The genuine works of Hippocrates, Vol. 1 · Hippocrates
THE BOOK OF PROGNOSTICS.
Distortions of the countenance, if not sympathetic with some other part of the body, quickly pass off either spontaneously or by remedial means. The others are of an apoplectic nature. In other cases, when the diseased part wastes from want of motion, there can be no relief afforded. But when wasting does not take place there may be recovery. With regard to the time when this may occur, it is to be prognosticated by attending to the severity of the disease, to its duration, to the age of the patient, and to the season, it being known that of all cases the inveterate, and such as are the consequences of repeated attacks, are the worst, and the most difficult to remove, and those in aged persons. Autumn and winter are more unfavorable seasons for such complaints than spring and summer. Pains in the shoulder, which, passing down the arms, occasion torpor and pains, do not usually terminate in deposits, but the patients get better by vomiting black bile. But when the pains remain in the shoulders, or extend to the back, the patients are relieved by vomiting pus or black bile. They are to be judged of thus:--If their breathing be free, and if they be slender, it is rather to be expected that they will vomit black bile. But if they have more difficulty of breathing, and if there is any unusual color on the countenance, whether reddish or black, it is to be expected that they will rather spit blood. It should also be attended to whether there be swellings on the feet. This disease attacks men most violently from forty to sixty years of age. At this period of life ischiatic diseases are most troublesome.
Ischiatic diseases are to be thus judged of:--In the case of old persons, when the torpor and coldness of the loins and legs are very strong, and when they lose the power of erections, and the bowels are not moved, or with difficulty, and the fæces are passed with much mucus, the disease will be very protracted, and it should be announced beforehand that the disease will not last shorter time than a year from its commencement; and amendment is to be looked for in spring and summer. Ischiatic diseases are no less painful in young men, but are of shorter duration, for they pass off in forty days; and neither is the torpor great, nor is there coldness of the legs and loins. In those cases in which the disease is seated in the loins and leg, but the patient does not suffer so much as to be confined to bed, examine whether any concretions have taken place in the hip-joint, and make inquiry whether the pain extends to the groin; for if both these symptoms be present, the disease will be of long duration.
And the physician should also inquire whether there be torpor in the thigh, and if it extend to the ham; and if he says so, he is to be again asked if it spreads along the leg to the ankle of the foot. Those who confess to the most of these symptoms are to be told that the limb will be sometimes hot and sometimes cold; but those persons in whom the pain leaves the loins, and is turned downwards, are to be encouraged; but when the disease does not leave the hip and loins, such persons are to be warned that it is to be dreaded. In those cases in which there are pains and swellings about the joints, and they do not pass off, after the manner of gout, you will find the bowels enlarged, and a white sediment in the urine; and, if you inquire, the patient will admit that the temples are often pained, and he will say that he has nightly sweats. If the urine have not this sediment, nor do the sweats take place, there is danger either that the joints will become lame, or that the tumor called meliceris will form in it. This disease forms in those persons who in their youth had epistaxis, and in whom it had ceased afterwards.
They are to be interrogated whether they had discharges of blood in their youth, and if they have pruritus in the breast and back. And the same thing happens to those who have severe pains in the bowels, without disorder of them, or who have hemorrhoids. This is the origin of these complaints. But if the patients have a bad color, they are to be interrogated whether their head be pained, for they will say that it is. In those cases in which the bowels are pained on the right side, the pains are stronger, and especially when the pain terminates in the hypochondrium at the liver. Such pains are immediately relieved if borborygmi take place in the belly. But when the pain ceases, they pass thick and green urine. The disease is not deadly, but very protracted. But when the disease is already of long standing, the patients have dimness of sight in consequence of it. But they are to be interrogated whether, when young, they had a flow of blood, and regarding the dimness of vision, the greenness of the urinary discharge, and regarding the borborygmi, if they took place and gave relief; for they will confess to all these symptoms. Lichen, leprosy, and leucè, when they occur in young children and infants, or when they appear at first small, and gradually increase in the course of a long time--in these cases the eruption is not to be regarded as a deposit, but as a disease; but when they set in rank and suddenly, this case is a deposit. Leucè also arises from the most fatal diseases, such as the disease called phthisis;[526] but leprosy and lichen are connected with black bile. These complaints are the more easily cured the more recent they are, and the younger the patients, and the more soft and fleshy the parts of the body in which they occur.
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