the book of prognostics-第1章

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　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　400　BC

　　　　　　　　　　　　　　　　　　　　　　　　　　　　THE　BOOK　OF　PROGNOSTICS

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　by　Hippocrates

　　　　　　　　　　　　　　　　　　　　　　　　　　Translated　by　Francis　Adams









　　　　　　　　　　　　　　　　　　　　THE　BOOK　OF　PROGNOSTICS



　　IT　APPEARS　to　me　a　most　excellent　thing　for　the　physician　to

cultivate　Prognosis；　for　by　foreseeing　and　foretelling；　in　the

presence　of　the　sick；　the　present；　the　past；　and　the　future；　and

explaining　the　omissions　which　patients　have　been　guilty　of；　he　will

be　the　more　readily　believed　to　be　acquainted　with　the　circumstances

of　the　sick；　so　that　men　will　have　confidence　to　intrust　themselves　to

such　a　physician。　And　he　will　manage　the　cure　best　who　has　foreseen

what　is　to　happen　from　the　present　state　of　matters。　For　it　is

impossible　to　make　all　the　sick　well；　this；　indeed；　would　have　been

better　than　to　be　able　to　foretell　what　is　going　to　happen；　but

since　men　die；　some　even　before　calling　the　physician；　from　the

violence　of　the　disease；　and　some　die　immediately　after　calling　him；

having　lived；　perhaps；　only　one　day　or　a　little　longer；　and　before　the

physician　could　bring　his　art　to　counteract　the　disease；　it

therefore　becomes　necessary　to　know　the　nature　of　such　affections；　how

far　they　are　above　the　powers　of　the　constitution；　and；　moreover；　if

there　be　anything　divine　in　the　diseases；　and　to　learn　a　foreknowledge

of　this　also。　Thus　a　man　will　be　the　more　esteemed　to　be　a　good

physician；　for　he　will　be　the　better　able　to　treat　those　aright　who

can　be　saved；　having　long　anticipated　everything；　and　by　seeing　and

announcing　beforehand　those　who　will　live　and　those　who　will　die；　he

will　thus　escape　censure。

　　2。　He　should　observe　thus　in　acute　diseases：　first；　the

countenance　of　the　patient；　if　it　be　like　those　of　persons　in

health；　and　more　so；　if　like　itself；　for　this　is　the　best　of　all；

whereas　the　most　opposite　to　it　is　the　worst；　such　as　the　following；　a

sharp　nose；　hollow　eyes；　collapsed　temples；　the　ears　cold；　contracted；

and　their　lobes　turned　out：　the　skin　about　the　forehead　being　rough；

distended；　and　parched；　the　color　of　the　whole　face　being　green；

black；　livid；　or　lead…colored。　If　the　countenance　be　such　at　the

commencement　of　the　disease；　and　if　this　cannot　be　accounted　for

from　the　other　symptoms；　inquiry　must　be　made　whether　the　patient

has　long　wanted　sleep；　whether　his　bowels　have　been　very　loose；　and

whether　he　has　suffered　from　want　of　food；　and　if　any　of　these

causes　be　confessed　to；　the　danger　is　to　be　reckoned　so　far　less；

and　it　becomes　obvious；　in　the　course　of　a　day　and　a　night；　whether　or

not　the　appearance　of　the　countenance　proceeded　from　these　causes。　But

if　none　of　these　be　said　to　exist；　if　the　symptoms　do　not　subside　in

the　aforesaid　time；　it　is　to　be　known　for　certain　that　death　is　at

hand。　And；　also；　if　the　disease　be　in　a　more　advanced　stage　either

on　the　third　or　fourth　day；　and　the　countenance　be　such；　the　same

inquiries　as　formerly　directed　are　to　be　made；　and　the　other

symptoms　are　to　be　noted；　those　in　the　whole　countenance；　those　on　the

body；　and　those　in　the　eyes；　for　if　they　shun　the　light；　or　weep

involuntarily；　or　squint；　or　if　the　one　be　less　than　the　other；　or

if　the　white　of　them　be　red；　livid；　or　has　black　veins　in　it；　if　there

be　a　gum　upon　the　eyes；　if　they　are　restless；　protruding；　or　are

become　very　hollow；　and　if　the　countenance　be　squalid　and　dark；　or　the

color　of　the　whole　face　be　changed…　all　these　are　to　be　reckoned　bad

and　fatal　symptoms。　The　physician　should　also　observe　the　appearance

of　the　eyes　from　below　the　eyelids　in　sleep；　for　when　a　portion　of　the

white　appears；　owing　to　the　eyelids　not　being　closed　together；　and

when　this　is　not　connected　with　diarrhea　or　purgation　from　medicine；

or　when　the　patient　does　not　sleep　thus　from　habit；　it　is　to　be

reckoned　an　unfavorable　and　very　deadly　symptom；　but　if　the　eyelid

be　contracted；　livid；　or　pale；　or　also　the　lip；　or　nose；　along　with

some　of　the　other　symptoms；　one　may　know　for　certain　that　death　is

close　at　hand。　It　is　a　mortal　symptom；　also；　when　the　lips　are

relaxed；　pendent；　cold；　and　blanched。

　　3。　It　is　well　when　the　patient　is　found　by　his　physician　reclining

upon　either　his　right　or　his　left　side；　having　his　hands；　neck；　and

legs　slightly　bent；　and　the　whole　body　lying　in　a　relaxed　state；　for

thus　the　most　of　persons　in　health　recline；　and　these　are　the　best

of　postures　which　most　resemble　those　of　healthy　persons。　But　to　lie

upon　one's　back；　with　the　hands；　neck；　and　the　legs　extended；　is　far

less　favorable。　And　if　the　patient　incline　forward；　and　sink　down　to

the　foot　of　the　bed；　it　is　a　still　more　dangerous　symptom；　but　if　he

be　found　with　his　feet　naked　and　not　sufficiently　warm；　and　the　hands；

neck；　and　legs　tossed　about　in　a　disorderly　manner　and　naked；　it　is

bad；　for　it　indicates　aberration　of　intellect。　It　is　a　deadly　symptom；

also；　when　the　patient　sleeps　constantly　with　his　mouth　open；　having

his　legs　strongly　bent　and　plaited　together；　while　he　lies　upon　his

back；　and　to　lie　upon　one's　belly；　when　not　habitual　to　the　patient　to

sleep　thus　while　in　good　health；　indicates　delirium；　or　pain　in　the

abdominal　regions。　And　for　the　patient　to　wish　to　sit　erect　at　the

acme　of　a　disease　is　a　bad　symptom　in　all　acute　diseases；　but

particularly　so　in　pneumonia。　To　grind　the　teeth　in　fevers；　when

such　has　not　been　the　custom　of　the　patient　from　childhood；

indicates　madness　and　death；　both　which　dangers　are　to　be　announced

beforehand　as　likely　to　happen；　and　if　a　person　in　delirium　do　this　it

is　a　very　deadly　symptom。　And　if　the　patient　had　an　ulcer

previously；　or　if　one　has　occurred　in　the　course　of　the　disease；　it　is

to　be　observed；　for　if　the　man　be　about　to　die　the　sore　will　become

livid　and　dry；　or　yellow　and　dry　before　death。

　　4。　Respecting　the　movement　of　the　hands　I　have　these　observations　to

make：　When　in　acute　fevers；　pneumonia；　phrenitis；　or　headache；　the

hands　are　waved　before　the　face；　hunting　through　empty　space；　as　if

gathering　bits　of　straw；　picking　the　nap　from　the　coverlet；　or　tearing

chaff　from　the　wall…　all　such　symptoms　are　bad　and　deadly。

　　5。　Respiration；　when　frequent；　indicates　pain　or　inflanunation　in

the　parts　above　the　diaphragm：　a　large　respiration　performed　at　a

great　interval　announces　delirium；　but　a　cold　respiration　at　nose　or

mouth　is　a　very　fatal　symptom。　Free　respiration　is　to　be　looked　upon

as　contributing　much　to　the　safety　of　the　patient　in　all　acute

diseases；　such　as　fevers；　and　those　complaints　which　come　to　a

crisis　in　forty　days。

　　　6。　Those　sweats　are　the　best　in　all　acute　diseases　which　occur　on

the　critical　days；　and　completely　carry　off　the　fever。　Those　are

favorable；　too；　which　taking　place　over　the　whole　body；　show　that

the　man　is　bearing　the　disease　better。　But　those　that　do　not　produce

this　effect　are　not　beneficial。　The　worst　are　cold　sweats；　confined　to

the　head；　face；　and　neck；　these　in　an　acute　fever　prognosticate　death；

or　in　a　milder　one；　a　prolongation　of　the　disease；　and　sweats　which

occur　over　the　whole　body；　with　the　characters　of　those　confined　to

the　neck；　are　in　like　manner　bad。　Sweats　attended　with　a　miliary

eruption；　and　taking　place　about　the　neck；　are　bad；　sweats　in　the　form

of　drops　and　of　vapour　are　good。　One　ought　to　know　the　entire

character　of　sweats；　for　some　are　connected　with　prostration　of

strength　in　the　body；　and　some　with　intensity　of　the　inflammation。

　　7。　That　state　of　the　hypochondrium　is　best　when　it　is　free　from

pain；　soft；　and　of　equal　size　on　the　right　side　and　the　left。　But　if

inflamed；　or　painful；　or　distended；　or　when　the　right　and　left　sides

are　of　disproportionate　sizes；…　all　these　appearances　are　to　be

dreaded。　And　if　there　be　also　pulsation　in　the　hypochondrium；　it

indicates　perturbation　or　delirium；　and　the　physician　should　examine

the　eyes　of　such　persons；　for　if　their　pupils　be　in　rapid　motion；　such

persons　may　be　expected　to　go　mad。　A　swelling　in　the　hypochondrium；

that　is　hard　and　painful；　is　very　bad；　provided　it　occupy　the　whole

hypochondrium；　but　if　it　be　on　either　side；　it　is　less　dangerous

when　on　the　left。　Such　swellings　at　the　commencement　of　the　disease

prognosticate　speedy　death；　but　if　the　fever　has　passed　twenty　days；

and　the　swelling　has　not　subsided；　it　turns　to　a　suppuration。　A

discharge　of　blood　from　the　nose　occurs　to　such　in　the　first　period；

and　proves　very　useful；　but　inquiry　should　be　made　if　they　have

headache　or　indistinct　vision；　for　if　there　be　such；　the　disease

will　be　determined　thither。　The　discharge　of　blood　is　rather　to　be

expected　in　those　who　are　younger　than　thirty…five　years。　Such

swellings　as　are　soft；　free　from　pain；　and　yield　to　the　finger；

occasion　more　protracted　crises；　and　are　less　dangerous　than　the

others。　But　if　the　fever　continue　beyond　sixty　days；　without　any

subsidence　of　the　swelling；　it　indicates　that　empyema　is　about　to　take

place；　and　a　swelling　in　any　other　part　of　the　cavity　will　terminate

in　like　manner。　Such；　then；　as　are　painful；　hard；　and　large；

indicate　danger　of　speedy　death；　but　such　as　are　soft；　free　of　pain；

and　yield　when　pressed　with　the　finger；　are　more　chronic　than　these。

Swellings　in　the　belly　less　frequently　form　abscesses　than　those　in

the　hypochondrium；　and　seldomest　of　all；　those　below　the　navel　are

converted　into　suppuration；　but　you　may　rather　expect　a　hemorrhage

from　the　upper　parts。　But　the　suppuration　of　all　protracted

swellings　about　these　parts　is　to　be　anticipated。　The　collections　of

matter　there　are　to　be　thus　judged　of：　such　as　are　determined　outwards

are　the　best　when　they　are　small；　when　they　protrude　very　much；　and

swell　to　a　point；　such　as　are　large　and　broad；　and　which　do　not

swell　out　to　a　sharp　point；　are　the　worst。　Of　such　as　break

internally；　the　best　are　those　which　have　no　external　communication；

but　are　covered　and　indolent；　and　when　the　whole　place　is　free　from

discoloration。　That　pus　is　best　which　is　white；　homogeneous；　smooth；

and　not　at　all　fetid；　the　contrary　to　this　is　the　worst。

　　8。　All　dropsies　arising　from　acute　diseases　are　bad；　for　they　do　not

remove　the　fever；　and　are　very　painful　and　fatal。　The　most　of　them

commence　from　the　flanks　and　loins；　but　some　from　the　liver；　in

those　which　derive　their　origin　from　the　flanks　and　loins　the　feet

swell；　protracted　diarrhoeas　supervene；　which　neither　remove　the　pains

in　the　flanks　and　loins；　nor　soften　the　belly；　but　in　dropsies　which

are　connected　with　the　liver　there　is　a　tickling　cough；　with

scarcely　any　perceptible　expectoration；　and　the　feet　swell；　there

are　no　evacuations　from　the　bowels；　unless　such　as　are　hard　and

forced；　and　there　are　swellings　about　the　belly；　sometimes　on　the

one　side　and　sometimes　on　the　other；　and　these　increase　and　diminish

by　turns。

　　9。　It　is　a　bad　symptom　when　the　head；　hands；　and　feet　are　cold；

while　the　belly　and　sides　are　hot；　but　it　is　a　very　good　symptom

when　the　whole　body　is　equally　hot。　The　patient　ought　to　be　able　to

turn　round　easily；　and　to　be　agile　when