The extremities of the human body must be observed in diseases, especially in the ones that are acute, because they can provide a large number of prognostic signs very important for judging the event. People never die without noticeable changes in the exterior surface of the extremities : here we can consider mainly heat, cold, color, movement, and situation relative to the natural state.

It is always a good sign in acute diseases, that the extremities have a warm temperature, the same as that of all other parts [of the body], with suppleness in the skin. One can find the extremities this warm in the most malignant fevers; but this warmth is not spread evenly throughout the body, such as when the extremities are cooler than the torso: moreover the lower abdomen is usually hard in this case, and the whole body is not uniformly supple in all its parts; this is what distinguishes warmth that is not a good sign from that which is: even a burning fever is not a bad sign, when it is spread evenly throughout the body, and thus in the extremities ; it is characteristic of intense, malignant fevers not to warm the extremities beyond the normal temperature; it is also a sign of malignancy when the extremities warm and cool in a short amount of time; this is a mortal sign in acute diseases, which promptly exhaust the whole body. Extreme warmth, with redness and inflammation of these parts, is a good sign in these same diseases: a mild, moderate warmth, with perspiration or even with a feeling of humidity, which tends to cool down throughout the body, but particularly in the extremities , which is found in conjunction with a continuous fever, must be very suspect; because there is good reason to fear that the warmth is located in the viscera: the mild, uniform warmth that is observed in consumptives does not last; it increases considerably after they have eaten, and it is particularly felt in the palm of the hands: moreover the warmth in the fever of consumptives, almost always produces a kind of grime on the skin. [1]

The coldness of the extremities in acute diseases is always a very bad sign, unless nature is preparing an attack; which is signaled by the good signs which compete against the coldness of these parts: when they are cold, when the other parts are hot with dryness, and when these symptoms are accompanied with a great thirst, it is a sign of malignancy in the disease: if it is difficult to dissipate the cold of the extremities by the means proper to warming them, and especially if one cannot succeed in restoring some warmth to them, it is a very bad sign which even becomes fatal and signals impending death, if at the same time these parts become livid and black. See Feverish coldness .

It is always a very good sign in acute diseases when the extremities preserve their natural color. The red and inflamed color of any parts of the body whatsoever is also a good sign if it results from a critical deposit which is made in these parts. The livid and black color of the extremities , especially if is combined with coldness, is a fatal sign.

It is also a very bad sign if the patient constantly shakes his feet and hands and in an extraordinary way, or if the patient uncovers them even though they are cold.

One must likewise see it as a very bad sign if a patient constantly lies on his back weakened with both the upper and lower extremities always extended. See Situation of the body in diseases, and the prognostics that one must draw from differences in them. See the excellent work of Prosper Alpin, De proesagienda vitâ et morte , from which this article is extracted. [2]

Notes

1. Consumption is now known as tuberculosis. In the eighteenth century it was considered one of the “wasting diseases,” in contrast to acute illnesses. The term d’Aumont uses is les hectiques . The OED defines “hectique” as “belonging to or symptomatic of the bodily condition or habit: applied to that kind of fever which accompanies consumption or other wasting diseases, and is attended with flushed cheeks and hot dry skin.”

2. D’Aumont refers to a sixteenth-century Latin treatise by the Italian physician, Prosperi Alpini (1553—1617), De praesagienda vita & morte aegrotantium libri septem: in quibus ars tota Hippocratica praedicendi in aegrotis varios morborum eventus , here in a 1733 edition with an introduction by the Dutch botanist and physician Herman Boerhaave (1668-1738). Thus, although D’Aumont’s source was hardly recent, its endorsement by Boerhaave suggests that it was still considered cutting-edge in the eighteenth-century. On Alpini see http://en.wikipedia.org/wiki/Prospero_Alpini (accessed April 3, 2014).