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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