Prognostic — First Draft Translation

PROGNOSTIC It seems to me that the physician who practices foreknowledge is best. For by knowing in advance and declaring to those who are sick what is present, what has already happened, and what is going to happen, and by explaining what the sick leave out in their own account, he would be more trusted to understand the condition of those who are ill, so that people would dare to entrust themselves to the physician. 1 He would manage treatment best by knowing in advance, from the present affections of the patient, what will come. For to make all the sick healthy is impossible—that would surpass even the power of foreknowledge of what is to come. But since people die, some before calling the physician, overcome by the violence of the disease, others having called him and dying immediately, some having lived one day, others a little more time, before the physician had the chance to contend with each disease by his art—it is therefore necessary to understand the natures of such affections, how far they exceed the capacity of the bodies, and at the same time whether there is something divine in the diseases, and to learn foreknowledge of this as well. For in this way he would be justly admired, and would be a good physician. For those who are able to survive, he could preserve them all the more rightly by deliberating in advance about each case over a longer time; and by knowing beforehand and declaring in advance who will die and who will be saved, he would be free from blame. One must observe the following in acute diseases: first, the face of the sick person—whether it resembles the faces of healthy people, and especially whether it resembles its own normal appearance. 2 For this would be the best sign; and what is most contrary to resemblance is most dangerous. Such a face would have this appearance: sharp nose, hollow eyes, sunken temples, cold and drawn-in ears with the earlobes turned outward, and the skin about the forehead hard, stretched taut, and parched. And the color of the whole face greenish or also black, livid, or lead-colored. If, then, the face is such at the beginning of the disease, and it is not yet possible to draw conclusions from the other signs, one should ask whether the sick person has had sleeplessness, or whether the bowels have been severely loosened, or whether he has something like a hunger-pang. And if any of these is admitted, one should consider the situation less dangerous; such cases resolve within a day and a night, if it is on account of these causes that the face has this appearance. But if he says none of these things is present, and the face does not return to normal within the time stated, one must know that death is near. And if the disease is older—of three or four days' standing—and the face is still such, one should ask about the things I directed to inquire about earlier, and observe the other signs: those in the whole face, those in the body, and those in the eyes. For if the eyes flee the light, or water involuntarily, or are turned askew, or one becomes smaller than the other, or the whites are reddened, or livid, or have small black veins in them, or rheum [λῆμαι: the crust and discharge of the eye] appears around the pupils, or the eyes are floating, or protruding, or become greatly sunken, or the pupils are dim and lusterless, or the color of the whole face is altered—all these are to be considered bad and lethal signs. One must also observe the undersides of the eyes during sleep: for if some of the white shows with the eyelids not closed—provided this is not from diarrhea or a drug draught, or from the person's habitual way of sleeping—the sign is poor and highly indicative of death. And if the eyelid becomes bent, or livid, or pale—or the lip, or the nose—along with any of the other signs, one must know that death is near. Lethal also are lips that have gone slack, and hang down, and are cold, and have turned completely pale. The physician should find the sick person lying on the right side or the left, with the hands, neck, and legs somewhat bent, and the whole body lying at ease—for this is how most healthy people lie down; and the best reclining positions are those resembling those of healthy people. 3 Lying on the back with the hands, neck, and legs extended is less good. If the patient were also to slip forward and slide toward the foot of the bed, that is more dangerous. If one were to find him also with bare feet—not very warm—and the hands, neck, and legs thrown about unevenly and uncovered, that is bad; for it signals restless distress. Lethal also is always sleeping with the mouth gaping open, and when lying on the back the legs are strongly drawn up and twisted. Lying on the belly for someone who is not accustomed to sleeping this way even in health signals some derangement of mind, or pain in the regions around the abdomen. The sick person wanting to sit up when the disease is at its peak is bad in all acute diseases, and worst of all in the pneumonic conditions. Grinding of the teeth in fevers in those who have not had this habit from childhood is a sign of madness and death, and one should declare danger from both possibilities; and if someone does this while also out of his mind, it becomes altogether lethal. Any wound that happens to be already present, or that arises during the disease, must be closely observed; for if the person is going to die, it will before death become livid and dry, or pale and dry. Concerning the movements of the hands, this is what I know: in those who in acute fevers, or in pneumonic conditions, or in phrenitis, or in headaches, carry the hands before the face and clutch at empty air, and pick off fragments [ἀποκαρφολογέω: the characteristic picking motion of those out of their senses], and pluck flocks from their garments, and pull chaff from the wall—all such movements are bad and lethal. 5 Pneuma that is rapid indicates pain or inflammation in the regions above the diaphragm; pneuma drawn in deeply and at long intervals indicates derangement of mind; cold breath exhaled from the nostrils and the mouth is by now altogether lethal. Easy, free breathing one must consider to have very great power for preservation in all acute diseases that come with fevers and are decided within forty days. The best sweats in all acute diseases are those that occur on the days of crisis and wholly dispel the fever. 6 Good also are those that, occurring over the whole body, render the person bearing the disease more easily. Those that do not produce such an effect are of no benefit. The worst are those that are cold and occur only about the head, face, and neck; for these together with acute fever presage death, and with milder fever, prolonged disease. And those that arise over the whole body in the same way as those about the head are similar; and those that are millet-seed-like and occur only about the neck are bad. Those that come with large drops and steaming are good. One must take note of sweats as a whole; for some arise from dissolution of the bodies, others from the tension of inflammation. The hypochondrium is best when it is free of pain, soft, and even, on both right and left. 7 But when inflamed, or causing pain, or tensed, or the right and left sides disposed unevenly—all these require watchful attention. If also a throbbing were present in the hypochondrium, it signals agitation or derangement of mind; but one should look carefully at the eyes of such persons: for if the pupils move rapidly, there is hope that these persons will go mad. A swelling in the hypochondrium that is hard and painful is worst if it extends over the whole hypochondrium; if it is on one side only, it is less dangerous on the left side. Such swellings at the outset signal that death will come in a short time; but if the fever lasts beyond twenty days and the swelling does not settle, the condition turns toward suppuration. In such cases in the first period there also occurs a breaking of blood from the nostrils, and this helps greatly; but one must ask whether they have pain in the head or dimness of sight: for if anything of that sort is present, the blood would be inclined to flow there. The breaking of blood is to be expected especially in those younger than thirty-five years. The soft swellings, free of pain and yielding to the finger, produce crises later and are less dangerous than those others. And if the fever persists and the swelling does not settle for sixty days, it signals that there will be empyema; and this applies equally to swelling in the rest of the abdominal cavity. Now those swellings that are painful, hard, and large signal the danger of imminent death; those that are soft, free of pain, and yield under pressure of the finger take longer than those others. Swellings in the belly produce abscessions less readily than those in the hypochondria, and those below the navel turn to suppuration least of all; and one should expect breaking of blood from the upper regions above all. For all swellings that persist in these areas, one must watch beneath for suppurations. The suppurations arising from this region must be observed as follows: those that turn outward are best when small, inclined as far as possible to the outside, and rounded to a point; those that are large and broad and least pointed at the summit are worst; those that burst inward are best when they have no connection with the outer region, but are contracted and free of pain, and the whole outer area appears of uniform color. The pus is best when white, uniform, smooth, and as little foul-smelling as possible; what is contrary to this is worst. Dropsies arising from acute diseases are all bad; for they neither dispel the fever, and they are quite painful and lethal. 8 Most begin from the flanks and the loins, others from the liver. In those where the onset comes from the flanks and loins, the feet swell and long-lasting diarrheas grip them, relieving neither the pains from the flanks and loins nor clearing out the belly. In those where dropsies arise from the liver, an urge to cough comes upon them, yet they spit up nothing worth mentioning, and the feet swell, and the belly does not pass anything except what is hard and with effort, and swellings arise around the abdominal cavity, some on the right side, some on the left, appearing and subsiding. Head, hands, and feet that are cold are bad when the belly and sides are hot. 9 Best is when the whole body is uniformly warm and soft. The one in pain should turn easily, and be light in being raised; but if he appears heavy in the rest of the body, the hands and the feet, it is more dangerous. If on top of the heaviness the nails and the toes also become livid, death is expected soon; but toes and feet that are entirely black are less lethal than livid ones; yet the other signs must be considered too: for if the person appears to bear the ill condition with ease, and shows some other sign among those indicating survival together with these signs, there is hope that the disease will turn to an abscession, so that the person survives while the blackened parts of the body slough off. Testicles and genitals drawn up signal strong pain and mortal danger. Concerning sleep: as is according to nature and customary for us, one should be awake during the day and sleep at night. 10 If this is altered, it is worse; least harmful would be to sleep in the morning up to a third of the day; sleep from that time onward is more unfavorable; worst of all is to sleep neither during the night nor during the day: for either lying sleepless from pain and toil, or going out of one's mind, follows from this sign. The best stool is that which is soft and formed, and at the time at which even while healthy the patient himself was accustomed to pass it, in an amount proportionate to what is taken in: for when the passage is of this kind, the lower belly would be in a healthy state. 11 But if the stool is liquid, it is fitting that it neither gurgle nor be frequent, and that it pass in small amounts; for the person, wearied by constant rising, would be kept sleepless; and if much passes frequently at once, there is danger of loss of strength. One should pass stool two or three times during the day, and once during the night, in proportion to the amount taken in, more in the early morning, as is customary for a person. The stool should thicken as the disease moves toward crisis. Let it be reddish-brown and not too foul-smelling. It is also fitting for round worms to pass out with the stool as the disease moves toward crisis. In every disease the belly should be loose and moderate in its bulk. To pass stools that are very watery, or white, or greenish, or strongly reddened, or frothy—all these are unfavorable. Further unfavorable is stool that is scanty, viscous, white, somewhat greenish, and smooth. Of these, the most lethal would be those that are black, or fatty, or livid, or verdigris-colored, or foul-smelling. Those that are mixed are more prolonged than these but no less lethal; such are those that are scrapings-like, and bilious, and leek-green, and black, sometimes passing together with each other, sometimes separately. Wind passing without noise and without sound is best; but it is better even to pass it with noise than for it to be coiled up inside; and even when it passes thus it signals that the person has some pain or is out of his mind, unless the person voluntarily makes the release of wind happen that way. Pains and bulgings in the hypochondria, if recent and without inflammation, are resolved by rumbling arising in the hypochondrium, and especially when it passes through together with stool, urine, and wind; but if not, even on its own when it passes through it helps; and it also helps when it subsides into the lower regions. The urine is best when the sediment is white, smooth, and even throughout the whole time until the disease is decided: for it signals safety and that the disease will be of short duration. 12 If it is intermittent, and sometimes clear urine is passed, sometimes the white smooth sediment settles, the disease becomes more prolonged and less safe. If the urine is reddish and the sediment of a similar color and smooth, this is more prolonged than the first but quite preserving. Bran-like sediments in the urine are unfavorable; and worse than these are the flaky ones; the white and thin ones are quite poor; and still worse than these are the bran-dust-like ones. Cloudlets floating in the urine—white ones are good, black ones poor. As long as the urine is tawny-red and thin, it signals that the disease is unconcocted; and if it has been such for a long time, there is danger that the person will not be able to hold out until the disease is ripened through. More lethal than other urines are those that are foul-smelling, and watery, and black, and thick; and for men and women the black urines are worst, while for children the watery ones. Those who pass thin and raw urine for a long time—if the other signs are those of someone who will survive—must be expected to develop an abscession in the regions below the diaphragm. The fatty films floating on top, like cobwebs, are to be faulted; for they are signs of wasting. One must observe in the urine where the cloudlets are, whether they are toward the top or the bottom, and what colors they bear; and those settling toward the bottom with the colors described, one should consider good and approve; those toward the top with the colors described, one should consider bad and find fault with. Let it not deceive you if the bladder, having some disease of its own, produces such urines; for this is not a sign of the whole body, but of the bladder itself alone. The most beneficial vomiting is that of phlegm and bile as thoroughly mixed together as possible; and let what is vomited not be very thick, nor very much, for the more unmixed kinds are worse. 13 If what is vomited is leek-green, or livid, or black—whatever one of these colors it may be—it should be considered unfavorable; and if the same person were to vomit all the colors, that becomes altogether lethal; and the fastest death is signaled by livid vomit, if it smells foul. All odors that are putrid and foul-smelling are bad in all that is vomited. Sputum in all ailments about the lung and sides should be expectorated quickly and easily, with the yellow component appearing thoroughly mixed in with the sputum. 14 For if it is brought up much later after the onset of the pain, being yellow or tawny-red, or producing much coughing, or not thoroughly mixed—that becomes worse; for the yellow unmixed is dangerous, and the white, viscous, and rounded is unhelpful. Bad also is what is very green and what is frothy; and if it were so unmixed as to appear also black, that is more dangerous than those others; bad too is when nothing is cleared out and the lung does not advance, but being full, seethes in the throat. Running of the nose and sneezing occurring before or after all diseases about the lung is bad; but in the other diseases that are most lethal, sneezes are beneficial. Sputum mixed with not much blood, when yellow, in pneumonic conditions—when expectorated at the beginning of the disease—is preserving and helps greatly; but in someone in the seventh day of illness and later, it is less safe. All sputa are bad when they do not relieve the pain. The worst are black ones, as has been set out. Those that relieve pain are, of all, the best to expectorate. Those pains in these regions that are not relieved by any of the following—neither by the clearing of the sputum, nor by clearing out the bowel, nor by bloodlettings, drug draughts, nor diaita (regimen / ordering of the way of living)—one must know will suppurate. 15 Of the suppurations, those that suppurate while the sputum is still bilious are altogether lethal, whether the bilious matter is expectorated separately from the pus or together with it; and most of all when the empyema begins to move from that sputum when the disease is in its seventh day. One must expect the person spitting such things to die by the fourteenth day, unless something good comes upon him. The good things are these: to bear the disease with ease, to breathe freely, to be free of pain, to cough up the sputum readily, for the body to appear uniformly warm and soft, to have no thirst, and for urine, stools, sleep, and sweats each to appear in the good form as set out: for if all of these come about together, the person would not die; but if some come about and others do not, the person would perish having lived no longer than fourteen days. The bad signs are the opposites of these—namely, to bear the disease with difficulty, for the breathing to be deep and rapid, for the pain not to cease, for sputum to be coughed up with difficulty, to be very thirsty, for the body to be held unevenly by fire, with the belly and sides very hot and the forehead, hands, and feet cold, and for urine, stools, sleep, and sweats each to be in the bad form as set out: for if in such circumstances something further befalls the sputum, the person would perish before reaching fourteen days—on the ninth day or the eleventh. One must therefore judge that this sputum is very lethal and does not wait upon fourteen days. By reckoning the bad and good signs that follow, one must from these give one's declarations in advance; for in this way one would speak most truly. The other suppurations rupture for the most part—some on the twentieth day, some on the thirtieth, some after forty days, some reaching sixty days. One must estimate when the beginning of the empyema will occur by reckoning from the day on which the person first had fever, or whenever a shivering seized him, and whether he says that instead of pain there has come a heaviness in the place where he was in pain; for these things occur at the beginnings of empyemas. 16 [10] From these time-points, then, one must expect the rupture of the empyemata to occur at the periods previously stated. If the empyema is on one side only, one must turn the patient and examine carefully on that side, whether he has any pain in the other flank; and if one side is warmer than the other, have him lie down on the healthy side and ask whether something heavy seems to him to be hanging down from above. For if this is so, the empyema is on whichever side the heaviness falls. All cases of empyema in general must be recognized by the following signs. 17 [35] First, the fever does not release its hold; rather, it remains light during the day and more intense during the night; and heavy sweats come on; a desire to cough arises in them, yet they spit up nothing worth noting; the eyes become hollow; the cheeks hold a flush; the fingernails become curved; the fingers grow warm, especially at the tips; swellings arise in the feet; they have no appetite for food; and blisters break out over the body. Those empyemata, then, that are long-standing have these signs, and one must trust them strongly. Those of short duration give indication by these signs, if anything of them appears—such as also appear at the outset—and at the same time if the person is somewhat more difficult-breathing. Those that rupture more quickly or more slowly must be recognized by these signs: if the pain arises at the outset, and the difficulty of breathing and the cough and the spitting persist, expect the rupture within twenty days, or even sooner; but if the pain is quieter and everything else follows a proportionate course, expect the rupture to come later in these cases; yet there must necessarily be both pain and difficulty of breathing and spitting before the rupture of the pus. Those who survive best are those whom the fever releases on the very day of the rupture, who quickly regain appetite for food, who are free of thirst, whose belly passes small and consolidated stools, and whose pus is white and smooth and uniform in color and free of phlegm, and is cleared up without pain and without violent coughing. In this way they recover most favorably and most quickly; and if not quite so, then those in whom the signs come closest to these. Those who perish are those whom the fever does not release, or who, when it seems to release them, are seen to heat up again; who have thirst but no appetite for food; whose belly is loose; and whose pus is greenish or livid, or phlegm-laden and frothy. If all these things occur together, they perish. Of those in whom some of these signs appear but not others, some perish and some survive after a long time. But one must interpret from all the indications present in these cases, and in all others likewise. In those in whom abscessions arise from lung-diseases beside the ears, and these suppurate, or go to the lower regions and form fistulas, these patients survive. 18 [30] One must examine such cases as follows: if the fever holds, and the pain does not cease, and the spitting does not proceed according to expectation, and the bowel passages are not bilious nor easy and unmixed, and the urine is not very copious and with heavy sediment, but the patient is sustained favorably by all the remaining favorable signs, in these cases one must hope that such abscessions will occur. Those going to the lower regions arise in patients who have something of phlegm about the hypochondria; those going upward, in patients in whom the hypochondrium remains slack and free of pain, and who, having been difficult-breathing for some time, cease without any other evident cause. Abscessions to the legs in severe and dangerous lung-diseases are beneficial in all cases, and are best when they occur while the spitting is in the course of changing; for if swelling and pain should arise in the leg, while the spitting changes from yellow to pus-like and is expelled copiously, in this way the person would most safely survive, and the abscession would most quickly become painless. But if the spitting does not proceed well, and the urine appears to have no good sediment, there is danger that the joint becomes lame or causes much trouble. And if the abscessions disappear and run back again when the spitting is not proceeding and the fever holds, this is grave; for there is danger that the person will become delirious and die. Of those with empyema arising from lung-diseases, older persons perish more readily; from other empyemata, younger persons die more readily. Of those empyema-patients who are cauterized or cut, those whose pus is clean and white and without foul odor are saved; those whose pus is blood-tinged and muddy perish. Pains around the loins and the lower regions occurring with fever, if they reach upward to the midriff while abandoning the lower parts, are highly destructive. 19 [15] One must therefore attend to the other signs, so that if any other bad sign appears, the person is beyond hope; but if, while the disease is rushing upward toward the midriff, the other signs that appear are not bad, there is great expectation that this person will develop an empyema. Hard and painful bladders are altogether dreadful and destructive; more destructive when they occur with continuous fever; for even the pains from the bladders themselves are capable of killing; and the bowels do not pass anything during this time except hard stools and only under compulsion. What dissolves the condition is the voiding of purulent urine bearing a white and smooth sediment. If neither the urine gives any relief nor the bladder softens, and the fever is continuous, there is expectation in the first periods of the disease that the suffering person will perish. This condition affects most especially children from seven years of age up to fifteen years. Fevers are resolved in the same number of days from which people either survive or perish. 20 [30] For the most benign fevers, those standing on the most secure signs, cease on the fourth day or sooner; and the most malignant, those arising on the most dreadful signs, kill on the fourth day or sooner. The first bout, then, ends in this way; the second reaches its crisis on the seventh day; the third on the eleventh; the fourth on the fourteenth; the fifth on the seventeenth; the sixth on the twentieth. These, then, from the most acute diseases, reach their crises at these successive points up to the twentieth. None of these can be counted exactly in whole days; for neither the year nor the months are by nature countable in whole days. After these, by the same method and the same increment, the first period is of thirty-four days, the second of forty days, the third of sixty days. Of these, it is hardest at the outset to distinguish those that are going to be resolved over the longest time; for their beginnings are most alike. But one must reflect from the first day and examine each additional period of four; and it will not escape notice which way the disease is turning. The pattern of quartan fevers arises from such an arrangement. Those likely to be resolved in the shortest time are easier to recognize; for the differences in them are greatest from the start: those who will survive are easy-breathing and free of pain, sleep through the nights, and have the most secure other signs; those who will perish are difficult-breathing, speaking confusedly, sleepless, and have the worst other signs. Knowing that these things go so, one must interpret accordingly, as the diseases move toward their resolution according to the time and each successive increment. By the same reasoning, the critical days in women follow the same periodic scheme, their counting reckoned from childbirth. Severe and continuous head-pains occurring with fever: if any of the deadly signs are additionally present, the outcome is highly destructive. 21 [10] If without such signs the pain persists beyond twenty days while the fever holds, one must look for a breaking of blood through the nostrils, or some other abscession to the lower regions. While the pain is fresh, one must expect likewise a breaking of blood through the nostrils, or suppuration—especially if the pain is around the temples and forehead; but one must expect the breaking of blood more in those younger than thirty-five years, and suppuration more in older persons. A sharp pain of the ear with continuous and intense fever is grave; for there is danger that the person will become delirious and perish. 22 [10] Since this region is thus treacherous, one must quickly attend to all the signs from the first day. Younger persons perish from this disease on the seventh day and even sooner; older persons much more slowly; for fevers and delirious episodes come upon them less, and on this account the ears get the chance to suppurate. But in these age-groups relapses of the disease coming on afterward carry off most of them. Younger persons perish before the ear suppurates—except that, if white pus flows from the ear, there is hope that the younger person will survive, provided some other good sign also comes about for him. A throat that ulcerates with fever is grave; but if any other sign from those previously judged bad also arises, one must declare that the person is in danger. 23 [30] The most dangerous forms of cynanche, and those that kill most quickly, are those that produce nothing visible either in the throat or in the neck, but cause the most intense pain and orthopnoea; for these suffocate even on the same day, and on the second, third, and fourth day. Those that cause pain similarly to the others in all other respects but swell and produce flushing in the throat are highly destructive, yet more prolonged than the former, when the redness is great. Those in which both the throat and the neck become reddened together—these are more prolonged, and some patients among them particularly escape, when both neck and chest hold the redness and the erysipelas does not run back inward. But if the erysipelas does not disappear on critical days, nor with a swelling gathered in the outer region, nor does the patient cough up pus, and yet seems to be at ease and without pain, this signals death or a recurrence of the redness. It is safer when the swelling and the redness turn as much as possible outward; if it should turn toward the lung, it produces derangement of mind, and some of these patients frequently develop empyema. The uvulae are dangerous to cut off or to incise as long as they are red and large; for inflammations and hemorrhages come upon these patients. But one must try to reduce such things by other means during this time. When it has fully separated out—what they call the bunch-of-grapes—and the tip of the uvula becomes larger and rounded while the part above it is more slender, at that moment it is safe to operate. It is also better to evacuate the belly somewhat before proceeding with the surgery, if time allows and the person is not being suffocated. In those whose fevers cease without any resolving signs appearing and not on critical days, one must expect a relapse. 24 [45] In any fever that lingers while the person remains in a favorable condition, with pain no longer present on account of inflammation or any other evident cause, one must expect for this person an abscession with swelling and pain into one of the joints, and no less into those of the lower parts. Such abscessions occur more readily and in a shorter time in those younger than thirty years; one must begin to look into the matter of abscession if the fever persists and goes beyond twenty days; in older persons it occurs less, the fever being more prolonged. One must expect such an abscession, if the fever is continuous; but if it intermits and seizes in a wandering fashion, it will settle into a quartan pattern—especially if while doing this it approaches autumn. Just as abscessions arise in those younger than thirty years, so quartan fevers arise more in those of thirty years and older. One must know that abscessions arise more in winter, cease more slowly, and are less liable to run back. In anyone who in a non-deadly fever says he has pain in the head, or that something shadowy appears before his eyes, or if heartburn additionally comes upon him, a bilious vomiting will follow; if shivering also seizes him and the lower parts of the hypochondrium are cold, the vomiting will come even sooner; and if he drinks or eats anything during this time, he will vomit it very quickly. Of these, those in whom the pain begins on the first day are most pressed on the fourth and fifth days, and are released by the seventh. Most of them, however, begin to be pained on the third day, are most severely afflicted on the fifth, and are released on the ninth or eleventh. Those who begin to be pained on the fifth day, and everything else follows proportionately, have the disease resolved by the fourteenth. These things occur in men and women most often in tertian fevers; in younger persons they occur in these too, but more in continuous fevers and in genuine tertians. In those who in this kind of fever, while suffering head-pain, instead of something shadowy appearing before the eyes experience dimness of vision, or flickering lights appear before them, and instead of heartburn something tightens in the hypochondrium on the right side or left, without pain and without inflammation, these patients can be expected to bleed from the nostrils instead of vomiting. And here again one must expect the breaking of blood more in younger persons; in those of thirty-five years and older, less so, and in these one must expect vomiting instead. In children, convulsions arise if the fever is acute and the belly does not pass stools, and they are sleepless and startled, and whimpering, and change their color, and become greenish or livid or red. 24 (50) [5] These things arise most readily in the youngest children up to seven years; older children and men are no longer seized by convulsions in fevers, unless some of the most powerful and worst signs additionally occur, such as arise in phrenitis. In judging which children and which others will perish or survive, use all the signs together, as each has been described for each condition. These things I say concerning both acute diseases and those that arise from them. One who intends to foreknow correctly those who will survive and those who will die, and in which cases the disease will remain longer and in which fewer days, must be capable of judging all the signs having learned them, reckoning their relative force one against another, as has been described concerning the others and urine and spitting, whenever pus and bile are coughed up together. 25 [20] One must also always take quick note of the tendencies of diseases that are currently prevalent in the population, and of the state of the season. One must know well concerning the indications and the other signs, and not fail to observe that in every year and every season the bad signs signify bad outcomes and the beneficial ones good, since in Libya and in Delos and in Scythia the signs as written above are seen to hold true. From this one must understand that in the same regions there is no difficulty in succeeding with them far more often, if one has learned them and knows how to judge and reason about them correctly. One need not seek the name of any disease that does not happen to be written here; for everything that is resolved in the time-periods previously stated, you will recognize by the same signs.