Front Page Titles (by Subject) HIPPOCRATES ON CRISES. - The Writings of Hippocrates and Galen
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HIPPOCRATES ON CRISES. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
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HIPPOCRATES ON CRISES.
This treatise is in an aphoristical form, and of great brevity, as if written, says Haller, by some pupil of Hippocrates, who had collected together the maxims of his master. Many of the presages appear in various other of the books, as in the Aphorisms, Prænotions, and De Locis. This contains a statement of the crises of diseases, both good and bad, as derived from the alvine discharges, the urine, sweat, abscesses, symptoms, and other circumstances; and of which are good or bad in fevers and other diseases.
In order the better to comprehend this treatise, it may not be improper to precede it by a short exposition of the subject of crises, as laid down by the ancients. By them a crisis was considered to be a sudden and unlooked-for change in a disease, pointing to recovery or death, occasioned by the contest between nature and the disease; wherein, if she was superior, the patient was preserved, otherwise death was the result. In a more limited sense, the term sometimes was applied to the secretion of some humour; but usually it was intended to convey the idea of a judgment formed on the existing disease. In this view, crises were considered as either perfect, or imperfect. The first implying a perfect and absolute liberation of the sick person from his disease, either by a restoration to health, or a termination in death. Hence it was termed salutary, or fatal. A salutary crisis required the following circumstances. 1. That it should be attended by a train of the most favourable signs or symptoms. 2. That it should be manifest and clear. 3. That it should occur on a critical day. 4. That it should be trustworthy. 5. Absolutely certain and secure; and 6. Of a character befitting both the disease and the patient. The imperfect crisis consisted in its not producing a perfect termination of the complaint, but in part only, leaving this for a future recurrence, which might be for the better or worse. If for the better, although not entirely removing the disease, yet the patient was evidently benefited by it; whilst, in the opposite case, every thing became exasperated and more dangerous. Many considered a crisis as depending upon the motions and influence of the moon and stars. Others supposed it owing to the greater or less degree of maturation of the humours, &c.; whilst others ascribed it to a difference in the constitution of patients, and to the plan of treatment that was pursued. The term crisis is derived from χρινω, judico.
I follow Haller’s division into chapters, as in the preceding treatise.—Ed.
What sweats, alvine discharges, urines, and other important symptoms, portend a favourable change and crisis.
The symptoms which portend a speedy recovery are the same as those which, for the most part, are indicative of health.
The best sweats are such as most speedily diminish fever, which take place on critical days, and finally subdue the fever. Those are also beneficial which are universal, and relieve the patient. When they do not produce this effect, they are of no advantage.
When disease is tending to a crisis, the alvine discharges should be more consistent, slightly yellow, and not very offensive. The discharge of worms at this period is beneficial.
The best urine is that which deposits a white, light, and uniform sediment, during the progress of the disease. It indicates safety, and a short attack. If the disease ceases at the coming on of sweat, and a white sediment appears in a reddish urine, it will recur on the same day, but terminate happily on the fifth day. In those whose recovery is at hand, we find them free from pain, tranquil, with sound sleep at night, and other favourable appearances.
Of the causes and solution of headache in fevers not of a dangerous character—Of critical days, and by what channel a crisis occurs—What a jaundice indicates in such cases.
In slight fever, accompanied with headache, with other attendant symptoms, bile predominates. When those attacked suffer much in the commencement, and the pain augments on the fourth and fifth days, the fever will subside on the seventh day.
Fevers terminate in a crisis in the same number of days in which the sick die or escape. When of the mildest character, accompanied with favourable symptoms, they finish on the fourth or sooner; but if dangerous in their nature and in their accompanying symptoms, death ensues on the fourth or before. This is the first period; the second extends to the seventh day, the third to the eleventh, the fourth to the fourteenth, the fifth to the seventeenth, the sixth to the twentieth. This order of diseases then, (acute,) extends to twenty days, by intervals of four, which however are not to be strictly and rigorously enumerated. The months and years do not exactly coincide in their subdivisions.
In ardent fevers, the best symptoms are such as approximate to those of health; those are less so that indicate a remission on the third day, &c. If after the seventh day a jaundice occurs, sweating may be expected. Usually they do not tend, per se, to sweat, or to suppuration. The heat subsiding, sweating follows, and a crisis consequently ensues, accompanied by a copious urinary or alvine discharge, or a bleeding from the nose, or copious sweat or vomiting. In females the menses sometimes appear. All these united will constitute a crisis, or a near approach to it; sometimes it is less marked and different from the above. When jaundice occurs in ardent fever, on or after the seventh day, with difficult yet abundant expectoration (and this happens in other fevers also), and the fever does not decline, it denotes that instead of terminating as above, an abscess will form in some great tumour, with severe pains, or a colliquation from the febrile heat of the humours.
Judgment as to health, death, or long continuance, of ardent fever—Its change into a lyperia or epialis; jaundice succeeding—Good, bad, and doubtful signs—Judgment of tertian and acute fevers.
Exacerbations and remissions in ardent fever indicate its prolongation, and if of great violence, the probability of death. Other ardent fevers without remissions are less dangerous, and terminate on the seventh or fourteenth day. They sometimes change into a lyperia, continuing for forty days, and ending in an epialis. Lyperia exhibits symptoms which appear and disappear the same day, with considerable headache. When lyperia does not terminate in forty days, but headache and delirium attend it, purge freely. But in whatever manner ardent fever ends, if jaundice succeeds, sweats and abscesses rarely follow, but recovery ensues. Tertian fever usually terminates on the seventh accession. If, in violent fevers, jaundice appears on the seventh, ninth, or fourteenth day, it is favourable, provided a hardness does not occur in the right hypochondrium; if so, it is of a doubtful character. Acute diseases commonly terminate in fourteen days. Fevers are terminated by sweats, if they occur on the third, fifth, seventh, ninth, eleventh, fourteenth, twenty-first, or thirtieth day; if they do not on one of those days, much trouble may be expected. The coction of the urine by gradual maturation, if occurring on a critical day, puts an end to the disease. What respects the urine, may be compared with what we see in ulcers. If they are covered with a white pus, a speedy cure may be looked for; but if the discharge is sanious, they assume a bad character. A similar presage may be derived from the urine. If after pain it becomes clear, we should investigate the cause; and if the disease increases and it still continues clear, we must not expect the disease soon to terminate.
If in headache fever should succeed, and the pain should still continue when it ceases, it is not critical. Many symptoms, even if favourable, may yet be associated with a tardy crisis.
Small and soft tumours in the præcordia, without pain, and readily yielding to pressure, indicate a continuance of disease, but of less danger than when the lumours are opposite in character. The same may be said of other ventral swellings.
Judgment derived from the urine as to gouty diseases—From sweats and alvine discharges, as tending to health, to death, or to a continuance.
If the urine when evacuated is turbid, it indicates, though the sediment be white and uniform, that the crisis is distant, and not as certain as when the urine is of a more healthful character. If it is red, and the sediment also red and light, the crisis will be still more remote, but at the same time salutary. All gouty affections, unaccompanied by inflammation, terminate in forty days, the symptoms mostly improving in this slow tendency to a crisis. When death threatens, the crisis occurs in twenty-four hours; the symptoms are those of great debility, as after taking a powerful medicine that operates both up and down, with anxiety and symptoms of a similar kind. If they do not cease in twenty-four hours, the case may be esteemed fatal. Of all sweats the worst are those that are cold and arise about the neck; they announce a prolonged disease, and death. Alvine discharges of different colours continue indeed for a longer period than black ones, but are not of a less pernicious character, and they are ultimately fatal. Some of these stools have the appearance of the washings of raw flesh, some are bilious, bloody, porraceous, black, sometimes all combined, sometimes separate and distinct. Urine that is sometimes clear, and at times deposits a white and smooth sediment, indicates a longer persistence than when it is of a healthy appearance. If it continues for a long time red and clear, there is a great chance that the patient cannot bear up to the period of its maturation; but if some other favourable symptoms combine, an abscess in some part below the diaphragm may be looked for. In fevers, changes in the urine indicate a prolonged disease, and the patient will vary for better and worse. If it is irregular, from thin, becoming thick, then clear and persistent, a crisis is difficult and uncertain.
Judgments derived from cold and copious sweats—From the heat and coldness of the body, from evacuations, from the pulsation of vessels, from the face, hypochondria, tremors of the hands, dyspnœa, watchfulness—From tetanus, jaundice, singultus, and critical days.
Cold sweats in acute fever are a fatal symptom, but if the fever is of a milder kind, they indicate a continuance of the disease. That part may be considered as the seat of disease, wherein cold and heat alternate, and when such changes are frequent. If those mutations are universal in the system, with frequent change of colour, they indicate a long disease. It is a bad sign when fever does not diminish on the coming on of sweat,—the disease will be of long continuance, accompanied with a superabundance of humours. Cold sweats occurring in fevers announce their long continuance. In health, a copious and incessant sweat denotes an approaching indisposition; milder, if in summer, more severe, if in winter. If the discharges have a deposit resembling scrapings, but in small amount, the disease is trifling; if large, then it will be more considerable, and the bowels require to be cleansed. If black bile is voided in small amount, the disease is moderate, but of more violence, if it is abundant. If the vessels pulsate, the forehead tense, the hypochondria hard and prominent, a prolonged disease is to be looked for, terminating in convulsions, epistaxis, or violent pains. Subsultus tendinum indicate a long continued fever, or an approaching crisis, followed by increased disease, and the probability of death. Such as are soon to die, have extremely violent symptoms from the very onset, such as difficult respiration, sleeplessness, and others of equal danger. If continued fever exacerbates on the fourth and seventh days, and does not finish on the eleventh, it is mostly fatal. Tetanus is commonly fatal in four days, but if that is surmounted, health is restored. If jaundice and singultus occur on the fifth day, it is fatal. Relapses happen in fevers, when obstinate insomnia or disturbed rest occur, with great debility of the body, or pain of the limbs, and when the fever has ceased on a non-critical day without any signs of crisis. Even if sweat succeeds the fever, and the urine deposits a white sediment, itself being red, a return of fever may be expected the same day. Such relapses are, however, not dangerous, and terminate on the fifth day; but if, after the crisis, a red urine deposits a red sediment, and a return of fever occurs the same day, very few of such escape. Mostly, a relapse of ardent fever is accompanied with sweat, especially if it continues as long as at first. The fever even returns a third time, unless the relapse terminates on an uneven day. If the urine is unconcocted, and no reasonable symptoms have preceded, the relapse happens on a critical day, and sometimes even when it is not the case.
Judgment as to relapses, abscesses—Of tetanus, melancholy, phrenitis, mania, suppuration—Of pains in the inferior parts—Of ardent fevers.
When, at the period of a crisis, tumours about the ears do not suppurate, the disease, as the tumours disappear, returns as it were, in the nature of a relapse, with a chance of an abscess forming in some other place. If the urine is thick, resembling the white appearance in the urine of those labouring under a quartan, the abscess is prevented. In some of these cases a bleeding from the nose takes place, which does not put and end to the disease; this is accomplished by an abscess forming. Hemorrhoids occurring in melancholic and phrenitic cases are beneficial. Those who at the spontaneous termination of disease become insane, are cured of this, if a pain of the feet or breast supervenes, or if a severe cough attacks them; if this should not be the case, blindness follows the cessation of the insanity. Stuttering and repetition of words, without a proper control of the lips, in disease, are followed by an imposthume, when those impediments cease. A severe pain in the lower extremities, or copious bleeding from the nose, are removed by deafness. Insanity sometimes removes violent constitutional diseases. Ardent fever is cured by ischiatic pains, or by distortion of the eyes and blindness, or swelling of the testicles or breasts, and at times by epistaxis. In such fevers, the occurrence of chilliness indicates sweating. Shiverings in such fevers end in delirium. If such fevers are not removed by deafness coming on, mania necessarily occurs, which is cured by epistaxis, by bilious stools, by dysentery, or by pains in the knees or ischium. Fever succeeded by cold, is removed thereby.
Judgments of unexpected pains—Of dropsy—Of leucophlegmatia—Diarrhœa—Volvulus—Cephalalgia—Ophthalmia—Convulsions—Tetanus.
In sudden pains, with swelling of the hypochondria, if the pains extend to the false ribs, bleeding and purging remove them; for fever will not attack with violence a weakened part. In dropsy, if the water finds a passage by the vessels to the intestines or bladder, a cure will result. A copious diarrhœa cures a leucophlegmasia. Such as are affected with a chronic diarrhœa, accompanied with cough, are not cured, except a severe pain in the feet attacks them. If any change in the nature of a disease is likely to happen, no diarrhœa attending, and merely flatus discharged, showing the absence of humours, you may safely administer what is proper for the patient. In iliac passion, give plenty of pure, cold wine, by small doses, until sleep, or pain of the legs ensue: fever or dysentery stops its progress. A discharge of pus from the ears or nostrils, checks headache in diseases. Whoever in health is suddenly attacked with headache, loss of speech, and snoring, will die within seven days, if fever does not come on. In severe and general headaches, apply cups to the upper parts. Should pains of the ischium or knees, or asthma take place, the headache ceases. In ophthalmia, a diarrhœa is useful. In spasm or tetanus, a fever coming on removes it. In fever, if spasm occurs, the fever is arrested within three days. In spasm of the hands and feet, if mania occurs, if the vessels of the hands beat, the face full, the hypochondria hard and swelled, the disease will be tedious, but without convulsions.