Section IV.

1. We must purge pregnant women, if matters be turgid (in a state of orgasm?), from the fourth to the seventh month, but less freely in the latter; in the first and last stages of pregnancy it should be avoided.

2. In purging we should bring away such matters from the body as it would be advantageous had they come away spontaneously; but those of an opposite character should be stopped.

3. If the matters which are purged be such as should be purged, it is beneficial and well borne; but if the contrary, with difficulty.

4. We should rather purge upward in summer, and downward in winter.

5. About the time of the dog-days, and before it, the administration of purgatives is unsuitable.

6. Lean persons who are easily made to vomit should be purged upward, avoiding the winter season.

7. Persons who are difficult to vomit, and are moderately fat, should be purged downward, avoiding the summer season.

8. We must be guarded in purging phthisical persons upward.

9. And from the same mode of reasoning, applying the opposite rule to melancholic persons, we must purge them freely downward.

10. In very acute diseases, if matters be in a state of orgasm, we may purge on the first day, for it is a bad thing to procrastinate in such cases.

11. Those cases in which there are tormina, pains about the umbilicus, and pains about the loins, not removed either by purgative medicines or otherwise, usually terminate in dry dropsy.

12. It is a bad thing to purge upward in winter persons whose bowels are in a state of lientery.

13. Persons who are not easily purged upward by the hellebores, should have their bodies moistened by plenty of food and rest before taking the draught.

14. When one takes a draught of hellebore, one should be made to move more about, and indulge less in sleep and repose. Sailing on the sea shows that motion disorders the body.

15. When you wish the hellebore to act more, move the body, and when to stop, let the patient get sleep and rest.

16. Hellebore is dangerous to persons whose flesh is sound, for it induces convulsion.

17. Anorexia, heartburn, vertigo, and a bitter taste of the mouth, in a person free from fever, indicate the want of purging upward.

18. Pains seated above the diaphragm indicate purging upward, and those below it, downward.

19. Persons who have no thirst while under the action of a purgative medicine, do not cease from being purged until they become thirsty.

20. If persons free from fever be seized with tormina, heaviness of the knees, and pains of the loins, this indicates that purging downward is required.

21. Alvine dejections which are black, like blood, taking place spontaneously, either with or without fever, are very bad; and the more numerous and unfavorable the colors, so much the worse; when with medicine it is better, and a variety of colors in this case is not bad.

22. When black bile is evacuated in the beginning of any disease whatever, either upward or downward, it is a mortal symptom.

23. In persons attenuated from any disease, whether acute or chronic, or from wounds, or any other cause, if there be a discharge either of black bile, or resembling black blood, they die on the following day.

24. Dysentery, if it commence with black bile, is mortal.

25. Blood discharged upward, whatever be its character, is a bad symptom, but downward it is (more?) favorable, and so also black dejections.

26. If in a person ill of dysentery, substances resembling flesh be discharged from the bowels, it is a mortal symptom.

27. In whatever cases of fever there is a copious hemorrhage from whatever channel, the bowels are in a loose state during convalescence.

28. In all cases whatever, bilious discharges cease if deafness supervenes, and in all cases deafness ceases when bilious discharges supervene.

29. Rigors which occur on the sixth day have a difficult crisis.

30. Diseases attended with paroxysms, if at the same hour that the fever leaves it return again next day, are of difficult crisis.

31. In febrile diseases attended with a sense of lassitude, deposits form about the joints, and especially those of the jaws.

32. In convalescents from diseases, if any part be pained, there deposits are formed.

33. But if any part be in a painful state previous to the illness, there the disease fixes.

34. If a person laboring under a fever, without any swelling in the fauces, be seized with a sense of suffocation suddenly, it is a mortal symptom.

35. If in a person with fever, the become suddenly distorted, and he cannot swallow unless with difficulty, although no swelling be present, it is a mortal symptom.

36. Sweats, in febrile diseases, are favorable, if they set in on the third, fifth, seventh, ninth, eleventh, fourteenth, seventeenth, twenty-first, twenty-seventh, and thirty-fourth day, for these sweats prove a crisis to the disease; but sweats not occurring thus, indicate pain, a protracted disease, and relapses.

37. Cold sweats occurring with an acute fever, indicate death; and along with a milder one, a protracted disease.

38. And in whatever part of the body there is a sweat, it shows that the disease is seated there.

39. And in whatever part of the body heat or cold is seated, there is disease.

40. And wherever there are changes in the whole body, and if the body be alternately cold and hot, or if one color succeed another, this indicates a protracted disease.

41. A copious sweat after sleep occuring without any manifest cause, indicates that the body is using too much food. But if it occur when one is not taking food, it indicates that evacuation is required.

42. A copious sweat, whether hot or cold, flowing continuously, indicates, the cold a greater, and the hot a lesser disease.

43. Fevers, not of the intermittent type, which are exacerbated on the third day, are dangerous; but if they intermit in any form, this indicates that they are not dangerous.

44. In cases attended with protracted fevers, tubercles (phymata) or pains occur about the joints.

45. When tubercles (phymata) or pains attack the joints after fevers, such persons are using too much food.

46. If in a fever not of the intermittent type a rigor seize a person already much debilitated, it is mortal.

47. In fevers not of the intermittent type, expectorations which are livid bloody, fetid and bilious, are all bad; but if evacuated properly, they are favorable. So it is with the alvine evacuations and the urine. But if none of the proper excretions take place by these channels, it is bad.

48. In fevers not of the intermittent type, if the external parts be cold, but the internal be burnt up, and if there be thirst, it is a mortal symptom.

49. In a fever not of the intermittent type, if a lip, an eye-brow, an eye, or the nose, be distorted; or if there be loss of sight or of hearing, and the patient be in a weak state-whatever of these symptoms occur, death is at hand.

50. Apostemes in fevers which are not resolved at the first crisis, indicate a protracted disease.

51. When in a fever not of the intermittent type dyspnoea and delirium come on, the case is mortal.

52. When persons in fevers, or in other illnesses, shed tears voluntarily, it is nothing out of place; but when they shed tears involuntarily, it is more so.

53. In whatever cases of fever very viscid concretions form about the teeth, the fevers turn out to be particularly strong.

54. In whatever case of ardent fever dry coughs of a tickling nature with slight expectoration are long protracted, there is usually not much thirst.

55. All fevers complicated with buboes are bad, except ephemerals.

56. Sweat supervening in a case of the fever ceasing, is bad, for the disease is protracted, and it indicates more copious humors.

57. Fever supervening in a case of confirmed spasm, or of tetanus, removes the disease.

58. A rigor supervening in a case of ardent fever, produces resolution of it.

59. A true tertian comes to a crisis in seven periods at furthest.

60. When in fevers there is deafness, if blood run from the nostrils, or the bowels become disordered, it carries off the disease.

61. In a febrile complaint, if the fever do not leave on the odd days, it relapses.

62. When jaundice supervenes in fevers before the seventh day, it a bad symptom, unless there be watery discharges from the bowels.

63. In whatever cases of fever rigors occur during the day, the fevers come to a resolution during the day.

64. When in cases of fever jaundice occurs on the seventh, the ninth, the eleventh, or the fourteenth day, it is a good symptom, provided the hypochondriac region be not hard. Otherwise it is not a good symptom.

65. A strong heat about the stomach and cardialgia are bad symptoms in fevers.

66. In acute fevers, spasms, and strong pains about the bowels are bad symptoms.

67. In fevers, frights after sleep, or convulsions, are a bad symptom.

68. In fevers, a stoppage of the respiration is a bad symptom, for it indicates convulsions.

69. When the urine is thick, grumoss, and scanty in cases not free from fever a copious discharge of thinner urine proves beneficial. Such a discharge more commonly takes place when the urine has had a sediment from the first, or soon after the commencement.

70. When in fevers the urine is turbid, like that of a beast of burden, in such a case there either is or will be headache.

71. In cases which come to a crisis on the seventh day, the urine has a red nubecula on the fourth day, and the other symptoms accordingly.

72. When the urine is transparent and white, it is bad; it appears principally in cases of phrenitis.

73. When the hypochondriac region is affected with meteorism and borborygmi, should pain of the loins supervene, the bowels get into a loose and watery state, unless there be an eruption of flatus or a copious evacuation of urine. These things occur in fevers.

74. When there is reason to expect that an abscess will form in joints, the abscess is carried off by a copious discharge of urine, which is thick, and becomes white, like what begins to form in certain cases of quartan fever, attended with a sense of lassitude. It is also speedily carried off by a hemorrhage from the nose.

75. Blood or pus in the urine indicates ulceration either of the kidneys or of the bladder.

76. When small fleshy substances like hairs are discharged along with thick urine, these substances come from the kidneys.

77. In those cases where there are furfuraceous particles discharged along with thick urine, there is scabies of the bladder.

78. In those cases where there is a spontaneous discharge of bloody urine, it indicates rupture of a small vein in the kidneys.

79. In those cases where there is a sandy sediment in the urine, there is calculus in the bladder (or kidneys).

80. If a patient pass blood and clots in his urine, and have strangury, and if a pain seize the hypogastric region and perineum, the parts about the bladder are affected.

81. If a patient pass blood, pus, and scales, in the urine, and if it have a heavy smell, ulceration of the bladder is indicated.

82. When tubercles form in the urethra, if these suppurate and burst, there is relief.

83. When much urine is passed during the night, it indicates that the alvine evacuations are scanty.