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 violence ends thus： the second is
protracted to the seventh day； the third to the eleventh； the fourth
to the fourteenth； the fifth to the seventeenth； and the sixth to
the twentieth。 Thus these periods from the most acute disease ascend
by fours up to twenty。 But none of these can be truly calculated by
whole days； for neither the year nor the months can be numbered by
entire days。 After these in the same manner； according to the same
progression； the first period is of thirty…four days； the second of
forty days； and the third of sixty days。 In the commencement of
these it is very difficult to determine those which will come to a
crisis after a long interval； for these beginnings are very similar；
but one should pay attention from the first day； and observe further
at every additional tetrad； and then one cannot miss seeing how the
disease will terminate。 The constitution of quartans is agreeable to
the same order。 Those which will come to a crisis in the shortest
space of time； are the easiest to be judged of； for the differences of
them are greatest from the commencement； thus those who are going to
recover breathe freely； and do not suffer pain； they sleep during
the night； and have the other salutary symptoms； whereas those that
are to die have difficult respiration； are delirious； troubled with
insomnolency； and have other bad symptoms。 Matters being thus； one may
conjecture； according to the time； and each additional period of the
diseases； as they proceed to a crisis。 And in women； after
parturition； the crises proceed agreeably to the same ratio。
21。 Strong and continued headaches with fever； if any of the
deadly symptoms be joined to them； are very fatal。 But if without such
symptoms the pain be prolonged beyond twenty days； a discharge of
blood from the nose or some abscess in the inferior parts may be
anticipated； but while the pain is recent； we may expect in like
manner a discharge of blood from the nose； or a suppuration；
especially if the pain be seated above the temples and forehead； but
the hemorrhage is rather to be looked for in persons younger than
thirty years； and the suppuration in more elderly persons。
22。 Acute pain of the ear； with continual and strong fever； is to be
dreaded； for there is danger that the man may become delirious and
die。 Since； then； this is a hazardous spot； one ought to pay
particular attention to all these symptoms from the commencement。
Younger persons die of this disease on the seventh day； or still
earlier； but old persons much later； for the fevers and delirium
less frequently supervene upon them； and on that account the ears
previously come to a suppuration； but at these periods of life；
relapses of the disease coming on generally prove fatal。 Younger
persons die before the ear suppurates； only if white matter run from
the ear； there may be hope that a younger person will recover；
provided any other favorable symptom be combined。
23。 Ulceration of the throat with fever； is a serious affection； and
if any other of the s