These are fatal symptoms: A deathlike countenance, sharp nose, hollow
eyes, and the other symptoms described by Hippocrates, when they do
not proceed from watchfulness, or evacuation, or want of food; also,
intolerance of the light, shedding tears from no external cause, there
being no particular affection of the eyes; or the one eye appearing less
than the other; or the white of the eyes becoming red, or livid, or
black, or having a muddiness in them; and the white of the eyes appearing
during sleep, the eyelids not being closed, unless this symptom proceed
from a great evacuation, or from habit. Likewise grinding the teeth,
a state of delirium, picking at flocks of wool, or bits of chaff, are
not favorable. Attention should also be paid to the patient’s mode of
lying. To lie on one’s back, as it were, in a relaxed state, and to
sink downwards in bed, are indications of extreme debility. It is still
worse to have a cold respiration at the mouth and nostrils; and a pulse
obscure, dense, and intermitting, and profuse sweatings with syncope are
most mortal symptoms. If all the symptoms we have mentioned, or even more
appear, or if they be fewer in number but strong, and if they be without
any of the favorable ones, death is inevitable. The breathing free, pulse
natural, soundness of intellect, being well disposed to take whatever is
offered, the appearance of countenance and mode of reclining like those
of persons in health,—all these symptoms are favorable and prognosticate
recovery; and, in general, whatever symptom is contrary to the natural
state indicates an unfavorable, whereas, what is correspondent, indicates
a favorable termination. Concerning the prognosis from the urine, alvine
discharges, and sputa, we will speak soon.
* * * * *
COMMENTARY. The great master of prognostics is Hippocrates, whose system
of medicine was entirely based on the observation of the favorable and
unfavorable symptoms of disease. It would appear that the first advances
in this art were made in the temples of the gods, and especially of
Æsculapius, which the sick were in the practice of resorting to in order
to ascertain the issue of their maladies. See a very ingenious and
learned disquisition, ‘de Hippocratis Doctrina a Prognostice oriunda,’
by F. Z. Ermerins, M.D. The works of Hippocrates, especially the
‘Prorrhetica and Coacæ,’ contain a rich treasure of observations which
cannot be too much explored by the student of medicine. His prognostics
are founded upon the appearances of the face, eyes, tongue, the voice,
hearing, the state of the hypochondriac region, the abdomen, the general
system, sleep, respiration, and the excretions. We can do little more, in
this place, than express our high sense of the value of the ‘Hippocratic
Treatises on Prognostics,’ and recommend the study of them to all members
of the profession who would wish to learn the true inductive system of
cultivating medicine. We shall give as a specimen of Hippocrates’ and
Galen’s labours, in this department, a few of Galen’s remarks on the
causes of the symptoms, as described by Hippocrates. It is one of the
prognostics of Hippocrates, that profuse perspiration in acute fevers is
unfavorable; and, in explanation of this, Galen states that a critical
sweat may indeed be favorable; but that such as are profuse and continued
indicate a complete prostration of the vital powers. A fixedness of the
eyes is said by Hippocrates to be a fatal symptom; the reason of which,
according to Galen, is, that it proceeds from paralysis, or insensibility
of the muscles of the eye. Hippocrates mentions it as an unfavorable
symptom when the patient lies with his mouth open; and Galen attributes
this symptom to the origin of the nerves, that is to say, the brain,
undergoing pressure. Hippocrates states, that involuntary discharges from
the bowels are an unfavorable symptom; and Galen justly remarks that they
indicate great insensibility.
The Prognostics and Aphorisms of Hippocrates are further illustrated
by the learned and interesting Commentaries of Stephanus Sophista,
Theophilus, and Damascius, which were published a few years ago by
Dietz. From the nature of their works, it is impossible to give any
satisfactory outline of their contents within our narrow limits. We shall
merely give one specimen of them. It is stated in one of the Aphorisms
of Hippocrates, that dyspnœa and delirium occurring together in fever,
indicate a fatal termination. Upon which Theophilus and Damascius remark,
that the one symptom implies disease of the heart and the other of the
brain. (Ed. Dietz. T. H., p. 415.)
Celsus gives an elegant translation of this part of the works of
Hippocrates. The following is his version of the description of the
Facies Hippocratica: “Ad ultima jam ventum esse testantur, nares acutæ,
collapsa tempora, concavi oculi, frigidæ languidæque aures et imis
partibus leniter versæ, cutis circa frontem dura et intenta, color aut
niger aut perpallidus.” Other unfavorable symptoms are also strikingly
portrayed: “Mali morbi testimonium est vehementer et crebro spirare:
a sexto die cepisse inhorrescere; pus expuere; vix excreare; dolorem
habere continuum; difficulter ferre morbum; jactare brachia et crura;
sine voluntate lachrimare; habere humorem glutinosum dentibus inhærentem;
cutem circa umbilicum et pubem macram, præcordia inflammata, dolentia,
dura, tumida, intenta, magisque si hæc dextra parte, quam sinistra est;
periculosissimum tamen est, si venæ quoque ibi vehementer agituntur.”
Aëtius and Oribasius, like our author, borrow almost every thing from
Hippocrates and Galen.
Rhases and Avicenna, particularly the latter, treat of the prognostics
in fever very fully. Avicenna, like Hippocrates, sets down deafness as
an unfavorable symptom. Hippocrates had stated, that jaundice coming
on before the seventh day is unfavorable; but Averrhoes affirms, that
all the Indian and Persian physicians reckoned it a favorable symptom.
Rhases considers yellowness of the skin an unfavorable symptom, unless
the fever be of a bilious nature. Alsaharavius says it is an unfavorable
complication when it does not prove critical. It is proper to mention
here that Hippocrates modifies the above prognostic by stating in one of
his aphorisms, that jaundice coming on on the 7th, 9th, 11th, or 14th day
is favorable. (iv. 64.) Alsaharavius states it as a dangerous symptom,
when the patient lies on his back with his legs drawn up. This agrees
with the prognostic of Celsus “Mors denuntiatur ubi æger supinus cubat,
eique genua contracta sunt.” Avicenna and Averrhoes state it as a fatal
symptom when the patient sinks down in bed and exposes his hands and
feet. (Averrhoes, Comment. in Cant. Avicennæ.)
According to Rhases it is a bad symptom when the patient has lost his
modesty, so as to expose freely those parts of the body that should
be covered. He holds also that it is a bad symptom when the vomitings
resemble verdigris. (Ad Mansor. x, 21.)
Prosper Alpinus gives an admirable account of the prognostics in
diseases. See his work, ‘De Præsagiendâ Morte et Vitâ ægrotantium,’
_passim_. He agrees with the ancients, that deafness is an unfavorable
symptom, unless it occur at the time of a crisis. Like the ancients,
he considers the absence of thirst an unfavorable symptom in ardent
diseases, as indicating that the system is insensible of its wants.