[p. 52]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.| The observations of Andral have in some measure confirmed the opinion of Hippoc-rates and other authors, ancient and modern, that there are certain days in the duration of the disease in which there is a greater tendency to amelioration. Of ninety-three cases, he found twenty-three give way on the seventh, thirteen on the eleventh, eleven on the fourteenth, and nine on the twentieth days. The recoveries in the remaining cases commenced on twelve out of forty-two non-critical days, as many as eleven being ascribed to the tenth day. Thus the recoveries on critical days averaged as high as four-teen, while those on non-critical scarcely exceeded three." (Dr. C. J. B. Williams on Pneumonia, Cyclop. of Pract. Med., vol. iii., p. 405.) See also Andral, Clin. Med., c. ii., p. 365. |
PART 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.
PART 17
Empyema may be recognized in all cases by the following symptoms:
In the first place, the fever does not go off, but is
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