De Medicina

3 But when fever has actually seized upon a man, it may be known that he is not in danger: if he lies upon his side, whether on his right or left, just as suits him, with his legs a little drawn up, as is generally the way with a healthy person when lying

down; if the patient turns readily in bed, if he sleeps through the night, and keeps awake by day; if he breathes easily; if he does not toss about; if the skin around the navel and pubes is plump; if the parts below the ribs on the two sides are uniformly soft, without any sensation of pain; for even although they are somewhat tumid, so long as they yield to pressure by the fingers, and are not tender, this illness, though it will continue for some time, yet will be safe. There is promise of freedom from anxiety when the body in general is uniformly soft and warm, and it sweats uniformly all over, and if with this sweating the touch of fever comes to an end. Among good signs are: sneezing, also a desire for food, whether maintained from the first, or even beginning after a distaste for food. Nor should a fever which ends on the same day cause alarm, nor indeed one which, although longer in disappearing, yet entirely quiets down before the next paroxysm, so that the body is rendered sound, or, as the Greeks call it, eilikrines. But should any vomiting occur, it should be of bile and of phlegm mixed; any sediment in the urine would be white, slimy, and uniform, and so that even if small clouds, as it were, are swimming in it, they sink to the bottom. Again the belly of one who is safe from danger yields soft, formed motions, at much the same time as was customary in health, as well as proportionate to the food taken. A loose motion is worse; but not even this should cause alarm at once, if on the following morning the stool is rather more solid, or if each succeeding motion becomes firmer, reddish, and smelling no worse than that of a man in health. There is no harm in passing off some round worms towards the crisis of the malady. When flatulence causes pain and swelling in the upper part of the abdomen, it is a good sign when intestinal rumbling passes thence downwards towards the lower belly, and the more so, when without difficulty the wind escapes along with the faeces.

4 On the contrary there is danger of a severe disease: when the patient lies on his back with his arms and legs outstretched; when at the onset of an acute disease, especially in lung troubles, he wants to sit up; when he is worn down by insomnia even if he gets some sleep in the day-time, in which case to sleep between ten o'clock in the morning and night is worse than from early morning till ten o'clock. The worst, however, is if he gets sleep neither by day nor by night; for this generally cannot happen unless there is continuous pain. It is not a good sign, however, to be oppressed beyond measure by sleep, and it is the worse the more that somnolence continues day and night. It is also evidence of a serious malady: when the breathing is forcible and quick, when the patient begins to have shiverings from the sixth day, to spit up pus, to expectorate it with difficulty, to have continuous pain, to bear up against the disease with difficulty, to toss the arms and legs, to shed tears involuntarily, to have sticky humor adhering to the teeth, the skin about the navel and the pubes wasted; the parts below the ribs inflamed, painful, hard, tumid, tense and this more on the right than on the left side; the greatest danger, however, is if in that region the

blood-vessels throb forcibly. It also indicates a serious malady: to become thinner too quickly; to have the head, feet and hands hot, and the belly and sides cold, or to have the extremities cold at the height of an acute disease, or to shiver after sweating; or after vomiting to hiccough or to get red eyes; or to have loss of appetite after eagerness for food or after prolonged fevers; or to sweat profusely, especially a cold sweat, or to have sweats unequally distributed over the body which do not put an end to the fever; and when those fevers which recur every day at the same hour, or which have always equal paroxysms, are not relieved on the third day, but continue; serious also are those fevers which, whilst they increase by paroxysms and are relieved by declining, yet never leave the body free. The worst is when the fever is not even relieved but continues uniformly at its height. It is likewise dangerous for a fever to supervene upon jaundice, especially if the parts below the ribs on the right side remain hard. In these sufferers every acute fever must make us seriously anxious; and never in acute fever or following on sleep is a spasm otherwise than terrifying. To lie in a fright on awaking from sleep is a sign of serious malady; and also when, immediately upon the onset of a fever, there is mental disturbance, or any one of the limbs is paralysed; in which case, although there is a return of vitality, yet generally that limb is weakened. A vomit also is a danger-sign if purely of phlegm or of bile, unmixed, and it is the worse if green or black. It is a bad sign when the urinary sediment is reddish and slimy; worse if it is like flower-petals, thin and white; worst of all if there is an appearance as if of fine clouds composed of bran. Also thin and white urine is faulty, but above all in phrenetics. Again it is bad for the motions to be totally suppressed; it is dangerous also during fevers when fluid stools allow the patient no rest in bed, and especially if the evacuation is quite liquid, whether it be whitish or greenish or frothy. In addition danger is indicated when the motion is scanty, viscid, slimy, white, the same when greenish yellow; or if it is either livid or bilious, or bloody, or if a worse odour when ordinary. It is bad after a prolonged fever when the stool is unmixed.