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questions for plenty of practice in mastering math concepts and learning
dosage calculations.
• Mnemonics throughout the text facilitate memorization and
conserve learning time.
• Red arrow alerts call attention to critical math and patient
safety theory to increase student awareness of potential
errors and patient safety issues.
• High-risk drug icons serve as visual reminders of high-risk
drugs in the text.
• UNIQUE! FAQs and answers break up the text, add to
comprehension, and provide additional necessary knowledge
for students studying both inside and outside of a classroom
environment.
• UNIQUE! Ask Yourself questions synthesize and reinforce
comprehension of content.
• UNIQUE! Communication boxes display sample nurse-patient,
nurse-prescriber dialogues that help reduce medication errors
and relate the math to the medications and to clinical
application.
• Multiple-choice review at the end of each chapter supplies a
multiple-choice format review for NCLEX exam preparation.
• Chapter final supplies you with a final practice over material
covered in the entire chapter so you can evaluate
understanding of chapter content.
• Comprehensive final practice at the end of the text covers
major concepts and offers additional practice for overall
evaluation of learning.
• Rapid Practice exercises follow each new topic presented in
each chapter to encourage and allow drug calculation and
math concepts to be completed in one sitting.
• Consistent chapter format provides you with a quick overview
of chapter contents including objectives, estimated time to
complete chapter, an introduction and essential vocabulary.
• A comprehensive math review section includes a self-
assessment test designed to help you identify areas of
strength and weakness in competency of basic math.
• Early introduction of the dimensional analysis method with
basic practice problems in chapter 2 facilitates application of
 the dimensional analysis method to various types of
medication-related calculations.
• TJC and ISMP recommendations help reduce medication
errors, increase patient safety, and ensure compliance with
agency regulations.
• Full-color design, bold print, boxed material, and ample space
to work out the practice problems make navigating chapters
easy and mastering content more effective.
• Test tips throughout the text enhance comprehension and
improve test-taking skills.
• Cultural boxes describe selected math notation and
medication related cultural practices to help reduce math-
related reading errors while broadening your cultural
perspective.
• Clinical Relevance boxes expand your perception of the
medication-related nurse’s role while motivating interest, and
increasing awareness of safety issues.
• Website and other applicable references at the end of each
chapter offer extra resources for further medication-related
theory.
• NEW and UPDATED!Examples in Dimensional Analysis
Method chapter have beenrevised for clarity with consistent
format of equations.
• NEW and UPDATED! Practice problems in parenteral nutrition,
advanced intravenous calculations, anticoagulants, blood
administration, diabetic meds, and pediatric have been
incorporated throughout the text.
• NEW and UPDATED! Medication labels and photos keep you
up-to-date on the latest medications in use today.
• NEW and UPDATED! Current medication-related patient safety
trends from QSEN, TJC, ISMP and NLN.
• NEW!Reorganized answer key places answers and the work to
practice problems at the end of each chapter for easier
accessibility.
The Nurse, The Math, The Meds, 3rd
Edition
by Joyce L. Mulholland, MS, RN, ANP, MA and Susan Turner, RN,
MSN, FNP
Paperback
Use the simplicity of the dimensional analysis method to minimize
drug calculation errors! The Nurse, The Math, The Meds, 3rd
Edition helps you overcome any math anxiety you may have by
clearly explaining how to use the dimensional analysis method. It
shows how to analyze practice problems, find the reasonable answer,
and then evaluate it. But first, it lets you refresh your math skills with a
review of essential math. Written by noted nursing educator Joyce
Mulholland, this book offers over 1,400 questions for plenty of practice
in mastering math concepts and learning dosage calculations.
• Key Features
New to This Editi

The Nurse, The Math, The Meds, 3rd

Edition
by Joyce L. Mulholland, MS, RN, ANP, MA and Susan Turner, RN,
MSN, FNP
Paperback
Use the simplicity of the dimensional analysis method to minimize
drug calculation errors! The Nurse, The Math, The Meds, 3rd
Edition helps you overcome any math anxiety you may have by
clearly explaining how to use the dimensional analysis method. It
shows how to analyze practice problems, find the reasonable answer,
and then evaluate it. But first, it lets you refresh your math skills with a
review of essential math. Written by noted nursing educator Joyce
Mulholland, this book offers over 1,400 questions for plenty of practice
in mastering math concepts and learning dosage calculations.
• Key Features
• New to This Edition
• Contents
PART I: MATH REVIEW FOR MEDICATION
CALCULATIONS Math Self-Assessment 1. Math Review
2. Dimensional Analysis Method
PART II: MODERN METRIC SYSTEM AND MEDICATION
CALCULATIONS 3. Measurement Units and Conversions
4. Patient Records, Medication Orders, and Medication Labels
PART III: RECONSTITUTED MEDICATIONS 5. Oral
Medications 6. Syringe Measurements 7. Reconstitution of
Medications
PART IV: PARENTERAL MEDICATIONS 8. Injectable
Medications 9. Basic Intravenous Calculations 10. Advanced
Intravenous Calculations
PART V: COMMON HIGH-ALERT MEDICATIONS 11. Diabetic
Medications 12. Anticoagulant Medications
PART VI: MEDICATIONS FOR INFANTS AND
CHILDREN 13. Pediatric Medications
Comprehensive Final Practice
Appendix A: TJC Do Not Use List Appendix B: ISMP List of
High-Alert Medications Appendix C: 5-Minute Sample Verbal
Communication Hand-Off Report Appendix D: Sample
Medication Error Chart with Implications Appendix E:
Apothecary System Measurements
Index
• on
• Contents
PART I: MATH REVIEW FOR MEDICATION
CALCULATIONS Math Self-Assessment 1. Math Review
2. Dimensional Analysis Method
PART II: MODERN METRIC SYSTEM AND MEDICATION
CALCULATIONS 3. Measurement Units and Conversions
4. Patient Records, Medication Orders, and Medication Labels
PART III: RECONSTITUTED MEDICATIONS 5. Oral
Medications 6. Syringe Measurements 7. Reconstitution of
Medications
PART IV: PARENTERAL MEDICATIONS 8. Injectable
Medications 9. Basic Intravenous Calculations 10. Advanced
Intravenous Calculations
PART V: COMMON HIGH-ALERT MEDICATIONS 11. Diabetic
Medications 12. Anticoagulant Medications
PART VI: MEDICATIONS FOR INFANTS AND
CHILDREN 13. Pediatric Medications
Comprehensive Final Practice
Appendix A: TJC Do Not Use List Appendix B: ISMP List of
High-Alert Medications Appendix C: 5-Minute Sample Verbal
Communication Hand-Off Report Appendix D: Sample
Medication Error Chart with Implications Appendix E:
Apothecary System Measurements
Index
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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.
[472]

7.[473] 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.[474] 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 large,
indicate danger of speedy death; but such as are soft, free of pain,
and yield when pressed with the finger, are more chronic than these.
Swellings in the belly less frequently form abscesses than those in
the hypochondrium; and seldomest of all, those below the navel are
converted into suppuration; but you may rather expect a
hemorrhage from the upper parts. But the suppuration of all
protracted swellings about these parts is to be anticipated. The
collections of matter there are to be thus judged of: such as are
determined outwards are the best when they are small, when they
protrude very much, and swell to a point; such as are large and
broad, and which do not swell out to a sharp point, are the worst. Of
such as break internally, the best are those which have no external
communication, but are covered and indolent; and when the whole
place is free from discoloration. That pus is best which is white,
homogeneous, smooth, and not at all fetid; the contrary to this is
the worst.
8.[475] All dropsies arising from acute diseases are bad; for they
do not remove the fever, and are very painful and fatal. The most of
them commence from the flanks and loins, but some from the liver;
in those which derive their origin from the flanks and loins the feet
swell, protracted diarrhœas supervene, which neither remove the
pains in the flanks and loins, nor soften the belly;[476] but in
dropsies which are connected with the liver there is a tickling cough,
with scarcely any perceptible expectoration, and the feet swell; there
are no evacuations from the bowels, unless such as are hard and
forced; and there are swellings about the belly, sometimes on the
one side and sometimes on the other, and these increase and
diminish by turns.[477]
9. It is a bad symptom when the head, hands, and feet are cold,
while the belly and sides are hot; but it is a very good symptom
when the whole body is equally hot.[478] The patient ought to be
able to turn round easily, and to be agile when raised up; but if he
appear heavy in the rest of his body as well as in his hands and feet,
it is more dangerous; and if, in addition to the weight, his nails and
fingers become livid, immediate death may be anticipated; and if the
hands and feet be black it is less dangerous than if they be livid, but
the other symptoms must be attended to; for if he appear to bear
the illness well, and if certain of the salutary symptoms appear along
with these there may be hope that the disease will turn to a
deposition, so that the man may recover; but the blackened parts of
the body will drop off. When the testicles and members are retracted
upwards, they indicate strong pains and danger of death.[479]
10. With regard to sleep—as is usual with us in health, the
patient should wake during the day and sleep during the night. If
this rule be anywise altered it is so far worse: but there will be little
harm provided he sleep in the morning for the third part of the day;
such sleep as takes place after this time is more unfavorable; but the
worst of all is to get no sleep either night or day; for it follows from
this symptom that the insomnolency is connected with sorrow and
pains, or that he is about to become delirious.[480]
11. The excrement is best which is soft and consistent, is passed
at the hour which was customary to the patient when in health, in
quantity proportionate to the ingesta; for when the passages are
such, the lower belly is in a healthy state.[481] But if the discharges
be fluid, it is favorable that they are not accompanied with a noise,
nor are frequent, nor in great quantity; for the man being oppressed
by frequently getting up, must be deprived of sleep; and if the
evacuations be both frequent and large, there is danger of his falling
into deliquium animi.[482] But in proportion to the ingesta he should
have evacuations twice or thrice in the day, once at night and more
copiously in the morning, as is customary with a person in health.
The fæces should become thicker when the disease is tending to a
crisis; they ought to be yellowish and not very fetid. It is favorable
that round worms be passed with the discharges when the disease is
tending to a crisis.[483] The belly, too, through the whole disease,
should be soft and moderately distended; but excrements that are
very watery, or white, or green, or very red, or frothy, are all bad. It
is also bad when the discharge is small, and viscid, and white, and
greenish, and smooth; but still more deadly appearances are the
black, or fatty, or livid, or verdigris-green, or fetid. Such as are of
varied characters indicate greater duration of the complaint, but are
no less dangerous; such as those which resemble scrapings,[484]
those which are bilious, those resembling leeks, and the black; these
being sometimes passed together, and sometimes singly.[485] It is
best when wind passes without noise, but it is better that flatulence
should pass even thus than that it should be retained; and when it
does pass thus, it indicates either that the man is in pain or in
delirium, unless he gives vent to the wind spontaneously.[486] Pains
in the hypochondria, and swellings, if recent, and not accompanied
with inflammation, are relieved by borborygmi supervening in the
hypochondrium, more especially if it pass off with fæces, urine, and
wind; but even although not, it will do good by passing along, and it
also does good by descending to the lower part of the belly.[487]
12. The urine is best when the sediment is white, smooth, and
consistent during the whole time, until the disease come to a crisis,
for it indicates freedom from danger, and an illness of short duration;
but if deficient, and if it be sometimes passed clear, and sometimes
with a white and smooth sediment, the disease will be more
protracted, and not so void of danger. But if the urine be reddish,
and the sediment consistent and smooth, the affection, in this case,
will be more protracted than the former, but still not fatal.[488] But
farinaceous sediments in the urine are bad, and still worse are the
leafy;[489] the white and thin are very bad, but the furfuraceous are
still worse than these. Clouds carried about in the urine are good
when white, but bad if black. When the urine is yellow and thin, it
indicates that the disease is unconcocted; and if it (the disease)
should be protracted, there may be danger lest the patient should
not hold out until the urine be concocted.[490] But the most deadly
of all kinds of urine are the fetid, watery, black, and thick; in adult
men and women the black is of all kinds of urine the worst, but in
children, the watery.[491] In those who pass thin and crude urine for
a length of time, if they have otherwise symptoms of convalescence,
an abscess may be expected to form in the parts below the
diaphragm.[492] And fatty substances floating on the surface are to
be dreaded, for they are indications of melting. And one should
consider respecting the kinds of urine, which have clouds, whether
they tend upwards or downwards, and the colors which they have
and such as fall downwards, with the colors as described, are to be
reckoned good and commended; but such as are carried upwards,
with the colors as described, are to be held as bad, and are to be
distrusted.[493] But you must not allow yourself to be deceived if
such urine be passed while the bladder is diseased; for then it is a
symptom of the state, not of the general system, but of a particular
viscus.[494]
13. That vomiting is of most service which consists of phlegm
and bile mixed together, and neither very thick nor in great quantity;
but those vomitings which are more unmixed are worse. But if that
which is vomited be of the color of leeks or livid, or black, whatever
of these colors it be, it is to be reckoned bad; but if the same man
vomit all these colors, it is to be reckoned a very fatal symptom. But
of all the vomitings, the livid indicates the most imminent danger of
death, provided it be of a fetid smell. But all the smells which are
somewhat putrid and fetid, are bad in all vomitings.[495]
14. The expectoration in all pains about the lungs and sides,
should be quickly and easily brought up, and a certain degree of
yellowness should appear strongly mixed up with the sputum. But if
brought up long after the commencement of the pain, and of a
yellow or ruddy color, or if it occasions much cough, or be not
strongly mixed, it is worse; for that which is intensely yellow is
dangerous, but the white, and viscid, and round, do no good. But
that which is very green and frothy is bad; but if so intense as to
appear black, it is still more dangerous than these; it is bad if
nothing is expectorated, and the lungs discharge nothing, but are
gorged with matters which boil (as it were) in the air-passages. It is
bad when coryza and sneezing either precede or follow affections of
the lungs, but in all other affections, even the most deadly, sneezing
is a salutary symptom.[496] 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.[497]
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.[498] 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 fæces, 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 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.[499]
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.[500]
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 (phlyctænæ) 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 dyspnœa, 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, dyspnœa, 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 hypochondria continue
soft and free of pain, and when dyspnœa having been present for a
certain time, ceases without any obvious cause.[501] 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.[502] 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.
[503]

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.[504] 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 enough 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.[505]
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.[506]
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.[507]
 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.[508]
23. Ulceration of the throat with fever, is a serious affection, and
if any other of the symptoms formerly described as being bad, be
present, the physician ought to announce that his patient is in
danger.[509] Those quinsies are most dangerous, and most quickly
prove fatal, which make no appearance in the fauces, nor in the
neck, but occasion very great pain and difficulty of breathing; these
induce suffocation on the first day, or on the second, the third, or
the fourth.[510] Such as, in like manner, are attended with pain, are
swelled up, and have redness (erythema) in the throat, are indeed
very fatal, but more protracted than the former, provided the
redness be great.[511] Those cases in which both the throat and the
neck are red, are more protracted, and certain persons recover from
them, especially if the neck and breast be affected with erythema,
and the erysipelas be not determined inwardly.[512] If neither the
erysipelas disappear on the critical day, nor any abscess form
outwardly, nor any pus be spit up, and if the patient fancy himself
well, and be free from pain, death, or a relapse of the erythema is to
be apprehended. It is much less hazardous when the swelling and
redness are determined outwardly; but if determined to the lungs,
they superinduce delirium, and frequently some of these cases
terminate in empyema.[513] It is very dangerous to cut off or scarify
enlarged uvulæ while they are red and large, for inflammations and
hemorrhages supervene; but one should try to reduce such swellings
by some other means at this season. When the whole of it is
converted into an abscess, which is called Uva, or when the
extremity of the variety called Columella is larger and round, but the
upper part thinner, at this time it will be safe to operate. But it will
be better to open the bowels gently before proceeding to the
operation, if time will permit, and the patient be not in danger of
being suffocated.[514]
24. When the fevers cease without any symptoms of resolution
occurring, and not on the critical days, in such cases a relapse may
be anticipated.[515] When any of the fevers is protracted, although
the man exhibits symptoms of recovery, and there is no longer pain
from any inflammation, nor from any other visible cause, in such a
case a deposit, with swelling and pain, may be expected in some
one of the joints, and not improbably in those below. Such deposits
occur more readily and in less time to persons under thirty years of
age; and one should immediately suspect the formation of such a
deposit, if the fever be protracted beyond twenty days; but to aged
persons these less seldom happen, and not until the fever be much
longer protracted. Such a deposit may be expected, when the fever
is of a continual type, and that it will pass into a quartan, if it
become intermittent, and its paroxysms come on in an irregular
manner, and if in this form it approach autumn. As deposits form
most readily in persons below thirty years of age, so quartans most
commonly occur to persons beyond that age. It is proper to know
that deposits occur most readily in winter, that then they are most
protracted, but are less given to return.[516] Whoever, in a fever that
is not of a fatal character, says that he has pain in his head, and that
something dark appears to be before his eyes, and that he has pain
at the stomach, will be seized with vomiting of bile; but if rigor also
attack him, and the inferior parts of the hypochondrium are cold,
vomiting is still nearer at hand; and if he eat or drink anything at
such a season, it will be quickly vomited. In these cases, when the
pain commences on the first day, they are particularly oppressed on
the fourth and the fifth; and they are relieved on the seventh, but
the greater part of them begin to have pain on the third day, and are
most especially tossed on the fifth, but are relieved on the ninth or
eleventh; but in those who begin to have pains on the fifth day, and
other matters proceed properly with them, the disease comes to a
crisis on the fourteenth day. But when in such a fever persons
affected with headache, instead of having a dark appearance before
their eyes, have dimness of vision, or flashes of light appear before
their eyes, and instead of pain at the pit of the stomach, they have
in their hypochondrium a fulness stretching either to the right or left
side, without either pain or inflammation, a hemorrhage from the
nose is to be expected in such a case, rather than a vomiting. But it
is in young persons particularly that the hemorrhage is to be
expected, for in persons beyond the age of thirty-five, vomitings are
rather to be anticipated. Convulsions occur to children if acute fever
be present, and the belly be constipated, if they cannot sleep, are
agitated, and moan, and change color, and become green, livid, or
ruddy. These complaints occur most readily to children which are
very young up to their seventh year; older children and adults are
not equally liable to be seized with convulsions in fevers, unless
some of the strongest and worst symptoms precede, such as those
which occur in frenzy. One must judge of children as of others,
which will die and which recover, from the whole of the symptoms,
as they have been specially described.[517] These things I say
respecting acute diseases, and the affections which spring from
them.
25. He who would know correctly beforehand those that will
recover, and those that will die, and in what cases the disease will be
protracted for many days, and in what cases for a shorter time, must
be able to form a judgment from having made himself acquainted
with all the symptoms, and estimating their powers in comparison
with one another, as has been described, with regard to the others,
and the urine and sputa, as when the patient coughs up pus and bile
together. One ought also to consider promptly the influx of
epidemical diseases and the constitution of the season.[518] One
should likewise be well acquainted with the particular signs and the
other symptoms, and not be ignorant how that, in every year, and at
every season, bad symptoms prognosticate ill, and favorable
symptoms good, since the aforesaid symptoms appear to have held
true in Libya, in Delos, and in Scythia;[519] from which it may be
known that, in the same regions, there is no difficulty in attaining a
knowledge of many more things than these; if having learned them,
one knows also how to judge and reason correctly of them. But you
should not complain because the name of any disease may happen
not to be described here, for you may know all such as come to a
crisis in the afore-mentioned times, by the same symptoms.[520]
 APPENDIX
TO

THE BOOK OF PROGNOSTICS.

As announced in the Preliminary Discourse (Sect. II., 18), I shall
now proceed to give an abstract of the principal matters contained in
the Second Book of Prorrhetics, which appear to me to be highly
interesting, and as they relate to the subjects treated of in the
Prognostics, they may be more suitably introduced here than in any
other place.
The author commences the treatise with expressing his
disapproval of certain modes of making prognostics which he had
seen practiced. He says he had heard of many and famous
predictions having been made by physicians, such as he himself did
not pretend that he could make. Such, for example, as for a
physician to call in upon a patient who was looked upon as being in
a desperate condition by another physician, and predict that he
would not die, but would lose his sight. Or to predict with regard to
another patient supposed to be in a bad way, that he will recover,
but will become lame of a hand. And of a third who, to all
appearance, cannot recover, to predict that he will get well, but that
his toes will blacken and putrefy. Similar predictions are related
under this class. Another mode of prediction is to prophecy to buyers
and traders, to one death, to another madness, and to the rest
diseases, and that from what is now occurring, or has occurred
before, and all the predictions to turn out true. Another kind of
predictions relates to Athletæ, and those who practice gymnastic
and laborious exercises for the cure of diseases, where the
practitioner pretends to so much exactness, that if the patient is
guilty of any act of omission or commission in regard to food, drink,
or venery, the physician will detect it. He himself makes no
pretensions to any such skill in divination, but announces it as his
object to describe the symptoms by which it may be known whether
a man will die or live, and whether his disease will be of short or of
long duration. With regard to the predictions of abscesses,
lameness, death, or madness, the author holds that they can only be
made after the morbid conditions leading to them have fairly set in.
He strongly disapproves of all ostentatious modes of making
predictions, and gives it as his advice that in all such cases the
greatest prudence and reserve should be observed, since if a man
become an adept in this art of prognostications, he will gain great
credit with his patient, whereas if he fall into mistakes, he will incur
odium, and will be looked upon as being deranged.
With regard to the prognostics made by those who practice
gymnastics, he recommends them not to be made in a charlatan
manner, but with suitable caution, and directs minute attention to be
paid to the circumstances of the patient, which one has superior
advantages in observing under this system. He says, for example,
that a physician who feels a patient’s belly and pulse, pays attention
to the breathing at the nostrils, and listens to the speech, and sound
of the respiration, will be less likely to be deceived in forming a
prognostic on his patients than he who neglects these things. He
expresses himself, however, as being incredulous as to the possibility
of detecting any little transgressions of orders which a patient may
commit, although greater departures from instructions may be
suspected. After some general observations in respect to diet, and
other matters relating to it, he proceeds to a more circumstantial
description of the symptoms upon which a prognosis is to be
founded. And first, with regard to the alvine dejections, those of
persons who live a laborious life, and use food and drink sparingly,
are small and hard, and are passed every day, every third day, or
every fourth day, but if they pass the last period there is danger of
the man’s being seized with fever or diarrhœa. When the stools are
so liquid that they do not assume a shape, they are all of a worse
character in these cases. The dejections of persons who lead an
active life are less copious than those of the indolent, provided they
use the same amount of food. Liquid dejections taking place on the
seventh day, and quickly coming to a crisis, are beneficial, if they
occur all at once, and are not repeated. But if accompanied with
fever, or if the diarrhœa is prolonged, all such dejections are bad,
whether bilious, pituitous, or of indigested matters, and require a
particular regimen and mode of treatment.
With regard to the urine, it should be in proportion to the drink
that is taken, and somewhat thicker than the fluid that is drunk. If it
be more copious than natural, this indicates either that the patient
has disobeyed orders as to the amount of his drink, or that his body
is in a state of atrophy. If the urine is passed in deficient quantity,
with a noise, it indicates either that the man stands in need of
purging, or that the bladder is diseased. A small quantity of blood
passed without fever and pain does not indicate anything bad, but
proves a solution to a state of lassitude. But if in large quantity, with
the addition of any of these symptoms, it is to be dreaded. But if the
urine be passed with pain, and if pus be passed along with the urine
in a fever, the physician should announce that the patient will thus
be relieved of his complaints.[521] Thick urine having a thin sediment
indicates some pain and swelling about the joints. All the other
sediments which occur in the urine of persons who practice exercises
are connected with disease about the bladder; this will be clearly
shown by the obstinate pains with which they are accompanied. The
author, although he states that he had been conversant with the
teachers of prognostics from urine, and their children and disciples,
seems to express himself doubtful as to the possibility of acquiring a
great degree of accuracy in regard to these matters.
Respecting dropsy, consumption, gout, and epilepsy, he states
generally that if they are hereditary they are difficult to remove. A
favorable prognosis is to be formed in dropsy when the patient’s
viscera are sound, when his strength is firm, the digestion and
respiration natural, when he is free of pain, the temperature of the
body moderate, and when there is no wasting of the extremities. It
is favorable when there is no cough, thirst, nor dryness of the
tongue, when the bowels are easily moved by medicine, and when,
at other times, the dejections are consistent. Dropsy, supervening,
along with fever, upon a great discharge of blood, is of a most
intractable nature, and the physician should intimate the danger to
some other person beforehand. When great swellings suddenly
subside and rise again, there is more hope in such a case than in
dropsies connected with a discharge of blood. He concludes his
observations on dropsies with the remark, that they are apt to
deceive the patients, so that they desert their physicians and thus
perish.
With regard to consumptive patients, he says, he has the same
observations to make with regard to the sputa and cough as he had
written with regard to empyema.[522] If the patient is to recover, the
sputa should be white, equable, of one color, without phlegm; the
defluxion from the head should be determined to the nose; there
should be no fever, nor anorexia, nor thirst; the alvine discharges
firm, proportionate to the ingesta, and the patient should not get
thin. The best form of the chest is when it is quadrangular and hairy,
and when the cartilage is small, and covered with flesh. Young
persons, who become affected with empyema from determination
(metastasis?), or fistula, or from any other similar cause, or from the
retrocession of an abscess, do not recover unless many of the
favorable symptoms combine in the case. They die, most commonly,
in autumn, which proves peculiarly fatal in protracted diseases. Of all
others, virgins, and women suffering from amenorrhœa, seldomest
recover; and in their cases there is no hope unless menstruation be
restored. All sexes, he seems to say (but the meaning appears to me
rather ambiguous), have a better chance of recovery, when there is
a discharge of blood, especially in those cases in which there are
pains in the back and chest, connected with black bile; and if, after
the evacuation, there be a remission of the pain; if the cough and
fever do not set in; and if the thirst be tolerable. He seems to state
(but the text is in an unsatisfactory condition), that relapses take
place unless there be deposits in the place, the best of which are
those which contain most blood; and that in those cases in which
there are pains in the chest, if the patients get emaciated, and
cough, and a dyspnœa supervenes, without fever or empyema, they
should be asked whether, when they cough, and have difficulty of
breathing, the sputa be compact, and attended with little smell.
With regard to persons affected with the gout, those who are
aged, have tofi in their joints, who have led a hard life, and whose
bowels are constipated, are beyond the power of medicine to cure.
But, the best natural remedy for them is an attack of dysentery, or
other determination to the bowels. Persons, under opposite
circumstances, may be cured by a skilful physician.
The prognosis in epilepsy is unfavorable when the disease is
congenital, and when it endures to manhood, and when it occurs to
a grown person, and without any obvious cause. When connected
with the head it is particularly to be apprehended, but least so when
it seems to be derived from the hands or feet. The cure may be
attempted in young persons, but not in old.
In the case of children, he mentions various complaints, such as
distortion of the eyes, tubercles about the neck, pain in the bowels,
omental hernia, etc., which, upon inquiry, will be found to be the
consequences of an attack of epilepsy.
The judgment to be formed in the case of ulcers is to be founded
on the age of the patient, the situation of the sore, and its
appearance.
Strumous tubercles, which end in suppuration, occur most
frequently in young persons. Adults are subject to bad favi, internal
cancers, and herpetic sores, after epinyetis, until they pass sixty. Old
persons are subject to cancers, both deep-seated and superficial,
which never leave them. They are particularly intractable when
seated in the armpits, the loins, and the thighs.
Of affections of the joints, the most dangerous are those seated
in the thumb and great toe. When there is a chronic sore on the side
of the tongue the surgeon should examine whether it be not
occasioned by the sharp edge of a tooth.[523]
 The most dangerous wounds are those which implicate the large
veins (blood-vessels), in the neck and groin; then those of the brain
and liver; next, those of the bowels and bladder. These cases are all
dangerous, but not uniformly fatal, as some suppose. Much depends
upon constitution, as to liability to fever and inflammation after a
wound. Sometimes, also, the wounds of smaller vessels prove fatal
by inducing hemorrhage, fever, or delirium. In all recent wounds,
however, the physician should endeavor to afford assistance.
Of spreading ulcers, the most fatal are such mortifications as are
very deep, black, and dry; and those are bad and dangerous which
are accompanied with a black ichorous discharge. Those which are
white and mucous are less dangerous, but are more subject to
relapse, and become inveterate. Herpes is the least dangerous of the
spreading sores, but is most difficult to remove about deep-seated
cancers.[524] An ephemeral fever, with very white and thick pus, is
beneficial in such a case; also, sphacelus of a nerve, of a bone, or of
both, in deep-seated and black mortifications. For a free discharge of
pus takes place and carries off the mortification.
The prognostics in wounds of the head are given in nearly the
same terms as laid down in the treatise on that subject, and
therefore I need not enter minutely into an exposition of what is
stated regarding them here. Those in the upper part of the head,
more especially if they implicate a suture, are said to be particularly
dangerous. The author directs the surgeon to inquire whether, at the
time of the accident, the patient fell down or became comatose, as
in this case greater danger is to be apprehended.
Large wounds of the joints, if they involve the connecting nerves,
necessarily leave the limb maimed. Several other observations
connected with these injuries are added, of which one of the most
important is the direction to practice flexion and extension of the
limb, frequently, with the view, no doubt, of preventing rigidity of the
joint.
Large excisions in the arm becoming inflamed end in
suppurations, which require to be evacuated by the knife or cautery.
Injuries of the spinal marrow, whether from disease or accident, are
attended with loss of motion and sensibility, retention of the alvine
and urinary discharges; but, after a time, involuntary evacuations
take place, which are soon followed by death. When the throat is
frequently filled with blood, and there is no headache or cough, nor
any other morbid symptoms, the physician should examine whether
there be not an ulcer or a leech in the part.
With regard to the eyes, the prognostics are given with so much
prolixity of detail that I must be content with a brief abstract of
them. Much attention is paid to the characters of the discharge from
the eyes in diseases of them, namely, of the glutinous matter and
tears; thus, if the gum be white and soft, the tears mixed with it not
very hot, and the swelling light and loose, under these
circumstances the eyelids are glued up during the night, so that the
eye is free of pain, and thus the disease is without danger, and of
short duration. The other appearances of the eye, and the
discharges, are also minutely given. When the discharge is green or
livid, the tears copious and hot, a burning heat in the head, and
pains darting through the head to the eye, there must necessarily be
ulceration in the eye; and there is much reason to apprehend that it
will burst. If, when one can get a sight of the eye, it should be found
burst, and the pupil projecting above the rupture, it is bad and
difficult to restore; and, if there be sloughing, the eye will be wholly
useless. According to the form and depth of the ulcers must be the
subsequent cicatrices. These are minutely described according to
their different varieties. Mention is also made of the prognostics from
the eyes in fevers, as described by the author in another work. It is
most likely that allusion is here made to the first book of
“Prorrhetics.” In conclusion, the surgeon is directed to pay great
attention to the state of the urine in diseases of the eyes.
Dysenteries, when they set in with fever, alvine discharges of a
mixed character, or with inflammation of the liver, or of the
hypochondrium, or of the stomach, such as are painful, with
retention of the food and thirst, all these are bad; and the more of
these symptoms there are, the greater the danger; and the fewer,
the more hope is there of recovery. Children from five to ten years of
age are the most apt to die of this complaint; the other ages less so.
Such dysenteries as are of a beneficial nature, and are attended with
blood and scrapings of the bowels, cease on the seventh, or
fourteenth, or twentieth, or thirtieth day, or within that period. In
such cases even a pregnant woman may recover and not suffer
abortion.
All cases of lientery are said to be of a bad character when they
are continued and protracted, both day and night, and when the
dejections are either very crude, or black, soft, and fetid; for they
occasion thirst and determine the fluids otherwise than to the
bladder, give rise to ulcerations (aphthæ?) in the mouth, redness
and ephelis[525] of all colors, and at the same time the belly is in a
state of ferment, and has a foul, wrinkled appearance externally.
This disease is most to be dreaded by old persons; it is formidable to
men of middle age, but less so in the other ages. The indications of
cure, it is acutely stated, are to determine the fluids to the urine, to
relieve the body from its atrophy, and change the color of the skin.
All the other varieties of diarrhœa without fever are of short
duration and mild; for they will all cease when washed out, or of
their own accord. The discharge may be predicted as about to cease
when, upon touching the belly, there is no movement, and flatulence
passes with the discharge. Eversion of the gut takes place in the
case of middle-aged persons having piles, of children affected with
the stone, and in protracted and intense discharges from the bowels,
and of old persons having mucous concretions (scybalæ?).
Women may be judged of whether they are in a fit state for
conception or not by attending to the following circumstances:—In
the first place to their shapes. Women of smaller stature more
readily conceive than taller persons; the thin than the fat; the white
than the ruddy; the dark than the pale; those who have prominent
veins than the contrary. In oldish women it is bad to have much
flesh, but a good thing to have swelled and large breasts. In
addition, inquiry should be made whether or not the menstruation
be regular as to time and quantity. And it should be ascertained
whether the uterus be healthy, of a dry temperament, and soft;
neither in a state of retraction nor prolapsus; and its mouth neither
turned aside, nor too close, nor too open. When any of these
obstructions come in the way, it is impossible that conception can
take place.
Such women as cannot conceive, but appear green, without
fever, and the viscera are not in fault; these will say that the head is
pained, and that the menstrual discharge is vitiated and irregular.
But such of these as have the proper color, are of a fat habit of body,
the veins are inconspicuous, they have no pains, and the menses
either never appear at all, or are scanty and intense, and this is one
of the most difficult states of sterility to remove. In other cases the
health is not to blame, but the fault lies in the position of the womb.
The other contingencies in this place are attended with pains,
discoloration, and wasting.
Ulceration in the womb from parturition, an abscess of a chronic
nature, or from any other cause, is necessarily accompanied with
fevers, buboes, and pains in the place; and if the lochial discharge
be also suppressed, all these evils are more intense and inveterate,
along with pains of the hypochondrium and head. And when the
ulcer heals, the part necessarily is smoother and harder, and the
woman is less adapted for conception. If, however, the ulceration be
in the right side only, the woman may conceive of a female child, or
if in the left, of a male. When a woman cannot conceive, and fever
comes on with a slight cough, inquiry should be made whether she
has any ulcer about the uterus, or any other of the complaints I
have described; for if she has no complaint in that region to account
for her loss of flesh and sterility, it may be expected that she will
have vomiting of blood, and the catamenia will necessarily be
suppressed. But if the fever be carried off by the evacuation of
blood, and if the catamenia appear, she will then prove with child.
But if looseness of the bowels having a bad character take place
before there is an evacuation of blood, there is danger lest the
woman perish before a vomiting of blood can take place.
 In cases of false conception, in which women are deceived by the
non-appearance of the menses, and by the increase of the belly and
movement in it, they will be found to have had headache and pains
about the neck and hypochondria, and there is no milk in the breasts
except a little of a watery character. But when the swelling of the
womb passes away they will conceive, unless there be any other
impediment. For this affection is beneficial in so far as it produces a
change in the uterus, so that afterwards the woman may prove with
child. Women with child have not these pains unless the headache
be habitual to them, and in addition they have milk in their breasts.
Women affected with chronic discharges are to be asked whether
they have pains in the head and loins, and in the lower part of the
belly, and whether their teeth be set on edge, and if they have
dimness of sight, and noises in their ears. Such women as vomit bile
for several days while in a fasting state, though they are not with
child nor have fever, are to be asked whether they have vomited up
round lumbrici, and if they say not, they should be warned that this
will happen to them. This affection happens principally to married
women, then to virgins, and less seldom to other people.
Pains without fever are not deadly, but mostly prove protracted,
and have many changes and relapses. Several varieties of headache
are described, and the prognosis in each laid down. The natural cure
of them is a coryza, a discharge of mucus from the nose, or
sneezing. Pains spreading from the head to the neck and back, are
relieved by abscesses, expectoration of pus, hemorrhoids,
exanthemata on the body, or pityriasis on the head.
Heaviness and pruritus in the head, either in a part or through
the whole of it, if, on inquiry, they extend to the tip of the tongue,
indicate a confirmed disease, and one difficult to remove. They are
best removed by the occurrence of an abscess. But those cases
which are accompanied with vertigo are difficult to cure, and are apt
to pass into mania. Other diseases in the head, of a very strong and
protracted character, occur to both men and women, but especially
to young persons, and virgins at the season of manhood, and
especially at the catamenial period. Women, however, are less
subject to pruritus and melancholic affections than the men, unless
the menses have disappeared.
Both men and women who have long had a bad color, but not in
the form of jaundice, are subject to headaches, eat stones and
earth, and have piles. Those who have green colors, without decided
jaundice, are affected in like manner, only instead of eating stones
and earth, they are more subject to pains in the hypochondriac
region. Persons who are pale for a length of time, and have the face
tumid, will be found to have headache, or pains about the viscera, or
some disease in the anus; and in most cases, not one, but many, or
all these evils make their appearance.
Nyctalopia is most apt to attack young persons, either males or
females, and to pass off spontaneously on the fortieth day or in
seven months, and in some cases it endures for a whole year. Its
duration may be estimated from the strength of the disease and the
age of the patient. They are relieved by deposits which determine
downwards, but these rarely occur in youth. Married women and
virgins that have the menstrual discharge regular are not subject to
the complaint. Persons having protracted defluxions of tears who are
attacked with nyctalopia, are to be questioned whether they had any
previous complaint in the head.
Such persons as have frequent pains in the vertex and temples,
without fever or loss of color, unless they have some other obvious
deposit in the face, or speak in a rough tone, or have pain in the
teeth, may be expected to have a hemorrhage from the nose. Those
who have bleeding at the nose, although they may appear to be
otherwise in good health, will be found to have enlarged spleen, or
pain in the head, or flashes of light before their eyes. Most of these
patients have both headache and affection of the spleen.
The gums are diseased and the mouth fetid in persons who have
enlarged spleens. But persons who, although they have enlarged
spleens, are exempt from hemorrhages and fœtor of the mouth have
malignant ulcers on the legs and black cicatrices. But if they have
any obvious deposit in the countenance, or if their speech be rough,
or if they have toothache, a hemorrhage from the nose may be
expected. Those who have great swellings below the eyes will be
found to have enlarged spleens. And if there come on swellings in
the feet, and if they appear to be dropsical, the belly and loins must
be attended to.
Distortions of the countenance, if not sympathetic with some
other part of the body, quickly pass off either spontaneously or by
remedial means. The others are of an apoplectic nature. In other
cases, when the diseased part wastes from want of motion, there
can be no relief afforded. But when wasting does not take place
there may be recovery. With regard to the time when this may occur,
it is to be prognosticated by attending to the severity of the disease,
to its duration, to the age of the patient, and to the season, it being
known that of all cases the inveterate, and such as are the
consequences of repeated attacks, are the worst, and the most
difficult to remove, and those in aged persons. Autumn and winter
are more unfavorable seasons for such complaints than spring and
summer.
Pains in the shoulder, which, passing down the arms, occasion
torpor and pains, do not usually terminate in deposits, but the
patients get better by vomiting black bile. But when the pains
remain in the shoulders, or extend to the back, the patients are
relieved by vomiting pus or black bile. They are to be judged of
thus:—If their breathing be free, and if they be slender, it is rather to
be expected that they will vomit black bile. But if they have more
difficulty of breathing, and if there is any unusual color on the
countenance, whether reddish or black, it is to be expected that they
will rather spit blood. It should also be attended to whether there be
swellings on the feet. This disease attacks men most violently from
forty to sixty years of age. At this period of life ischiatic diseases are
most troublesome.
Ischiatic diseases are to be thus judged of:—In the case of old
persons, when the torpor and coldness of the loins and legs are very
strong, and when they lose the power of erections, and the bowels
are not moved, or with difficulty, and the fæces are passed with
much mucus, the disease will be very protracted, and it should be
announced beforehand that the disease will not last shorter time
than a year from its commencement; and amendment is to be
looked for in spring and summer. Ischiatic diseases are no less
painful in young men, but are of shorter duration, for they pass off
in forty days; and neither is the torpor great, nor is there coldness of
the legs and loins. In those cases in which the disease is seated in
the loins and leg, but the patient does not suffer so much as to be
confined to bed, examine whether any concretions have taken place
in the hip-joint, and make inquiry whether the pain extends to the
groin; for if both these symptoms be present, the disease will be of
long duration. And the physician should also inquire whether there
be torpor in the thigh, and if it extend to the ham; and if he says so,
he is to be again asked if it spreads along the leg to the ankle of the
foot. Those who confess to the most of these symptoms are to be
told that the limb will be sometimes hot and sometimes cold; but
those persons in whom the pain leaves the loins, and is turned
downwards, are to be encouraged; but when the disease does not
leave the hip and loins, such persons are to be warned that it is to
be dreaded. In those cases in which there are pains and swellings
about the joints, and they do not pass off, after the manner of gout,
you will find the bowels enlarged, and a white sediment in the urine;
and, if you inquire, the patient will admit that the temples are often
pained, and he will say that he has nightly sweats. If the urine have
not this sediment, nor do the sweats take place, there is danger
either that the joints will become lame, or that the tumor called
meliceris will form in it. This disease forms in those persons who in
their youth had epistaxis, and in whom it had ceased afterwards.
They are to be interrogated whether they had discharges of blood in
their youth, and if they have pruritus in the breast and back. And the
same thing happens to those who have severe pains in the bowels,
without disorder of them, or who have hemorrhoids. This is the
origin of these complaints. But if the patients have a bad color, they
are to be interrogated whether their head be pained, for they will
say that it is. In those cases in which the bowels are pained on the
right side, the pains are stronger, and especially when the pain
terminates in the hypochondrium at the liver. Such pains are
immediately relieved if borborygmi take place in the belly. But when
the pain ceases, they pass thick and green urine. The disease is not
deadly, but very protracted. But when the disease is already of long
standing, the patients have dimness of sight in consequence of it.
But they are to be interrogated whether, when young, they had a
flow of blood, and regarding the dimness of vision, the greenness of
the urinary discharge, and regarding the borborygmi, if they took
place and gave relief; for they will confess to all these symptoms.
Lichen, leprosy, and leucè, when they occur in young children
and infants, or when they appear at first small, and gradually
increase in the course of a long time—in these cases the eruption is
not to be regarded as a deposit, but as a disease; but when they set
in rank and suddenly, this case is a deposit. Leucè also arises from
the most fatal diseases, such as the disease called phthisis;[526] but
leprosy and lichen are connected with black bile. These complaints
are the more easily cured the more recent they are, and the younger
the patients, and the more soft and fleshy the parts of the body in
which they occur.
 ON REGIMEN IN ACUTE DISEASES.
THE ARGUMENT.

In this treatise two very important questions are discussed: first,

a nosological question, regarding the proper distinction of diseases
from one another; and secondly, a therapeutical, respecting the rules
by which the regimen in acute diseases ought to be regulated. The
former of these is of a polemical nature, being an attack directed
against the physicians of the Cnidian school of medicine, who
distinguished diseases from one another in an arbitrary manner,
from incidental varieties in their constitution, and without proper
attention to their true constitution and identity. As will be seen in the
annotations, the Cnidians pretended to recognize several varieties of
disease connected with bile,—several fanciful divisions of diseases of
the bladder, and so forth; to which mode of distinguishing diseases
there would obviously be no end, since of incidental varieties in any
case there can be no limit. The other question discussed in this
treatise relates to what may justly be pronounced to be one of the
most important points connected with the practice of medicine,
namely, the proper regimen in acute diseases; that is to say, in
idiopathic fevers and febrile diseases, comprising most of those
diseases now classed under the head of Zymotic, and which
constitute by far the highest item in our bills of mortality at the
present day. Our author distinguishes them by the names of pleurisy,
pneumonia, phrenitis, lethargy, causus, and their cognate diseases,
including fever of the continual type. Now it is to be borne in mind,
that the phrenitis,[527] lethargy, and causus of Hippocrates, were all
epidemic fevers, so that, with the exception of pleurisy and
pneumonia, all the diseases here treated of are fevers of the country
in which Hippocrates resided. One, then, cannot well imagine a
question which from the commencement of the medical Art must
have been felt of higher importance than this,—how so numerous
and formidable a class of diseases ought to be treated. In the
attempt to solve it, every imaginable mode of treatment, as might
have been expected beforehand, was tried, and its effects
determined by experience. Herodicus, the master of Hippocrates in
gymnastics, applied his panacea in the treatment of febrile diseases,
and, as we are informed, with the most disastrous results.
“Herodicus,” says the author of the sixth Book of Epidemics, “killed
persons in fever by promenading, much wrestling, and
fomentations.” (§ iii., 18.) It may now appear wonderful that so
extraordinary a mode of practice should have ever been attempted
in this case; but while men of all ranks continue to resort for the
cure of all sorts of diseases to any individual who has got a single
hobby with which he constantly works to his own profit, whether it
be gymnastics, or shampooing, or the wet sheet, we may expect to
hear that such rash experiments have been repeated. Truly mankind
pay as dearly for their tame submission to the insane practices of
professional chiefs, as the Greeks are represented by the poet to
have suffered from the follies of their princes:

“Quicquid delirant Reges, plectuntur Achivi.”[528]

And surely it is much to be desired that men would learn a lesson

from the Past, and not allow every new page in the history of society
and of the profession to furnish a repetition of the oft-told tale of
supine credulity on the one side, and of audacious folly on the other.
From what has been stated, it will readily be understood that it was
soon settled that active exercise is inadmissible in febrile diseases.
[529] It would next come to be determined, what rule was to be
followed with regard to the administration of food in fevers. On this
point, as will be seen below in our annotations, the most
diametrically opposite plans of treatment were essayed. One
authority administered the most highly nutritious articles of food,
namely, fleshes, to his patients, while, on the other hand, some
wasted them by enforcing a total abstinence for several days.
Experience, we may be well assured, was not long in deciding
against both the starving and the glutting system: the palled
appetite would soon refuse to accept of solids, and the parched