7 Now that I have set out the signs which are of general occurrence in any case of illness, I pass on to indicate signs which may be presented in particular sorts of diseases. There are, moreover, certain signs, some preceding, some in the course of fevers, which show what is, or what is about to become, the state of the internal parts. Before fever, if the head is heavy, or the eyes dimmed after sleep, or there are frequent sneezings, some attack of phlegm about the head is to be apprehended. If a man is full blooded or very hot, it is likely that there will be haemorrhage from some part. If a man without cause becomes thin, there is fear that his body may lapse into a dangerous state. If there is pain below the ribs or severe flatulence, or if for a whole day undigested urine is passed, there is clearly indigestion present. Persons whose colour is bad when they are not jaundiced are either sufferers from pains in the head or are earth eaters. Those who for a long time have a pale or puffy face are sufferers from head, bowel or stomach trouble. If in the case of a child with constant fever no motion is passed, the colour is altered, and sleeplessness persists and constant crying, there is danger of spasms. Again running from the nose recurring often in a slender and tall man is a sign that consumption is to be apprehended. When for several days no motion passes, it shows that a sudden[p. 119] motion or a touch of fever is impending. Dropsy is impending, when with prolonged diarrhoea the feet swell; when there is pain in the lower belly and hips; but this class of disease is wont to arise from the flanks. There is danger, the same as just stated, to those in whom, when there is a desire for stool, the bowels yield nothing unless a forced hard motion; also in whom there is swelling in the feet, and a swelling in turn in the right and then the left half of the abdomen which rises and subsides: but this disease appears to begin from the liver. It is a sign of the same disease, when intestines in the umbilical region undergo twisting (the Greeks call it strophos), when pains in the hips persist, which are not dispersed either by time or by medicaments. But when heat of joints, whether in the feet, hands, or any other part, is such that at that spot the sinews are contracted, or if that same limb, fatigued by a slight cause, is disturbed by heat and by cold alike, it denotes that there is about to set in pain in feet or hands, or disease of that joint in which heat is felt. Children in whom there has been nose-bleeding, which then has ceased, are sure to be troubled by pains in the head, or they get some severe joint-ulcerations, or they also become debilitated by disease of some kind. Women in whom the menstrua are not forthcoming are sure to have the most acute pains in the head, or some part or other becomes subject to disease. There are similarly dangers for those in whom joint-disorders, pains and swellings, arise and subside[p. 121] without pain in the feet and such like diseases, especially if they have often pain in the temples and night sweats. Running from the eyes is to be apprehended when the forehead itches. If after childbirth a woman has severe pains, yet without other bad signs, about the twentieth day either blood will burst out from the nose, or there will be some congestion in the lower parts. Indeed anyone getting great pain in the temples or forehead may be rid of it in one of these two ways, by haemorrhage especially if young, if older by suppuration. Fever, moreover, which suddenly, unaccountably and without good signs comes to an end, generally recurs. He will be found to have ulceration either in the nose or in the throat, whose throat, whether in the day-time, or by night, fills with blood, when this has been preceded neither by pains in the head, nor by pain over the heart, nor by coughing, nor by vomiting, nor by slight fever. In a woman, if without apparent cause an inguinal swelling has arisen with slight fever, there is ulceration in the womb. Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera. Similar urine, when greenish, is a sign that there will be either visceral pain and swelling with some danger, or certainly that the patient is not free from fever. But if there is blood or pus in the urine, either the bladder or the kidneys have become ulcerated. The kidneys at any rate are the seat of disorder: if the urine is thick and contains bits of flesh like hairs; if it froths and is malodorous; if at one time it presents something like sand, at another time like blood; when the hips are painful,[p. 123] as also the parts intermediate and above the pubes, and there are frequent eructations, now and again bilious vomiting, and the extremities become cold; when there is frequent desire to urinate but great urinary difficulty, and when what is passed is like water, reddish or pallid, yet is followed by little relief, and much wind too is passed with a motion. But the bladder is the actual seat of the disorder: when urine is passed drop by drop, or when blood is emitted with it, and in the blood are some clots which are passed with difficulty, and when the lower parts in the region of the pubes are painful. Cases of stone in the bladder are recognized by the following signs: urine is passed with difficulty and slowly, now and again even involuntarily, drop by drop, the urine being sandy; at times blood, or something blood-stained or purulent, is excreted with the urine; this some pass more readily standing, some whilst lying on the back and especially those with large calculi, some even pass urine bending forwards whilst they relieve the pain by drawing out the penis. There is in that part also a feeling of weight, increased by running, or by any kind of movement. Some also when in great pain interlock their feet, crossing alternately the one over the other. Women again are forced to put their hands to their vulvar orifice and scratch; at times they feel the stone when they put a finger to the place where it is pressing upon the neck of the bladder. But there is a lung disease in those who spit up frothy blood. In a pregnant woman immoderate looseness of the bowels can drive out the foetus; in the same condition, what she is carrying is a weakling, if milk escapes from her breasts; firm breasts testify that it is[p. 125] healthy. It signifies that the liver is inflamed when there is hiccough both frequent and continuing longer than usual. When swellings which have supervened upon ulcerations subside suddenly, if situated in the back, either spasm or rigor may be apprehended; but if this happens in front, either acute pleural pain or madness is to be expected: at times also in such a case, diarrhoea follows, which is the safest thing. If a customary bleeding from haemorrhoids is suddenly suppressed, dropsy or phthisis follows. Phthisis likewise supervenes if, after beginning with pain in the side, suppuration cannot be cleared off within forty days. And the black bile disease supervenes upon prolonged despondency with prolonged fear and sleeplessness. Those who often have bleeding from the nose, have swelling of the spleen, or pains in the head, and as a consequence some observe phantoms before their eyes. But those in whom the spleens are enlarged, in these the gums are diseased, the mouth foul, or blood bursts out from some part. When none of these things happen, of necessity bad ulcers will be produced on the legs, and from these black scars. In those who, with a cause for pain, do not feel it, the mind is disordered. If blood flows into the abdomen it is there turned into pus. There is danger of suppuration in the chest when pain spreads there from the hips and lower parts, even although no other bad sign is added. When, without any fever, there is pain or itching in some part, with redness and heat, some suppuration is taking place there. Also urine which is not limpid enough for a man in health denotes that some parotid suppuration is about to set in.
[p. 127] Now these signs, though even in the absence of fever, they afford indications of latent or oncoming affections, do so with much more certainty when there is fever in addition; and then signs of other diseases besides may develop. Thus madness is to be apprehended immediately: when a patient speaks more hurriedly than he did when well, and of a sudden becomes loquacious, and that with more audacity than was his wont; or when he breathes slowly and forcibly, and has dilated blood-vessels, while the parts below the ribs are hard and swollen. Further signs of madness are: frequent movement of the eyes, and, in cases of headache, shadows passing before the eyes; or loss of sleep in the absence of pain, the wakefulness persisting night and day; or lying on the belly contrary to habit without being obliged to do so by abdominal pain; or, while the body is still vigorous, an unaccustomed grinding of the teeth. If also there has been congestion which has subsided without the formation of pus, whilst fever persists, there is brought about danger first of delirium, then of death. Acute pain in ear with continuous severe fever also often disturbs the mind; from which affection younger patients die at times within seven days; older ones later, for they experience neither such high fever, nor are equally delirious, hence they hold out until this condition is converted into pus. The breasts of a woman, when they become suffused with blood, also indicate that delirium is about to supervene. But in those in whom fevers are prolonged, there will be an abscess somewhere or pains in the joints. When during fever the breathing in the throat becomes impeded, spasms are impending. If angina subsides suddenly, the malady has passed[p. 129] into the lung; and it is then often fatal within seven days. If that does not happen, it follows that somewhere there is suppuration. Again after a prolonged looseness of the bowels there arise dysenteries, and after these intestinal lubricity; phthisis after excessive runnings from the nose; lung diseases after pain in the side; and from these madness; after ardent fevers rigor or spasm of sinews; after a head wound, delirium; when wakefulness tortures, spasms of sinews; when in wounds blood-vessels throb violently, haemorrhage. But suppuration is induced by many diseases; for if fever continues for a long while without pain and without evident cause, suppuration is developing in some part — in younger patients, however; for generally in the elderly from a self-same malady a quartan fever is developed. Suppuration is likewise being produced if the parts below the[p. 131] ribs are hard and painful, and have not carried off the patient by the twentieth day, or nose-bleeding has not occurred, and this chiefly in the case of adolescents, especially if from the commencement there has been dimness of vision, or headache; but in these cases something is abscessing in the lower parts of the abdomen. Or if the parts below the ribs present a soft swelling which persists and does not subside within sixty days, and fever holds all that time; but in these cases an abscess is being produced in the upper parts of the abdomen. And if it is not produced in the actual viscera, it breaks out around the ears. Whilst every swelling of long standing is generally an expectant abscess, it tends more to this in the region in front of the heart, than in the abdomen, and in the abdomen rather above than below the navel. Something is abscessing, either in the jaws or in the joints, if there is with the fever also a feeling of lassitude. At times too the urine remains thin and unconcocted for so long that other signs are salutary, and from this condition an abscess often occurs below the transverse membrane which the Greeks call diaphragma. Pain in the lung again, when not terminated by expectoration or by blood-letting, or by regulation of the diet, may excite some abscesses in it about the twentieth, thirtieth, fortieth, occasionally sixtieth day. But we will count from the day when there is first fever or shivering or sense of weight in that part. These abscesses originate sometimes from the lung, sometimes from the opposite side. Whichever side is affected the suppuration gives rise to pain in inflammation; it is hotter there, and if the patient lies on the sound side he seems to oppress it by some weight. Further, any suppuration, not yet evident to the eye, can be detected as follows: if the fever does not remit, but whilst diminishing by day, increases at night, there is profuse sweating, a desire to cough, yet hardly anything is expectorated in coughing; the eyes are sunken, the cheeks flushed, the veins under the tongue pale; the finger nails become curved, the fingers hot, especially at their tips; there are swellings in the feet; there is greater difficulty in breathing, and distaste for food; pustules spring up all over the body. But if there was pain from the commencement with cough and difficult breathing, the abscess will burst before or[p. 133] about the twentieth day; if these signs happen later they necessarily have to develop, but the less quickly they come to a head, the later the relief. In a grave disease the feet, toes and nails also tend to blacken; and when death does not follow, and the rest of the body recovers, nevertheless the feet fall off.
