Restlessness precedes every crisis, and if the crisis be to take place
by day, it will occur by night; or if the crisis be to take place during
the night, it will occur by day; and then certain symptoms supervene,
such as headach not previously occurring, sympathetic pain of the neck,
retraction of the hypochondrium, sudden difficulty of breathing, and
other dangerous symptoms which did not manifest themselves before then
take place. And if, when these occur, the pulse, instead of sinking,
is increased in magnitude and becomes stronger, and the critical
day approaches, and if it be one of the favorable, you may not only
anticipate a crisis, but also a good one. And be not then alarmed if you
see the patient become delirious and disturbed, for these are indications
of the humours being carried upwards; in like manner as certain other
symptoms indicate their being determined downwards, such as pain of the
belly, gripes about the navel, pain in the loins, borborygmi, and other
similar symptoms, when they occur. In addition to these, if the patient
was accustomed to have a hemorrhoidal discharge, and if the period of it
be at hand, and in like manner with respect to the menstrual discharge
(if the patient be a woman), it is not unlikely that the crisis may take
place by such an evacuation. And a critical sweat is recognized by a
precursory moistness of the skin (especially if occurring upon one of
the days called indicatory), and by openness of the pores. From these
you may recognize crises by evacuations upwards; for, in addition to the
aforesaid, you ought to examine the face of the patients, and whether
there be palpitation in any part, or throbbing of the temporal arteries;
or if the cheek, nose, or eye be redder than usual, you ought the rather
to anticipate the coming crisis. But if they shed tears involuntarily,
or fancy that they see sparks of light, and constantly carry their hands
to their nose as if to rub it, then indeed you may see not only an
approaching but a present flow of blood; for when they rub it once or
twice the blood straightway breaks forth. Pungent pain at the stomach,
and trembling of the under-lip often indicate a crisis by vomiting. These
considerations are sufficient, but to them may be joined the age and
constitution of the patient, as strengthening the anticipation; to which
may be added, the season of the year and the present constitution. For if
the patient be a child, or otherwise by nature warm and full of blood,
you may still more form this anticipation; or if formerly, when in health
or disease, as we remarked before, an evacuation of blood appeared, this
circumstance alone may be sufficient to make you expect a hemorrhagy. And
if the season of the year be summer, or, if not summer, if the present
state of the weather be hot, and if the patient had often experienced
a crisis at that season by hemorrhage, if the body be plethoric, if
there is retention of the customary evacuations, all these things ought
to strengthen your expectations. In like manner you ought to judge of
the other evacuations; or, if none of these symptoms should appear, but
if there be uneasiness occurring on one of the critical days after the
20th; or if, when the disease is at its acme, pains should seize certain
joints, or near the ears, or in other parts; or if not pains, but local
sweats should occur unceasingly in any part of the body, then indeed you
may expect a crisis to take place by abscess, and in that part where the
sweats, pains, or swelling occurred.
* * * * *
COMMENTARY. This is taken with very slight alterations from Galen
(Therap. ad Glauc. i: see also, de Crisibus, iii, 2.) The critical
evacuations enumerated by Galen are, those by vomiting, by the belly,
by urine, by sweats, by hemorrhage from the nose, by hemorrhoids,
by the menses in women, by abscesses of the parotid glands, and by
determination to the knees, feet, or some other parts not vital. He says
there are three ways in which a fever may terminate favorably, namely,
by an evacuation, by an imperfect crisis without an evacuation, and by
resolution, that is to say, when the febrile symptoms go off gradually.
There are likewise three unfortunate terminations; for the patient may
die suddenly with much agitation, or in consequence of a metastasis, or
he may be slowly wasted by a marasmus.
Averrhoes enumerates the same kinds of critical evacuation as Galen, and
otherwise treats of them very judiciously. (Collig. iv, 39.) Avicenna
gives a long account of all the circumstances attending the crisis, but
he copies closely from Galen and Hippocrates. (iv, 2, 1.) Haly Abbas,
in like manner, is sensible and correct, but borrows from the Greeks.
(Theor. x, 10.) The account given by Rhases is excellent, but it differs
little from our author’s. (Ad Mansor. x, 27.) In his ‘Continens,’
he gives a full exposition of the Galenic doctrines, with his own
Commentaries. He states, that a crisis may take place in six ways: by
hemorrhage at the nose, by an alvine evacuation, by vomiting, by a
discharge of urine, by a sweat, or by an aposteme. (xxxi.)