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tient suddenly and unexpectedly grow decidedly better Order I.
Pyrectica. or worse in the progress of a fever of almost any kind, Fevers.ca. and pass on rapidly towards a successful or an unsuccess- Doctrine ful termination.
But the important question is, whether there be any Whether in particular periods in the progress of a fever in which the anci
sense, or on such changes may be expected ? Hippocrates conceive critical days. ed there were: he endeavoured to point out and distinguish them by the name of critical days. Asclepiades and Celsus denied the 'existence of such periods; and the same diversity of opinion has prevailed in modern times. It is not very easy to determine upon the subject in Not easy to
determine the present day, and especially in our own country. For, in cold first, fever, like many other complaints, may have un- climates. dergone some change in its progress from a like change in the nature of its remote causes, or in the constitution of man. And, next, it seems to be generally allowed, that sudden transitions, whether regular or irregular, are more apt to take place in almost all diseases in warm than in cold climates. On these grounds, it is probably a subject which will never become of great practical importance at home. Yet it is well worthy of attention as a question of history, and which may yet be of great importance to many parts of the world..
If we examine the phænomena of the animal economy, Periodical as they occur in a natural series, we shall find that they
mey in all the ' are in almost every instance governed by a periodical re- phænomena volution. A man, in a state of health and regular habits,
So mal econogenerally becomes exhausted of sensorial power within a my. given period of time, and requires a periodical succession of rest : his appetite requires a periodical supply, and his intestines a periodical evacuation. This tenden
cy equally accompanies and even haunts him in disease; she cannot disengage himself from it. Gout, rheumatism, Examples
of this remania, rapidly and pertinaciously establish to themselves mark ** periods of return. The hemorrhoidal discharge often
does this, and the catanienia constantly. The same occurs in fevers, but especially in intermittents; for the
n the ani.
ORDER I. quotidian, the tertian, the quartan, have, upon the whole,
very exact revolutions. And, though accidental circumDoctrine of stances may occasionally produce a considerable influcrises.
ence on every one of these facts, whether morbid or natural, the tendency to a revolutionary course is clear and
unquestionable. They sup Now, although Hippocrates has not appealed to this port the observations of reasoning, it forms a foundation for his observations : Hippocrates, and when, stript of the perplexities that encumber his upon criticala days. writings upon this subject, partly produced by erroneous
transcripts, and in a few instances perhaps by his own irresistible attachment to the Pythagorean hypothesis of
numbers, he may be regarded as laying down the followCritical days ing as the critical days of continued fever : the 3d, 5th, of Hippo
7th, 9th, 11th, 14th, 17th, 20th; beyond which it is not worth while to follow the series, for it is not often that they extend further.
In other parts of his works, he regards also the 4th and 6th, and even the 21st as critical days; so that in the first week, every day, after the disease has fully established itself, evinces a disposition to a serious change; in the second week, every other day; and in the third week, every third day. It is not easy to determine .why the 21st day should be a critical day as well as the 20th. Various conjectures have been offered upon the subject; by some, it has been regarded as a mistake in the Greek copy, and by others, as a piece of favouritism in Hippocrates for this number, in consequence of its being an
imperfect one in the Pythagorean philosophy, as the
0 commencement of a septenary. Hippocrates De Haen with rigid and patient assiduity has put put to the
Hippocrates to the test upon these data; for he has accurately analyzed Hippocrates's own journal of the numerous cases of fever he has so industriously collected and recorded, and finds the positions, in most instances, to be strictly justified ; and that out of 168 terminations of fever, not less than 107, or more than two-thirds, happened on the days denominated critical, not reckoning the 4th, 6th, or 21st, and that the 4th and 6th were very
test by Haen.
frequently critical. There are a few anomalies ; but it Order I. is not necessary to notice them, because they are easily referable to accidental causes, similar to those that retard Doctrine of or accelerate the paroxysm of intermitting fevers. .
crises. Now, admitting the Hippocratic table to be true, the Critical days continued fever, in its progress, is measured by the va
of Hipporious types exhibited by intermittent fevers. Thus, the counted for quotidian prevails through the first seven days; there is upons on each day a slight exacerbation, and no one day is different in
termittents. more critical than any other. After this period the tertian type commences, and runs through the ensuing week; the principal changes occur on the 9th and 11th days, and would occur on the 13th, but that the quartan type now assumes its prerogative; and the principal transitions, after the 11th, take place on the 14th, instead of on the 13th; on the 17th ; and on the 20th. Dr. Cul- The subject len, who has examined this subject with great attention, by Cullen's and simplified it from many of its difficulties, directly as- experience, serts that his own experience coincides with the critical days of Hippocrates; Dr. Fordyce, who scarcely does and Forjustice to Cullen upon other points, unites with him upon ayc the present, and justly compliments him upon his ingenious examination and explanation of the Greek distribution of critical days: and Dr. Stoker of Dublin has arrived at a like conclusion after what appears to have been a very patient, discriminating, and extensive enquiry.* It is, nevertheless, admitted on all hands, that Still less
distinct in the order of succession is far less distinct as well as less o regular in cold than in warm climates; and that it re- hot climates. quires a thoroughly attentive and practised eye to notice these changes in our own country, or indeed in any part of northern Europe. And hence, Craanen says, it is lost time to look for them t; Stoll, that they are only to be found in inflammatory fevers I; Le Roy, that the supposed critical days have no influence and can lead to no
cold than in
• Medical Report of the Fever Hospital, &c. for 1816. Trans. of the King's and Queen's Coll. Dubl. Vol. 11. 434. 8vo. 1824. † De Homine.
Rat. Med. Part iv. p. 283.
ORDER I. prognosis or peculiarity of practice *: and Frank that Pyrectica.
.. nature has fixed upon no one day rather than another, Fevers,
for a solution of fever, nor at any time forbids our attempt at executing a present indication to Dr. Jackson, partly from the strength of his attachment to the doctrines of Cullen, and partly from having principally practised in hot climates, is a great advocate for the existence of critical days, and believes them to take place iņ fevers from human as well as marsh miasm ; though less dis
tinctly as also less frequently in the former than in the Difficulties latter f. Why the first week of a fever should incline attending the subject. to a quotidian type rather than to a tertian, or the se
cond to a tertian rather to a quartan, we know no more than we do why fevers should ever intermit, or at any time observe the distinctions of different types. We are in total ignorance upon all these subjects. We see, moreover, that intermitting fevers, whether quotidian, tertian, or quartan, have their paroxysms recur regularly in the day time; the quotidian in the morning, the tertian at noon, and the quartan in the afternoon; and that in no instance do the paroxysms take place at night: and we see also that in continued fevers, the exacerbations uniformly take place later in the day than the paroxysms of the latest intermittent; for these rarely occur earlier than between five and six o'clock in the evening, while the paroxysms of the quartan return commonly before five. Of these interesting and curious scenes we are spectators; but we are nothing more ; for we are not ad
mitted to the machinery behind the curtains. Crises re By some pathologists the source of these phænomeva ferred to the influence is sought in the influences of the heavenly bodies, and
especially in those of the sun and the moon. In ancient heavenly bo
times these luminaries were supposed to produce an efTheir in- fect on all diseases, and especially on mania, epilepsy, fluence in the opinion
catamenia, and pregnancy.'. And when the Newtonian of the an
' * Du Pronostic dans les Maladies Aigués, 8vo. Montpel. 1778. + De Curandis Hom. Morbis Epit. Tom. 1. 29.
Hist. and Cure of Fever, Part 1. Ch. Ix. p. 242..
philosophy first illumined mankind with the brilliant ORDER I. doctrine of universal attraction, Dr. Mead stepped forth into the arena, and revived and supported the ancient doctrine with great learning and ingenuity. And as an ingenious conjecture and possible fact, of which no practical use could be made, it was contemplated till towards the close of the last century: about which time Dr. Darwin, by interweaving it with his new hypothesis, of Darwin ; once more endeavoured to raise it into popular notice, and give it an air of serious importance. Dr. Balfour, of Dr. of British India, however, has still more lately brought B it forward as a doctrine capable of direct proof, and as peculiarl yaffecting the progress of fevers. His opinion, which he endeavours to support by weighty facts and arguments, is, that the influence of the sun and the moon, when in a state of conjunction, which is named sol-lunar influence, produces paroxysms or exacerbations in continued fever, in all cases in which a paroxysmal diathesis (for such is his expression) exists; and as this influence declines, in consequence of the gradual separation of these luminaries from each other, and their getting into a state of opposition, a way is left open to the system for a critical and beneficial change, which is sure to take place provided the critical disposition is at this time matured. In other words, paroxysms and exacerbations in fever may be expected to take place (and do in fact take place) at spring-tides, and crises at neap-tides. This is a new view of the influence of the heavenly General
remarks. bodies upon the human frame; and a view which, though feebly supported by facts, is advanced with all the dogmatism of an established science. Dr. Stoker, at the particular request of Dr. Balfour, put his doctrines to the test of 276 patients between July 6 and September 6 1817 in Dublin. He has candidly given us his tables, and as candidly observes that “ very little coincidence indeed is to be remarked from a view of these tables”*. There is, nevertheless, more in medical astrology than
• Trans. of the King's and Queen's Coll. Dublin, Vol. 11. p. 435. 8vo. 1824.