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the lungs； but in all other affections； even the most deadly； sneezing
is a salutary symptom。 A yellow spittle mixed up with not much blood
in cases of pneumonia； is salutary and very beneficial if spit up at
the commencement of the disease； but if on the seventh day； or still
later； it is less favorable。 And all sputa are bad which do not remove
the pain。 But the worst is the black； as has been described。 Of all
others the sputa which remove the pain are the best。
15。 When the pains in these regions do not cease； either with the
discharge of the sputa； nor with alvine evacuations； nor from
venesection； purging with medicine； nor a suitable regimen； it is to
be held that they will terminate in suppurations。 Of empyemata such as
are spit up while the sputum is still bilious； are very fatal； whether
the bilious portion be expectorated separate； or along with the other；
but more especially if the empyema begin to advance after this
sputum on the seventh day of the disease。 It is to be expected that
a person with such an expectoration shall die on the fourteenth day；
unless something favorable supervene。 The following are favorable
symptoms： to support the disease easily； to have free respiration；
to be free from pain； to have the sputa readily brought up； the
whole body to appear equally warm and soft； to have no thirst； the
urine； and faeces； sleep； and sweats to be all favorable； as described
before； when all these symptoms concur； the patient certainly will not
die； but if some of these be present and some not； he will not survive
longer than the fourteenth day。 The bad symptoms are the opposite of
these； namely； to bear the disease with difficulty； respiration
large and dense； the pain not ceasing； the sputum scarcely coughed up；
strong thirst； to have the body unequally affected by the febrile
heat； the belly and sides intensely hot； the forehead； hands； and feet
cold； the urine； and excrements； the sleep； and sweats； all bad；
agreeably to the characters described above； if such a combination
of symptoms accompany the expectoration； the man will certainly die
before the fourteenth day； and either on the ninth or eleventh。 Thus
then one may conclude regarding this expectoration； that it is very
deadly； and that the patient will not survive until the fourteenth
day。 It is by balancing the concomitant symptoms whether good or
bad； that one is to form a prognosis； for thus it will most probably
prove to be a true one。 Most other suppurations burst； some on the
twentieth； some on the thirtieth； some on the fortieth； and some as
late as the sixtieth day。
16。 One should estimate when the commencement of the suppuration
will take place； by calculating from the day on which the patient
was first seized with fever； or if he had a rigor； and if he says；
that there is a weight in the place where he had pain formerly； for
these symptoms occur in the commencement of suppurations。 One then may
expect the rupture of the abscesses to take place from these times
according to the periods formerly stated。 But if the empyema be only
on either side； one should turn him and inquire if he has pain on
the other side； and if the one side be hotter than the other； and when
laid upon the sound side； one should inquire if he has the feeling
of a weight hanging from above； for if so； the empyema will be upon
the opposite side to that on which the weight was felt。
17。 Empyema may be recognized in all cases by the following
symptoms： In the first place； the fever does not go off； but is slight
during the day； and increases at night； and copious sweats
supervene； there is a desire to cough； and the patients expectorate
nothing worth mentioning； the eyes become hollow； the cheeks have
red spots on them； the nails of the hands are bent； the fingers are
hot especially their extremities； there are swellings in the feet；
they have no desire of food； and small blisters （phlyctaenae） occur
over the body。 These symptoms attend chronic empyemata； and may be
much trusted to； and such as are of short standing are indicated by
the same； provided they be accompanied by those signs which occur at
the commencement； and if at the same time the patient has some
difficulty of breathing。 Whether they will break earlier or later
may be determined by these symptoms； if there be pain at the
commencement； and if the dyspnoea； cough； and ptyalism be severe；
the rupture may be expected in the course of twenty days or still
earlier； but if the pain be more mild； and all the other symptoms in
proportion； you may expect from these the rupture to be later； but
pain； dyspnoea； and ptyalism； must take place before the rupture of
the abscess。 Those patients recover most readily whom the fever leaves
the same day that the abscess bursts；… when they recover their
appetite speedily； and are freed from the thirst；… when the alvine
discharges are small and consistent； the matter white； smooth； uniform
in color； and free of phlegm； and if brought up without pain or strong
coughing。 Those die whom the fever does not leave； or when appearing
to leave them it returns with an exacerbation； when they have
thirst； but no desire of food； and there are watery discharges from
the bowels； when the expectoration is green or livid； or pituitous and
frothy； if all these occur they die； but if certain of these
symptoms supervene； and others not； some patients die and some
recover； after a long interval。 But from all the symptoms taken
together one should form a judgment； and so in all other cases。
18。 When abscesses form about the ears； after peripneumonic
affections； or depositions of matter take place in the inferior
extremities and end in fistula； such persons recover。 The following
observations are to be made upon them： if the fever persist； and the
pain do not cease； if the expectoration be not normal； and if the
alvine discharges be neither bilious； nor free and unmixed； and if the
urine be neither copious nor have its proper sediment； but if； on
the other hand； all the other salutary symptoms be present； in such
cases abscesses may be expected to take place。 They form in the
inferior parts when there is a collection of phlegm about the
hypochondria； and in the upper when the continue soft and free of
pain； and when dyspnoea having been present for a certain time； ceases
without any obvious cause。 All deposits which take place in the legs
after severe and dangerous attacks of pneumonia； are salutary； but the
best are those which occur at the time when the sputa undergo a
change； for if the swelling and pain take place while the sputa are
changing from yellow and becoming of a purulent character； and are
expectorated freely； under these circumstances the man will recover
most favorably and the abscess becoming free of pain； will soon cease；
but if the expectoration is not free； and the urine does not appear to
have the proper sediment； there is danger lest the limb should be
maimed； or that the case otherwise should give trouble。 But if the
abscesses disappear and go back； while expectoration does not take
place； and fever prevails； it is a bad symptom； for there is danger
that the man may get into a state of delirium and die。 Of persons
having empyema after peripneumonic affections； those that are advanced
in life run the greatest risk of dying； but in the other kinds of
empyema younger persons rather die。 In cases of empyema treated by the
cautery or incision； when the matter is pure； white； and not fetid；
the patient recovers； but if of a bloody and dirty character； he dies。
19。 Pains accompanied with fever which occur about the loins and
lower parts； if they attack the diaphragm； and leave the parts
below； are very fatal。 Wherefore one ought to pay attention to the
other symptoms； since if any unfavorable one supervene； the case is
hopeless； but if while the disease is determined to the diaphragm； the
other symptoms are not bad； there is great reason to expect that it
will end in empyema。 When the bladder is hard and painful； it is an
extremely bad and mortal symptom； more especially in cases attended
with continued fever； for the pains proceeding from the bladder
alone are to kill the patient； and at such a time the bowels are not
moved； or the discharges are hard and forced。 But urine of a
purulent character； and having a white and smooth sediment； relieves
the patient。 But if no amendment takes place in the characters of
the urine； nor the bladder become soft； and the fever is of the
continual type； it may be expected that the patient will die in the
first stages of the complaint。 This form attacks children more
especially； from their seventh to their fifteenth year。
20。 Fevers come to a crisis on the same days as to number on which
men recover and die。 For the mildest class of fevers； and those
originating with the most favorable symptoms； cease on the fourth
day or earlier； and the most malignant； and those setting in with
the most dangerous symptoms； prove fatal on the fourth day or earlier。
The first class of them as to violenc