysteric(13) or has a difficult labour, is relieved by sneezing. To one, that has a heat and tremour, a delirium is salutary. Dysenteries are of service to splenetic people. Lastly, a fever itself, which may seem very wonderful, is often a remedy _for other distempers_. For it both cures pains of the præcordia, that are not attended with inflammation, and relieves in a pain of the liver; and entirely removes convulsions, and a tetanus, if it comes after them; and where the distemper of the smaller intestine has been occasioned by a difficulty in making urine, if by the heat it promotes urine, it gives ease. Pains of the head attended with dimness of the eyes and redness with an itching in the forehead, are removed by a discharge of blood, either spontaneous or procured. If pains of the head and forehead arise from being exposed to the wind, or cold, or heat, they are cured by a gravedo, and sneezing. A sudden shuddering puts an end to an ardent fever, which the Greeks call causodes[AV]. When in a fever, there is a deafness, if blood is discharged from the nose, or the belly turns loose, that disorder is entirely removed. Nothing is more prevalent against deafness, than bilious stools. Those, that have small abscesses, which the Greeks call phymata[AW], formed in the urethra, are cured, when pus is discharged from thence. Now as most of these favourable turns happen of themselves, we may conclude, that nature has very great power in these very helps, which are applied by art.

[AV] καυσώδης.

[AW] φύματα.