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8 It follows now that I have to explain the special signs which in any particular affection indicate either hope or danger. When there is pain in the bladder, if purulent urine is discharged which has in it a sediment slimy and white, it allays apprehension. In pulmonary disease a patient may possibly regain health, if expectoration, although purulent, relieves pain, so long as he breathes and expectorates freely, and bears the disease without difficulty. Nor is there cause for alarm at an early stage, if the expectoration is mixed with something reddish and with blood, so long as it is expectorated at once. Pain in the side ends if the suppuration which has arisen is cleared off within forty days. If there is an abscess in the liver, and the pus let out is uniform and white, in that case recovery is easy, because the mischief is enclosed in a capsule. Among suppurations too those are tolerable which point and discharge outwards. And of those which move inwards, those are the most favourable which do not affect the overlying skin, but leave it free from pain, and of the same colour as the surroundings. Pus indeed causes no fear, wherever it breaks out, when slimy and uniformly white, and if the fever subsides at once upon its discharge, and distaste for food and thirst cease to be troublesome. Also whenever suppuration descends into the legs,[p. 135] and the patient's expectoration from being reddish becomes purulent, there is less danger. But in phthisis, he that is to recover should have his expectoration white, uniform in consistency and colour, unmixed with phlegm; and that which drips into the nose from the head should have similar characters. It is the best by far for there to be no fever; second best when the fever is so slight as not to impair the appetite or cause frequent thirst. In this affection the patient's state is favourable: when the bowels are moved once a day, the motions being formed and in amount corresponding to the food consumed; the body least attenuated, the chest most broad and hairy; its cartilages small, and covered with flesh. If supervening on phthisis, a woman's menses also become suppressed and pain is continuous over her chest and shoulders, a sudden eruption of blood customarily relieves the disease; for the cough becomes less, and the thirst and slight fever subside. But generally in these cases, unless the haemorrhage recurs, an abscess bursts, and the more blood comes from it the better. Dropsy is the least alarming when it has commenced without being preceded by any disease; next when it has supervened upon a long illness, certainly if the viscera are sound, if the breathing is easy, if there is no pain, if the body is not hot, and the extremities are wasted uniformly, if the abdomen is soft, if there is no cough, no thirst, if the tongue is not much parched even after sleep; if there is desire for food, if the bowels are moved by medicaments, if the motions when spontaneous are soft and formed, if the size of the abdomen are reduced; if the urine is altered both by a change of[p. 137] the wine and of certain medicinal draughts; if there is no lassitude and the disorder is easily borne: a patient who presents all these signs is thoroughly safe, and that case is hopeful which exhibits the greater number of them. Joint-disorders, too, such as foot and hand aches, if they attack young people and have not induced callosities, can be resolved; for the most part they are removed by dysenteries and fluid motions, whatever the sort. Epileptic fits again are not difficult to bring to an end, when they have commenced before puberty, and whenever the sensation of the coming fit begins in some one part of the body. It is best for it to begin from the hands or feet, next from the flanks, worst of all from the head. In such patients, also, the most favourable signs are when the disease can be discharged in the stools. Diarrhoea is itself harmless, when there is no fever, if it is quickly over, if on touching the abdomen no movements are to be felt, if wind follows the last of the motion. Even dysenteries are not a danger although blood or shreds are passed, as long as fever and other accessories of this malady are absent, so that even a pregnant woman can not only be preserved herself, but the foetus preserved also. It is helpful in this malady if the patient's age is already mature. Intestinal lubricity on the other hand is more easy got rid of in childhood, certainly if urine begins to be passed and the body to be nourished by the food. The same age has the advantage in cases both of hip and shoulder pains, and of all forms of para-[p. 139]lysis; in such the hip may be cured easily and early, if it is not numbed, if slightly cool, even though the pains are severe, and a paralysed limb can be restored if its nutrition is not at all impaired. Paralysis of the face may be even ended by a quick motion; and any purging benefits runnings of the eyes. But madness is relieved rather by the formation of varicose veins or by a sudden effusion of blood from haemorrhoids or by dysentery. Shoulder pains spreading to the shoulder-blades or hands are relieved by a vomit of black bile; and pain of any kind which moves downwards is the more curable. Sneezing puts an end to hiccough. Prolonged diarrhoeas are suppressed by vomiting. In a woman a vomiting of blood is relieved by menstruation; when not cleared up by menstruation, nose-bleeding removes all danger. A woman in trouble with her womb or labour difficulty is relieved by sneezing. Quartan fever in summer is mostly short. In a case of ardent fever with a tremor, delirium is salutary. For enlargement of the spleen dysenteries are good. Then again fever itself is in the end often a protection, which may appear very strange. For it brings to an end pains over the heart if there is no inflammation; and it also relieves a painful liver; and if it begins after spasm and rigor, it gives entire relief; and it removes the disease of the small intestine arising from urinary difficulty, if by its heat it promotes urination. Now pains in the head, accompanied by dimness of vision and redness of the eyes, along with some[p. 141] itching of the forehead, may be relieved by a haemorrhage, whether fortuitous or procured. Pains in the head and forehead due to wind or to cold or to heat are terminated by running from the nose and sneezings. The ardent fever, however, which the Greeks call causodes, is got rid of by a sudden shivering. During a fever, if the ears have become dulled, that trouble is entirely removed by a flux of blood from the nose, or by loose motions from the bowel. Against deafness nothing can be more efficacious than a bilious stool. Those who have begun to suffer from the smaller kinds of abscesses in the urethra which they call phumata, get well when pus has come away from that part. . . . and since they mostly arise of themselves, we may know that even where the resources of art are applied, nature can do the most. On the other hand, pain in the bladder with persistent fever, when nothing is passed by the bowel, is a fatal evil; the danger is greatest in boys from the seventh to the fourteenth year. In pulmonary disease, if there was no expectoration during the first days, if it then begins from the seventh day and persists beyond a further seven days, it is dangerous. And the more the sputum has an undistinguishable admixture of colours, the worse it is. But nevertheless nothing is worse than for the expectoration emitted to be homogeneous, whether reddish, or clotted, or white, or glutinous, or pallid,[p. 143] or frothy; worst of all, however, is the black. In this same disease the following are signs of danger: cough, catarrh, and even sneezing, which in other maladies is held salutary; and a sudden diarrhoea following upon the above is a most dangerous sign. Generally too the same signs hold good for pain in the side as for that in the lung, both the more favourable as well as the graver signs. If the pus discharged from the liver is bloody, it is a deadly sign. Now of suppurations the worst are those which tend inwards, whilst also discolouring the overlying skin: of those again which burst externally, the worst are those which are largest and most widespread. But even after the abscess has ruptured, or the pus has been let outwards, there is danger for certain if the fever does not subside, or although it subsides, nevertheless recurs; or further if there is thirst, if distaste for food, if liquid motions, if the pus is livid and pallid, if the patient expectorates nothing but frothy phlegm. And of such suppurations, old people die mostly of those excited by lung diseases; younger people of other kinds. But that in phthisis danger threatens a thin man is signified as follows: the expectoration is purulent with admixtures, a persistent fever robs him of his appetite at meal-times and afflicts him with thirst. Death is at hand if, after the patient has dragged on for a long while, the hair falls out, the urine exhibits sediment like cobwebs and has a foul odour, and most of all when upon the above diarrhoea supervenes; especially if it is the autumn season, when patients who have lasted through the rest of the year are generally undone. Moreover, in this[p. 145] disease, after pus has been expectorated, it is fatal for there to be an entire cessation of spitting. In the course of phthisis, even in adolescents, abscesses followed by fistulae arise in the lung; and unless numerous signs of convalescence follow, they do not readily heal. But as regards others, the least easily cured are girls, or those women in whom suppression of menses has supervened upon the phthisis. When again in a man who has been healthy there arises suddenly pain in the head, next he is so overcome by sleep that he snores and cannot be awaked, he will die by the seventh day; the more so, if a loose motion has not preceded, if the eyelids of the sleeper are unclosed and the whites of the eyes show. And in these cases death follows except if the malady has been dispersed by fever. Again dropsy, if caused by an acute disease, is seldom conducted to a cure, at any rate when signs supervene the reverse of those noted above. Likewise too in this disease a cough takes away hope as is also the case if there is an outburst of blood whether upwards or downwards and water fills the middle of the body. In some also in this disease swellings arise, then subside, and again recur: such patients are in a somewhat safer state than those mentioned above, if they give attention; but generally they are undone by over-confidence in their health. Here we may wonder with good reason why there should be occurrences which cause our bodies harm, and yet at the same time in a measure are beneficial: for whether it is dropsical fluid which has filled a patient up, or whether it is a quantity of pus which has collected in a large abscess, evacuation all at once is as fatal to him, as if a healthy man loses blood by a wound.[p. 147] Those too who suffer in their joints, so that growths of hard stuff are formed upon them, are never relieved entirely: all these damages, whether they have begun in old age, or have lasted from youth up to old age, although there is a possibility of some alleviation, are never entirely cured. Also fits which have arisen after the twenty-fifth year are hard to relieve, much harder when they begin after the fortieth; hence at this age, whilst there may be some hope from nature, there is scarcely any from the Art of Medicine. In this affection, if the whole body is affected all together, and there has not been beforehand in any part some feeling of an oncoming ill, but the patient falls down unexpectedly, he scarcely ever gets well, be his age what it may: further, if either the mind is diseased, or paralysis has been set up, there is no opportunity for the Art of Medicine. Again in cases of diarrhoea, danger of death is at hand: if there is fever in addition, if there is inflammation of the liver or of the parts over the heart or of the stomach, if excessive thirst, if the affection is prolonged; if the stools are varied and passed with pain, and especially if with these signs true dysenteries set in; and this disease carries off mostly children up to the age of ten; other ages bear it more easily. Also a pregnant woman can be swept away by such an event, and even if she herself recovers, yet she loses the child. Dysenteries are fatal, moreover, when originated by black bile, or if a black motion suddenly issues from a body already wasted by dysentery. Now intestinal lubricity is the more dangerous, if there is a frequent motion, if there is a flux from[p. 149] the bowel at all hours, with or without noise, if the same condition continues by night and in the day-time, if what is passed is either undigested or black, and besides that also slimy and foul; if there is urgent thirst, if urine is not passed after a drink (which happens because then all fluid passes down, not into the bladder, but into the intestine); if the mouth becomes ulcerated, the face reddened and marked as if by kinds of spots of all colours; if the belly is as though in a state of fermentation, fatty and wrinkled, also if there is no desire for food . . . ; while death is imminent in these circumstances, it is much more imminent if also this disease has already lasted a long while, especially if it be in an old patient. If again there is disease in the smaller intestine, vomiting, hiccough, spasm, delirium are bad signs. In jaundice again it is most pernicious for the liver to become hard. If dysentery has seized upon those with disease of the spleen which has then turned into dropsy or into leientery, scarcely any medical treatment can save them from danger. The disease of the smaller intestine, unless resolved, kills within seven days. A woman after childbirth is in danger of death, if[p. 151] also oppressed by violent and persistent pain in the head along with fever. To breathe rapidly is a bad sign if there is pain and inflammation in those parts which contain viscera. A prolonged pain in the head, if without cause it shifts to the neck and shoulders, and again returns to the head, or if it spreads from the head to reach the neck and shoulders, is most pernicious, unless it induces some abscess so that pus is coughed up, or unless there is an outburst of blood from some part, or unless there is upon the head an eruption of much scurf or of pimples all over the body. Equally severe is this malady when a numbness or an itching wanders, now all over the head, now over part of it, or there is felt there a sensation as of something cold, and when these symptoms extend to the tip of the tongue. And since the abscesses described above are beneficial, recovery is more difficult, in proportion as they supervene less often upon such maladies. When there are pains in the hips, if there is great numbness, and both the leg and hip become cold, if there is no movement of the bowel except forced, and the stool passed is mucous, and if the patient is already over forty, there will be a very prolonged illness, lasting at least a year, nor will it possibly come to an end except either in spring or in autumn. Treatment is likewise difficult at that age when pain in the shoulders either spreads to the hands or extending to the shoulder-blades gives rise to numbness and pain there, which is not relieved by a vomit[p. 153] of bile. Whatever too the part of the body, any limb which becomes paralysed if it is not moved and wastes, will not be restored to its former state, and the less so the longer the paralysis has been, and the older the patient. And for the cure of all cases of paralysis, winter and autumn are not favourable seasons; there is possibly hope in spring and summer; even when mild this disease is scarcely curable, a severe attack cannot be cured. All pain also becomes less amenable to treatment as it spreads upwards. In a pregnant woman, if the breasts suddenly shrivel up, there is danger of abortion. A woman has a defective menstruation who has milk in her breasts, not having just borne a child, or being pregnant. Quartan fever, whilst brief in summer, is generally prolonged in autumn, and especially so when beginning at the approach of winter. There is danger of death if haemorrhage is followed by dementia and by spasm; the same is the case when, after purgation by medicaments, and, with the bowel still empty, there is an attack of spasm, as also if with great pain in the bowel the extremities become cold. He does not return to life who has been taken down from hanging with foam around the mouth. A black stool resembling black blood, passed suddenly, whether accompanied by fever, or even without fever, is dangerous.
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