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119. From the universality of tertian or quartan periods in intermittent fevers, we cannot doubt of their being, in the animal economy, a tendency to observe such periods; and the critical days above mentioned are consistent with this tendency of the economy, as all of them mark either tertian or quartan periods. ■These periods, however, are not promiscuously mixed, but occupy constantly their several portions in the progress of the disease; so that, from the beginning to the eleventh day, a tertian period takes place; and, from the eleventh to the twentieth, and perhaps longer, a quartan period is as steadily observed.
120. What determines the periods to be changed about the eleventh day, we have not clearly perceived; but the fact is certain: for there is no instance of any termination on the thirteenth, that is, the tertian period next following the eleventh; whereas, upon the fourteenth, seventeenth, and twentieth, which mark quartan periods, there are forty-three instances of terminations, and six only on all the intermediate days between these.
This prevalence of a quartan period leaves no room for doubting that the twentieth, and not the twenty first, is the critical day marked by Hippocrates, though the last is mentioned as such in the common edition of the aphorisms, taken from an erroneous manuscript, which Celsus also seems to have copied.
131. A consistency with the general tendency of the system, renders the series of critical days we have mentioned probably the true one; and the only remaining difficulty in finding what we have delivered to be the same with the genuine doctrine of Hippocrates, is the frequent mention of the fourth as a critical day.
It is true, there are more instances of terminations happening on this day, than on some of those days we have asserted to be truly critical: but its inconsistency with the more general tendency, and some other considerations, lead us to deny its being naturally a critical day; and to think, that the instances of terminations, which have really occurred on the fourth day, are to be reckoned among the other irregularities that happea in this matter.
122. I have thus endeavoured to support the doctrine of critical days, chiefly upon the particular facts to be found in the writings of Hippo.crates.: and although I might also produce many other testimonies of both ancient and modern times; yet it must be owned, that some of these testimonies may be suspected to have arisen rather from a veneration of Hippocrates, than from accurate observation.
123. With respect to the opinions of many moderns, who deny the prevalence of critical days, they are to be little regarded: for the observation of the course of continued fevers is known to be difficult and fallacious; and therefore the regularity of that course may have often escaped inattentive and prejudiced observers.
124. Our own observations amount to this; that fevers with moderate symptoms, generally cases of the synocha, frequently terminate in nine days, or sooner, and very constantly upon one or other of the critical days which fall within that period: but it is very rare, in this climate, that cases of either the typhus or synochus terminate before the eleventh day, and when they do terminate on this day, it is for the most part fatally. When they are protracted beyond this time, I have very constantly found, that their terminations were upon the fourteenth, seventeenth, or twentieth day.
In such cases, the salutary terminations are seldom attended with any considerable evacuation. A sweating frequently appears, but is seldom considerable; and I have hardly ever observed critical and decisive terminations attended with vomiting, evacuations by stool, or remarkable changes in the urine. The solution of the disease is chiefly to be discerned from some return of sleep and appetite, the ceasing of delirium, and an abatement of the frequency of the pulse. By these symptoms we can often mark a crisis of the disease: but it seldom happens suddenly and entirely; and it is
most commonly from some favourable symptoms occurring upon one critical day, that we can announce a more entire solution upon the next following. * . • Upon the whole, I am persuaded, that, if observations shall be made with attention, and without prejudice, I shall be allowed to conclude with the words of the learned and sagacious Gaubius, 'Fallor, ni sua constiterit Hippocrati auctoritas, * Galeno fides, Nature virtus.et ordo.'
6F THE METHOD OF CL'llE IN FEVEBS.
10.5; A.s it is allowed, that, in every fever which has its full course, there is an effort of nature of a salutary tendency, it might be supposed that the cure of fevers should be left to the operations of nature, or that our art should be only directed to support and regulate these operations, and that we should form our indications accordingly. This plan, however, I cannot adopt, because the operations of nature are very precarious, and not so
well understood as to enable us to regulate them properly. It appears to me, that trusting to these operations has often given occasion to a negligent and inert practice; and there is reason to believe, that an attention to the operations of nature may be often superseded by art.
126, The plan which to me appears to be most suitable, is that which forms the indications of cure upon the view of obviating the tendency to death; while, at the same time, the means of executing these indications are directed by a proper attention to the proximate cause of fevers.
Upon this plan, in consequence of what has "been laid down above on the subject of the prognostic, we form three general indications in the cure of continued fevers; and the one or other of these is to be employed according as the circumstances of the fever (102), shall direct.
The first, therefore, is to moderate the violence of reaction.
The second is, to remove the causes, or obviate the effects of debility. And,
The third is, to obviate or correct the tendency of the fluids to putrefaction.
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111. The first indication-may be answered, that is, the violence of reaction may be moderated,
1, By all those means which diminish the action of the heart and arteries.