The Art of Physick
Section C. Of things Preternatural
3b. Of Signs

D. What is a Sign?

C. Whatever being obvious to our Sense, is attended with something hidden, that is a sign of it. Thus a Symptom being conspicuous, is the express sign of the latent design from whence it flows; in like manner the evident cause, as vicious Diet, is the sign of the Disease which is occasioned.

D. How many sorts of signs are there?

C. They reckon up three principal sorts; wholesome, which indicate Health; unwholesome, which indicate a sickly constitution; and neuter, which show a neutral constitution between sick and well.

D. How many are the signs that indicate unsoundness of Health?

C. Twofold; Diagnostic, which declare the present constitution of the Patients. Some add the Anamnestie, which, by calling to remembrance what was past, guess at the present and future state of the Disease.

D. How many are the Diagnostic Signs?

C. Threefold: In regard that some demonstrate the part affected, others the cause, other the kind of the Disease; which if proper and inseparable, are called Pathognomic Judges of the Affection; if common and separable Accidents, they are called Associates.

D. What Signs are to be considered for the obtaining the Prognostic?

C. Besides the proper and inseparable Symptoms of the Disease, there are others that come over and above, which declare the bigness of the Disease; and others that appear over and above, which declare the Motion and Nature of the Disease.

D. What are the proper and inseparable Diagnostics of a Disease numbered among Prognostics?

C. Because future conjectures are drawn from the species of the Disease; for some Diseases in their species are incurable; as in a Cancer; Others curable, as a Tertian Fever; some short, as Quotidians; other tedious, as Hectic and Quartans. Add to this, that the proper Symptoms much increasing, signify the violence of the Disease, and therefore portend danger; as, if a vehement pain in the side extend it self to the Throat or Hypochondrium, and there happen a great difficulty of breathing, and a strong Cough, it is adjudged a dangerous Pleurisy.

D. What d’ye call the Symptom superi enientia, or coming over and above?

C. Symptoms arising from the propagation and increase of the Cause, which indicates the increase of the Disease; as in a Pleurisy, Frenzy, Looseness, difficulty of Breath, Redness of the Face and Eyes, Spots upon the Breast, Redness of the Back and Shoulder-blades.

D. What d’ye call Appearing over and above, or insuper apparentia?

C. Such as besides the inseparable Symptoms, manifestly show themselves, as if were going or proceeding forth; such are the signs of Crudity or Concoction, which argue that the Crisis will be sooner or later.

D. What is the Crisis?

C. The Crisis is a sudden change in the Disease, either to Life or Death: whereby it happens that a Crisis is either good or bad; and both either perfect ir imperfect.

D. What does the Word Crisis denote?

C. The Word Crisis comes from a Greek Word that signifies to judge, or make a judgement of: So that Crisis is no more then Judgement, and is often taken for the Combat of Nature with the Disease, and sometimes for the separation and expulsion of noxious Humors, and sometimes for the issue of the Disease, be it what it will.

D. What Crisis is perfectly good?

C. Such as being shown by the signs of Concoction appearing upon the day of the Sign, comes to perfection upon the Critical day without any dangerous Symptoms, with a manifest excretion or purgation according to the Species of the Disease, and Nature of the Patient.

D. Which is imperfectly good?

C. That which does not altogether remove the Disease, but causes the Patient to be more cheerful in his distemper.

D. D. Which Crisis is perfectly bad?

C. That which hastens Death.

D. Which is imperfectly Evil?

C. That which precipitates the Patient into a worse condition.

D. How are the Critical Signs divided?

C. Some Critical Signs precede, others accompany, and some follow the Crisis.

D. How many Signs precede?

C. There are of two sorts; some show the fay and time of the Crisis, others what sort the future Crisis will be.

D. Which are the signs that show the time and day of the Crisis?

C. The signs of Concoction and Crudity, which appear in the universal Excrements, as Urine and Ordure: For they certainly foretell whether the Crisis will be sooner or later, and what day Judgement will be made of the Disease; for if the Urine appear concocted upon the fourth day, as, if it have a white settlement, smooth and equal, it shows the Crisis will be upon the seventh.

D. What more do the signs of Concoction and Crudity declare?

C. As the signs of Crudity sometimes portend not only diuturnity of the Disease, but Death, so the signs of Concoction promise not only a short stay of the Disease, but also security.

D. Is that perpetual?

C. Yes; so that the concoction be continual and constant; for that is the best Urine, says Hippocrates, when both the Urine and the Sediment is white, smooth and equal, during the whole time, until Judgement be given of the Disease. But if there be an Intermission, that it be sometimes pure, and sometimes crude, with a white, and smooth Settlement now and then, it argues longer continuance, and less safety; for continuance of Concoction argues strength of Nature, and predominancy of the Natural Heat. But if the Concoction be interrupted, and that signs of Concoction appear in the morning, but none in the Evening, and that the Water be sometimes crude, sometimes concocted, no security of a Crisis can be expected from such a Concoction, for that the Disease and Nature are upon equal terms, and the Victory remains doubtful. Nature begins the concoction, but cannot perfect it through Imbecility, or else the Malignity of the severe Humor, that it will not admit of concoction.

D. Are there no other signs that indicate the Time and Day of the Crisis?

C. Besides the signs of Coction and Crudity, the Motion also of the Disease is to be observed to tell the time and day of the Crisis. For such Diseases as move with violence and swiftness are soonest judged of; those that are extremely peracute, in the first fourth day; peracute, the first seventh day; simply acute, the fourteenth day; acute, by mutation from species to species, may be put off till the fortieth day. The motion also of the Disease declares whether the Crisis will happen upon an even or odd day. For when a Crisis is only made when Diseases are in their vigor and exasperation, never in the beginning, nor in the declination, if the exasperation of the Disease happen upon and even day, the Crisis may be expected upon an even day, and so on the contrary.

D. What are the signs of a Crisis at hand?

C. The signs that usually next precede a Crisis, are , a vehement pain in the Head, tumbling and tossing, anxiety, unquenchable thirst, an unequal Pulse, and the like. For as Hippocrates says, The Night becomes very tedious to them upon whom the Crisis is made before the Fit.

D. How many sorts are thereof a Crisis?

C. Two; Excretion and Removal. For the Translation of every Humor from one part to another, is made either by flowing forth, or by removal.

D. Which are the Differences of Excretion?

C. Bleeding at Nose, Sweating, Looseness, Vomit, and Streaming forth of the Urine.

D. How many are the signs of a Crisis by Excretion, or Removal and Settling?

C. Two; for some are universal others proper to every species.

D. Whence are the Universal gathered?

C. From the motion of the Diseases the part affected, and the Age of the Patient.

D. What is the motion of the Disease?

C. Acute Diseases are judged by evacuation or excretion; Diuturnal, by removal and settlement; for the nature of Acute Diseases consists in quick and vehement, that of Diuturnal Diseases, in a slow motion.

D. But Diuturnal Diseases are often judged by evacuations; so Nicodemus was judged the 24th day by Urine; Anaxion the 34th by Sweat; and Cleonactides was perfectly judged the 80th day.

C. I answer, Chronic Diseases are sometimes cured by excretion, in respect of the acute exasperations that happen.

D. What Judgements are to be made from the affected Party?

C. If the convex parts of the Liver be inflamed, a Crisis may be expected either by bleeding at the right Nostril, or by Sweat, or by stream of Urine; but if the hollow parts be affected, the Disease will be determined either by Looseness or by Vomits. Inflammations of the Head are judged by the Blood bursting forth at the Nostrils; for there the extremities of the Vessels end; but Vomiting and Looseness cure the Inflammations of the Mesentery and Stomach.

D. What Conjectures may be made from the Age of the Patient?

C. Bleeding at Nose most commonly happens to young men in burning Fever; to old men in the same distemper Looseness. Galen gives this reason, because the Humors in young men are full of Choler, thin and sharp, and therefore flow upward; in old men Phlegmatic, and therefore flowing downward.

D. There are the universal Signs of a future Crisis; now for the Signs proper to every Species. And first, what are the signs of a critical Bleeding presently expected?

C. If in an acute Fever you observe a redness all over the Patients face, a vehement pain in the Head and Neck, a high Pulse in the Arteries of the Temples, a dimness of Sight, and dilatation of the Hypochondriums, with difficulty of Breath, you may expect a flux of Blood at the Nose.

D. Give me the reason of every sign.

C. When the Flux of Blood is near at hand, the Face grows red, the Blood being translated from the lower to the upper parts, and preparing to make its way through the Nostrils. The pain in the Head and Neck proceeds from the translation of the Morbisic Humor, which tearing and rending the membranous parts, most exquisite in their feeling, beget that vehement pain; the Arteries beat high, by reason of the compression, which proceeds from the particular repletion of the veins; the Eyes wax dim by reason of the abundance of thick Spirits carried to the upper parts, that obstruct the passages, not admitting entrance to the Animal Spirits. The Hypochondrium is distended, that is, the Liver swells, by reason of the motion of the Blood, which begins its motion at the fountain and roots of the Veins. The difficulty of breathing proceeds from hence, for that the Blood coveting to ascend, oppresses the Diaphragm, which is the principal Organ of Respiration.

D. Are there any other Signs of instant Bleeding?

C. Besides those which are numbered up by Hippocrates, Galen adds, Noises in the Ear, Tickling in the Nostrils, seeming Apparitions of red things. Thus to a certain young man that lay in an acute Fever, and suddenly leapt out of his bed, he foretold an instant Bleeding; for that the young man being by him asked why he leapt out of his bed, when there was nothing to scare him made answer, that he saw a red Serpent creeping in at the Window.

D. What are the betokening signs of a critical Sweat?

C. Suppression of Urine, and a cold Quivering.

D. Why suppression of Urine?

C. Because the Matter of Urine and Sweat is the same; the serous parts of those Humors that are contained in the Veins; so that there being a Translation of the serous into the whole Body, the Urine comes to be suppressed.

D. What causes the Shuddering?

C. The Acrimony of the serous Humor hurting the Nervous Pannicle, which is of most exquisite sense.

D. Are there any other Signs of future Sweat?

C. The Moderns add a slow and feeble Pulse, fluctuating and uneven, and the fore-running of a hot Vapor steaming from the Head.

D. What are the signs of an approaching Looseness?

C. Belching, breaking Wind, rumbling and swelling of the Belly. For these Signs argue the removal of the noxious Humor into the Veins of the Mesentery, and from thence into the Guts. The Urine also appears then and white, the Choleric part being all removed into the Belly.

D. What are the Signs of approaching Vomit?

C. These are mentioned by Hippocrates; a reaching and desire to Vomit; griping of the Stomach by reason of the vicious Humor there harbouring; frequent spitting, the Humor evaporating from the Stomach to the Mouth, a darkness of Sight, by reason of the cloudy Vapour exhaling from the Stomach. Others add a bitterness upon the Tongue, and palpitation of the lower lip.

D. What are the signs of a Flux of Urine?

C. Hippocrates delivers none; but Galen admonished, that they are to be gathered from the privation of other Purgations. For if no signs appear of Bleeding, Sweating, Looseness or Vomit, but that the signs of Critical Concoction and Crudity have preceded it, it is most agreeable to Reason that the Disease must be judged by Urine, especially if there be a heaviness in the Hypochondrium, and a burning in the extreme parts of the Yard, and that the Patients has all along during the Distemper, made thick and plentiful Water.

D. So far for the Signs if Excretion; now tell us the signs of a future removal and settlement.

C. In Diuturnal Disease, where Nature is not able to throw off the thick Humors by excretion, a settlement must be expected, especially in Winter; also if Purgation were by Nature begun, but not perfected; or if the Patient have made thin and crude Urine during the whole course of the Disease, with healthful and good signs.

D. Tell us now the Signs portending a good or bad Crisis?

C. Whether the Crisis be good or bad, we judge by the Signs concomitant and subsequent.

D. Which d’ye call Signs concomitant?

C. Such as appear with the Crisis it self, so that the Excretion or Settlement happening, easily show whether it be good or bad.

D. Which are the Signs of a good Excretion?

C. To make an Excretion advantageous, four things are required, convenient Quality, convenient Quantity, reasonable Time, and a manner of Purgation familiar to Nature.

D. What Quality is required?

C. That quality is most to be commended when the peccant Humor is purged out after due concoction; for the Purgation and Expulsion of crude Humors is bad.

D. What is Quantity?

C. It ought to be moderate: For as immoderate Expulsion is dangerous, in regard all Excess is an Enemy to Nature, so of critical Excrements there ought to be no small purgation; for a small Expulsion shows that the more copious and malignant Humors cannot be governed by Nature; or else it shows laboring Nature’s sudden Dissolution: And therefore little Sweats, Droppings of Blood, and Vomits in small Quantity are all condemned by Hippocrates; for all the noxious Humor, not any part of it ought to be evacuated; in regard that what is left after the Crisis in Diseases, is the occasion of a Relapse.

D. What time?

C. Upon the critical day; for all other expulsions are to be suspected.

D. What is the Method of Purgation?

C. Purgation ought to come forth all together in a good quantity, and not by degrees, through the places proper, not through the nobler parts; not obliquely, but in a straight line through the open passages.
  Thus when the Spleen is affected, for the Blood to burst from the right Nostril; and when the Liver is affected, to break out at the left Nostril, is evil. For excretion in a straight line argues a stronger contention of Nature; whereas oblique excretion argues the Malignity of the Humor, the weakness of the part oppressed, and an obstruction of the Passages.

D. What are the good conditions of a wholesome Abscess or Settlement of the bad Humor.

C. In a wholesome Abscess three things are requisite in the Opinion of Hippocrates; Where, from whence, and for what reason. Where, denotes the Part where the settlement is made, which ought to be some inferior or more ignoble Part, remote from the Part affected, capable to contain all the Morbisic Matter, otherwise there is danger of a reflux. From Whence, denotes from what Part the Matter is removed, from the right or the left; for the removal ought to be in a straight line. For What reason, denotes the cause of the removal; that is, whether through a true concoction of the morbisic matter, or whether by some unseasonable provocation; for if it happen while the matter of the Disease is crude, the consequence will be evil.

D. There remain the consequent signs, that show us either a prosperous or doubtful Crisis. From whence are they gathered?

C. From the Quality of the Body, the Actions and Excrements.

D. What is to be regarded in the Quality of the Body?

C. The Quality of the Body is discerned by the color and bulk. If the Face be well colored, the excretion or purgation was wholesome; if the Color be livid, yellowish, or black, the purgation is symptomatical; if the swelling of the Face falls, that was swelled before, the Crisis is perfect; if it continue puffy, there is some fear of relapse.

D. What as to the Actions?

C. Whether the Actions Natural, Vital and Animal are right: If there be a good Reception, Concoction and Expulsion, the Crisis is true and good; if kecking, loathing of Meat, sour Belches, and offensive to the smell, Thirst and Extension of the Hypochondriums, a Relapse is to be feared; is an equal and more remiss Pulse, ease respiration, and temperate Heat, the Crisis is safe; if a thick Pulse, and an ardent heat, it argues a remaining want of Temper in some of the Bowels, which may breed a new generation of Humor; if the Mind and Senses be at ease and sound; if the Patient sleep quietly, and turn without disturbance from one side to the other, it argues a good Crisis; the contrary justifies an evil one.

D. What as to the Excrements?

C. If the Excrements be well colored and figured, and the Urine like those of healthy people, they testify a healthy Crisis; if thin or red, they threaten a relapse.

D. Tell me now the difference of Critical Days?

C. There are three differences of Critical Days; some are truly Critical, called Principal; other Indicatory, and others such as fall between the Principal and the Indicatory.

D. What are the Days truly Critical?

C. Such as judge perfectly, faithfully, manifestly, and without danger.

D. How many are the principal Critical Days?

C. Three; the seventh, fourteenth, and twentieth. The seventh is the term of peracute Diseases; the fourteenth, of simply acute; the twentieth of acute Diseases, that were slow from the beginning, or such whose Acuteness did not last.

D. What is the Cause of Critical Days?

C. The Cause of Critical Days is twofold; the one Material, the other Efficient. The Material is a noxious Humor, peccant both in quality and quantity. The Efficient is twofold; the one Universal, and most remote; the Heaven, all whose influences the Inferior Moon receives, and communicates them to us. The other particular and near, that is to say, Nature; which tho void of Counsel and Reason, has certain motions confined to certain Order, and therefore has made choice of the seventh, fourteenth, and twentieth day, for the Perfection of Crisis’s.

D. But why is the twentieth day more critical than the twenty first, seeing all the Sevenths are perfectly critical?

C. I answer, that the twenty first is the end of the third Seventh; for of the three Sevenths only the first is to be reckoned whole, and the second is copulated with the third, so that of the fourteenth day is the beginning of the Second, and beginning of the third.

D. Why are both the latter Sevenths coupled together shorter by one day then the first?

C. That happens for two reasons: the first is, because the natural motion, of which kind is the Critical, is slower in the beginning, swifter in the end. Secondly, because the Morbisic Matter attenuated and mitigated during the first Seventh, is more easily and swifly expelled by Nature in the following Septenaries.

D. Is not the 21st, sometimes critical?

C. Yes; for in regard the thicker and more contumacious Matter if the Disease is not so easily overcome by Nature, the Crisis is sometimes prolonged to the 21st day, and then the Septenaries are all equal. Therefore, says Hippocrates, when a Crisis happens upon odd days, there is the 3, 7, 9, 11, 14, 17, 21. Sweat are good in Fevers that appear upon the 3, 5, 7, 9, 11, 14, 17, 21; so that although we give the pre-eminence to the 20, yet we do not exclude the 21st.

D. Which are the indicatory days?

C. Those which prepare us to judge the future Crisis upon the three seventh days.

D. How many are they reckoned to be?

C. Three; the 4th, 11th, 17th. To which the Prerogative of judging is denied; for the Judgement made upon those days is imperfect; only they may give some light into the true Crisis; for the 4th is the Index of the 7th, the 10th, of the 14th, and the 17th, of the 20th.

D. Is that Perpetual?

C. Yes, yes; if there be nothing internal or external that disturbs the ordinary course of Nature; as if the Physician has not mistaken, or that the Patient or Tenders have not gone according to Directions. For it may happen through some external cause, that the 4th may not always be the index of the 7th, nor the 11th of the 14th, nor the 17th of the 21st.

D. Which are the interfalling days?

C. Those that provoke Nature, and cause Purgations before their time, as on the first Septenary the third and fifth, in the second, the 9th and 13th, in the third, the 19th. These days are indicatory and preparatory, because they are uneven; but the Crisis that is made upon those days is imperfect and dangerous, in regard that Nature is so provoked by the malignant Quality of the morbisic Humor, that she only expels crude and concocted together, and good Humors with bad.

D. How are the other Days called?

C. The other interfalling days, are, the 6th, 8th, 10th, 12th, 16th, 18th, and these are called Vacant Days, because they are neither Critical, nor Indicatory, nor Provocative. For tho some Purgations may happen upon those days, yet they all proceed from the malignity of the Disease, not from Nature either victorious or exasperated, and therefore they are only Symptomatical, not Critical.
  The 6th of all days is the worst, cruel, treacherous, and altogether an Enemy to the 7th. Wherefore the latter is liked to a merciful Prince, who rescues many from Destruction; the 6th day by Galen is called a Tyrant, in regard it precipitates all that are sick into the Tombs, or at least to great danger of Death.
  The Vacant Days by some Learned Physicians are called Medicinal, because upon those Days the Physician may safely administer his Cathartic Remedies, which he dares not do upon the Critical days, for fear of disturbing Nature.

FINIS.

A lot of the following text, especially regarding signs of a Crisis, and important days is specifically related to Fevers and acute diseases.

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The Art Of Physick
Section A.
OF THE 7 NATURALS
(Physiology)
Introduction to the 7 Naturals
1. Elements
2. Temperaments
3. Parts
4. Humors
5. Spirits
6. Faculties
7. Actions
Section B.
OF THE 6 NOT-NATURALS
(Preservation of Health)
Introduction to the 6 Not-Naturals
1. Ambient Air
2. Food and Drink
3. Sleep and Waking
4a. Exercise &
4b. Rest
5. Excrements
6. Emotions (Passions of the Mind)
Section C.
OF THE 3 PRETER-NATURALS
(Pathology)
1. Diseases
2. Causes
3a. Symptoms &
3b. Signs