第 3 节
作者:打倒一切      更新:2022-05-05 13:48      字数:9322
  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