Of the critical days, some terminate the disease frequently, faithfully,
well, completely, clearly, decidedly; and others contrariwise to these.
But the 13th has been shown to possess an intermediate character. Some
of these are such as to prove critical if they experience even the most
moderate impetus of nature, such as the 7th and 14th; whilst most of them
prove critical in violent commotions of the system, but not otherwise.
Neither are the favorable all equally favorable, nor the unfavorable
all equally unfavorable; nor is their favorableness and unfavorableness
according to any order. Those in the first rank of favorable days may be
arranged thus: the best of all are the 7th and 14th, next to them the
9th, and 11th, and 20th; and near to them the 17th and 5th, after these
the 4th, after it the 3d and 18th. Opposed to them, of the second rank,
are these: the worst, which proves obscurely critical with danger, and
is, as it were, diametrically opposed to the 7th, is the 6th: near to it
are the 8th and 10th, after these the 12th, 16th, and 19th. Intermediate
between these is the 13th, being neither so objectionable as those of the
second rank, nor so powerful in freeing from diseases as those of the
first. The critical days then are thus arranged according to their degree
by Galen. Numerically thus: the favorable are the 3d, 4th, 5th, 7th,
9th, 11th, 14th, 17th, 18th, 20th; the unfavorable, the 6th, 8th, 10th,
12th, 16th, 19th; the intermediate, the 13th. Some of the critical days
give information concerning the others, and are hence called indicatory
by Hippocrates, because they indicate the crisis that is to happen on
another critical day. Thus the 4th indicates a crisis on the 7th, by
inducing sweats, perspirations, or some such particular evacuation, or
by displaying certain signs which had not formerly taken place, or some
symptoms of concoction. Galen says that the 4th is indicatory of the 6th,
although it be unfavorable, as the 11th is of the 14th, and the 17th of
the 20th. Until the 14th day the crises are the most decided, next to
these until the 20th; from the 20th to the 40th they gradually lose their
decided character. Of these, the first in degree are the 27th, 34th, and
40th, after which are the 24th and 32d. The other numbers intermediate
between the 20th and 40th are indeterminate, and those after the 40th
are not properly critical, as they terminate diseases by concoctions and
abscesses rather than by crises. Hippocrates seems entirely to disregard
all those after the 40th day, yet he enumerates the 60th, 80th, and
100th. After these, he says that some diseases prove critical in seven
months, some in seven years, and others, as it would appear, in twice or
thrice seven years.
* * * * *
COMMENTARY. The Father of Medicine who was profoundly skilled in
Semeiology, appears to have attached great importance to the observance
of the critical days. At first, as Galen remarks, he seems to have been
undecided respecting certain days, and, accordingly, he gives a somewhat
different list of them in his ‘Prognostics’ and ‘Aphorisms,’ from what he
has given in his ‘Epidemics.’ His latter list of critical days differs
little or nothing from that of Galen.
Galen reposes such confidence in the doctrine of critical days, that he
affirms that, by a proper observance of them, the physician may be able
to prognosticate the very hour when a fever will terminate. The following
is his list: The 7th is particularly favorable; next, the 14th; next to
these, the 9th, 11th, and 20th; then the 17th and 5th; afterwards the
4th, 3d, and 18th. The 6th is very doubtful and unfavorable; the 8th and
10th, like the 6th; the 12th, 16th, and 19th, like the 8th and 10th.
Intermediate between these two lists of favorable and unfavorable days is
the 13th. He informs us that Diocles and Archigenes held the 21st to be
particularly favorable, but he agrees with Hippocrates in rejecting it
and adopting the 20th.
Celsus follows the system of Archigenes. He says, “κρίσιμοι dies erant,
dies tertius, quintus, septimus, nonus, undecimus, quartus-decimus,
unus et vicesimus; ita ut summa potentia septimo, deinde quarto-decimo,
deinde uni et vicesimo daretur.” But he does not hesitate, afterwards,
to express his distrust in the whole system; for, he adds, “verum in his
quidem antiquos tunc celebres Pythagorici numeri fefellerunt; cum hic
quoque medicus non numerare dies debeat, sed ipsas accessiones intueri.”
The Greek writers subsequent to Galen adopt his system, with little or no
alteration. Aëtius arranges the critical days thus: First in order, the
7th and 14th; then the 9th and 11th; next to them the 17th and 5th; then,
the 4th; and afterwards the 3d and 20th. The 6th is usually bad.
The last of the ancient authorities, Actuarius, is very full and
confident in laying down the received doctrines, with regard to the
critical days. He follows Galen.
The Arabians, with scarce one exception, adopt the Galenic system.
Avicenna, who treats of the critical days very fully, mentions the list
of them given by Hippocrates and Galen, and also that by Archigenes, but
decides in favour of the former.
Rhases mentions the critical days in the following terms: The 3d is
critical in very acute fevers; the 4th is indicative of the 7th and
6th; the 5th is favorable; the 6th generally unfavorable; the 7th is a
particularly favorable or unfavorable crisis; the 8th rarely critical,
but if it be, unfavorable; the 11th critical and indicative of the 14th;
the 12th rarely critical, and like the 8th; the 13th rarely critical; the
14th, critical and favorable; the 15th like the 13th; the 16th like the
12th; the 17th like the 9th, and indicative of the 20th; the 18th rarely
critical, or unfavorable; the 19th rarely critical, or, if so, not bad;
the 20th next to the 14th, and favorable; the 21st sometimes critical,
but less frequently so than the 20th; the 24th resembling the 20th; after
these the 27th, 31st, 37th, and 40th are critical. Averrhoes remarks,
that great deference is due to Rhases’ opinion upon this subject, since
it was confirmed by experience, in more than ten thousand cases, in an
infirmary (in infirmaria Relenson). His list is very little different
from that of Galen. In his ‘Continens,’ he gives an account of the system
of Archigenes, but prefers that of Hippocrates. (xxxii.)
Averrhoes states that the medical world was divided between the systems
of Archigenes and Galen, but he inclines to the side of the latter in
this case, although on most occasions given to dispute his authority.
Avenzoar, upon the whole, nearly agrees with Rhases, but expresses
himself undecided with regard to the 20th and 21st days. His authority
must also be allowed to be of great weight upon this subject, if we
may believe Averrhoes, that he lived to the age of one hundred and
thirty-five, and practised medicine from his fortieth year.
To the first class of critical days, according to Haly Abbas, belong the
7th and 14th; to the second, the 11th and 20th; to the third, the 4th,
17th, and 21st; and to the fourth, the 3d, 5th, 9th, and 18th.
Alsaharavius gives a similar list to Haly’s. He inclines rather to the
20th than the 21st day.
Galen, and most of the ancient authorities, believed that the critical
days are influenced by the moon. Actuarius, in particular, attributes
much to the influence of the sun and moon in influencing the course of
fevers.
Prosper Alpinus gives a correct summary of the ancient doctrines
respecting the critical days. (De præs. Vita et Morte ægrot. vi, 4.)
SECT. VIII.—THAT CRITICAL SYMPTOMS APPEARING IN THE COMMENCEMENT ARE
UNFAVORABLE.
The signs of concoction are never unfavorable, for concoction always take
place when nature prevails, and therefore the signs of it are always
favorable. But the critical signs may sometimes appear unfavorably, owing
to the crisis partaking of a double character (as was said with regard to
the critical days), being sometimes favorable and sometimes unfavorable.
They ought not therefore to appear at the commencement, nor during the
increase of the disease, but after its acme, at which time nature is
prevailing over the disease.
* * * * *
COMMENTARY. The opinion here delivered is derived originally from Galen,
but is maintained also by Oribasius, and the other authorities. It
requires no comment.