Front Page Titles (by Subject) OF CRITICAL DAYS, OR OF WHAT HAS A RELATION TO CRISES. - The Writings of Hippocrates and Galen
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OF CRITICAL DAYS, OR OF WHAT HAS A RELATION TO 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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OF CRITICAL DAYS, OR OF WHAT HAS A RELATION TO CRISES.
According to Haller, this treatise was not by the ancients attributed to Hippocrates, although Mercurialis considers it as containing his opinions. Haller regards it as an abbreviated transcript from the book “De Internis Adfectionibus,”—in which are contained the Gnidian sentences;—referring sundry diseases here mentioned to similar ones in that treatise. All, however, are not from that source. Diseases are by the author derived, some from bile, or from bile and pituita, or blood. The book in general treats of the judgments to be formed by the art of medicine; and of the requisites by which the physician can form a just estimate of diseases; and of the various symptoms and circumstances by which his judgments may be formed.—(Ed.)
What is essential to be known by the physician is here pointed out, to prevent his being deceived.
I esteem it an important part of our art, to be well acquainted with the best writings that have reached us on the subject; for he who is thus informed and properly employs his knowledge, cannot, in my opinion, make many mistakes. Now, he should know the constitution of the different seasons of the year and of diseases accurately; and of diseases individually—the good or bad of each, either as depending on their own peculiar character, or on the existing state of things; the signs that announce their duration and danger; of chronic diseases, which are salutary; and if acute—which are dangerous, which safe. He should know from these how to judge of the order of critical days, and to predict from them the event; and deduce his rules as to the proper regulation of diet, as to time, amount, and quality. It is of the highest import to the welfare of a patient in ardent fever, that the disease and every thing connected with it, should be consistent with its nature; for what depends on natural laws, is salutary. A second and not less important circumstance is, the concurrence of the season with the disease; for the nature of man is not superior to the power of the universe. After this, we are to notice the general appearance of the patient; if the face is extenuated; if the vessels of the hands and in the angles of the eyes, and the eyebrows are quiescent, after having been previously active; if the voice is weaker and softer; the respiration less frequent and laborious than before;—in such a case, a remission will occur the following day; and hence the importance of attending to every circumstance connected with crises. Examine the tongue, whether its body or tip is furred or moist, and in what degree. If all these signs are but slight, a change for the better will occur probably on the third day; but if more strongly marked, the succeeding day, or even the same day, when they are of the highest grade. The white of the eye, moreover, is necessarily rendered dull when the disease is violent; when brilliant, it is a sign of health, and indicates its approach in proportion as its brilliancy is restored.
Description, causes, signs, and symptoms of acute affections of the liver—Fanciful influences in such affections.
Acute diseases originating in an afflux of bile to the liver, and tending to the head, proceed as follows: the liver tumefies, and is pressed towards the diaphragm; immediately headache ensues, especially at the temples; hearing and sight are diminished; and chills and fever come on. These symptoms are the first observed, and vary in intensity in different cases. As the disease progresses the pains increase; the eyes wander and become obscured; if the finger is presented to them it is not perceived, as may be concluded from their not winking at its approach; yet the patient appears to see something, for he picks the bedclothes as if catching bugs; and in proportion as the liver presses against the diaphragm, he becomes delirious, thinking he sees snakes and wild beasts around him, or soldiers fighting with him,—talking at the same time in terms, as if this was truly the case. He strives to escape, and threatens those who oppose him. If raised up, his legs fail him, and he falls down; his feet are constantly cold; and when sleeping he starts, and has horrid dreams, as may be presumed from his waking suddenly in a fright; and when recovering his recollection he details his dreams, which correspond with his actions and talking during sleep. Such are his sufferings; at times he is speechless for twenty-four hours; his respiration rapid, and elevated; his reason returns at the ceasing of his flightiness, and he replies consistently to any question, and understands every thing that is said, but almost immediately relapsing into his preceding condition. Such affections are more common in long journeys across deserts, but are not confined to these.
Three varieties of tetanus described, and the judgment respecting them.
There are two or three kinds of tetanus: when it arises from a wound, the jaws are rigid like a piece of wood, and the mouth cannot be opened. Tears flow abundantly at times, and the eyes sink. The back is stiff, and neither the legs, arms, nor spine, can be bended. Food and liquors taken previously, are frequently discharged through the nostrils. In opisthotonos, the symptoms are similar. It arises from the tendons of the back of the neck being affected from angina, or from an affection of the uvula, or other parts of the throat or tonsils. Sometimes it occurs from fevers attacking the head. That arising from wounds, affects the posterior parts; the pain renders the spine rigid, and the breast suffers; the spasms are so severe, that the patient can scarcely be prevented from being thrown from the bed. There is another variety, less fatal than the former, arising from the same causes, and affecting in like manner the whole body.
Ardent fever does not originate as tetanus. It at once shows its nature to resemble that of a great fire. It commences with a violent thirst and high fever; the tongue cracks, becomes rough and dry, and from its natural colour, turns black. If this change of colour is early in the disease, the crisis will be hastened; if later, so will be the crisis.
Of the distinction and judgment of sciatica and jaundice.
Sciatica commonly arises from long exposure to the sun, by which the hip joint becomes heated, and its humours are dried up; that this is the case, is apparent from the patient’s inability to turn or move his limbs, owing to the pain of the joints, and to a constriction of the spine. The pain is most severe in the loins and vertebræ adjoining the ischium, and in the knees; but it is often felt in the groin. If the patient is raised up he cannot move himself, the severity of the pain causes him to groan aloud, and not unfrequently convulsions attack him, followed by rigor and fever. Bile is the origin of sciatica, and sometimes blood, and pituita. The pains in all these diseases are pretty similar, and chills and slight fever sometimes attend. There is a species of acute jaundice that speedily terminates in death; the skin is every where of the colour of the rind of a pomegranate, verging on a green, similar to that of some lizards; the sediment of the urine is nearly of the same hue, red like orobes;a the fever and chill are inconsiderable. At times the patient cannot bear any covering; he feels in the morning internal twitchings, as if from a grater, and although the intestines are empty, there is great rumbling. If spoken to, or raised up, he complains. Death takes place usually within fourteen days; if that period is surmounted, he recovers.
Diagnosis and critical days of peripneumony and of fevers.
Peripneumony occurs as follows: violent fever, respiration hot and impeded; anxiety, debility, and restlessness; pains about the scapula, clavicle, and breast; a sense of weight in the chest, with delirium. Sometimes there is an absence of pain, although cough has commenced; such cases are of longer duration and more dangerous. At first the cough yields only a white and frothy sputum; the tongue is yellow, but ultimately assumes a dark colour. If dark-coloured at the beginning, the changes are more rapid than when this colour ensues at a later period: the tongue finally cracks, and if the finger is applied, it adheres to it. The change in this disease and in pleurisy is announced by the state of the tongue. It continues at least fourteen and may reach to twenty-one days, during which period the cough is vehement, and the expectoration tinged with blood; at first, indeed, it is copious and frothy. On the seventh or eighth day, when the fever is at its height, the inflammation softens down, and the sputum thickens, though not invariably; on the ninth and tenth days, it changes to a palish green, intermixed with a little blood; from the twelfth to the fourteenth, it is profuse and purulent. In those of a moist temperament, the disease is very violent, but much less so in those of an opposite character.
As to critical days, I have elsewhere mentioned them. Fevers, however, have their crises on the fourth, seventh, eleventh, fourteenth, seventeenth, and twenty-first days. Some of an acute nature even, terminate on the thirtieth, fortieth, and sixtieth day, beyond which the diurnal characters are entirely lost.
[a ]A leguminous plant.