He should observe thus in acute diseases: first, the countenance of the patient, if it be like those of persons in health, and more so, if like itself, for this is the best of all; whereas the most opposite to it is the worst, such as the following; a sharp nose, hollow eyes, collapsed temples; the ears cold, contracted, and their lobes turned out: the skin about the forehead being rough, distended, and parched; the color of the whole face being green, black, livid, or lead-colored. If the countenance be such at the commencement of the disease, and if this cannot be accounted for from the other symptoms, inquiry must be made whether the patient has long wanted sleep; whether his bowels have been very loose; and whether he has suffered from want of food; and if any of these causes be confessed to, the danger is to be reckoned so far less; and it becomes obvious, in the course of a day and a night, whether or not the appearance of the countenance proceeded from these causes. But if none of these be said to exist, if the symptoms do not subside in the aforesaid time, it is to be known for certain that death is at hand. And, also, if the disease be in a more advanced stage either on the third or fourth day, and the countenance be such, the same inquiries as formerly directed are to be made, and the other symptoms are to be noted, those in the whole countenance, those on the body, and those in the eyes; for if they shun the light, or weep involuntarily, or squint, or if the one be less than the other, or if the white of them be red, livid, or has black veins in it; if there be a gum upon the eyes, if they are restless, protruding, or are become very hollow; and if the countenance be squalid and dark, or the color of the whole face be changed- all these are to be reckoned bad and fatal symptoms. The physician should also observe the appearance of the eyes from below the eyelids in sleep; for when a portion of the white appears, owing to the eyelids not being closed together, and when this is not connected with diarrhea or purgation from medicine, or when the patient does not sleep thus from habit, it is to be reckoned an unfavorable and very deadly symptom; but if the eyelid be contracted, livid, or pale, or also the lip, or nose, along with some of the other symptoms, one may know for certain that death is close at hand. It is a mortal symptom, also, when the lips are relaxed, pendent, cold, and blanched.
It is well when the patient is found by his physician reclining upon either his right or his left side, having his hands, neck, and legs slightly bent, and the whole body lying in a relaxed state, for thus the most of persons in health recline, and these are the best of postures which most resemble those of healthy persons. But to lie upon one's back, with the hands, neck, and the legs extended, is far less favorable. And if the patient incline forward, and sink down to the foot of the bed, it is a still more dangerous symptom; but if he be found with his feet naked and not sufficiently warm, and the hands, neck, and legs tossed about in a disorderly manner and naked, it is bad, for it indicates aberration of intellect. It is a deadly symptom, also, when the patient sleeps constantly with his mouth open, having his legs strongly bent and plaited together, while he lies upon his back; and to lie upon one's belly, when not habitual to the patient to sleep thus while in good health, indicates delirium, or pain in the abdominal regions. And for the patient to wish to sit erect at the acme of a disease is a bad symptom in all acute diseases, but particularly so in pneumonia. To grind the teeth in fevers, when such has not been the custom of the patient from childhood, indicates madness and death, both which dangers are to be announced beforehand as likely to happen; and if a person in delirium do this it is a very deadly symptom. And if the patient had an ulcer previously, or if one has occurred in the course of the disease, it is to be observed; for if the man be about to die the sore will become livid and dry, or yellow and dry before death