203 
PATHOLOGY. 
degree juft defcribed, and after the general heat has con¬ 
tinued for an indefinite time, (in the ephemera] and in¬ 
termittent fevers a few hours, in continued fevers feveral 
days,) it often happens, that a partial moifture begins to 
appear on the fkin, generally on the forehead, which ex¬ 
tends gradually downwards to the neck and breaft, and 
at length a free fweat takes place from the whole furface 
of the body. At the fame time the fymptoms of the firft 
ft age of the fever begin to abate, fometimes one giving 
_ way firft, and fometimes another, fo that it cannot be faid 
which has the priority : fometimes the weight and anx¬ 
iety about the prascordia are firft obferved to diminilh, 
fometimes the change of the pulfe from hardnefs to foft- 
fiefs is the firft obvious amendment, and fometimes the 
relaxation of one or other fet of fecretory veffels, See. 
Such a change of the fymptoms, terminating fpeedily in 
a reftoration of the health, has been called, by a term 
borrowed from the Greek, a erifis; and the excreted 
fluids, which are poured forth at the time of this change, 
have hence been denominated critical difeharges. The 
moll linking appearance, both to the patient and by- 
ftander, is the perfpiration, which is frequently carried 
to the extent of profufe fweating in internments and 
the Ampler forms of fever, but fometimes amounts only 
to gentle moifture. While the fweating continues, all 
the fymptoms of the previous ftages abate s the preter¬ 
natural heat is gradually diminilhed ; the pulfe becomes 
fofter and lefs frequent; the breathing is likewife frequent, 
and more free, and is unaccompanied by fighing ; and the 
anxiety and heavinefs in the cheft are greatly alleviated. 
The head-ache gradually goes off, and" the pains of the 
loins and extremities ceafe ; the naufea and vomiting no 
longer diftrefs the patient, who now acquires a relilh for 
light nourifhment; the thirft is removed ; the mouth and 
tongue become moift, as the falivary and mucous glands 
pour out their fluids, and the tongue becomes gradually 
clean, firft upon the edges, afterwards in the middle and 
®H&r the root; the cruft, which had formed upon it, 
coming off in fmall flakes, until the whole furface is in 
its ordinary ftate. The fecretions of the liver, pancreas,, 
and inteftinal glands, being reftored, the bowels begin to' 
aft, and the evacuation from them comes to its ordinary 
quantity. A loofe ftool is commonly paffed at the end of 
a paroxyfm of intermittent fever; and fometimes a diar¬ 
rhoea comeson in continued fever, and, being the molt ob¬ 
vious, is then confidered as the critical difeharge. The 
urine generally undergoes fome peculiar changes in the 
erifis of fever: it is not only fecreted in larger quantity, 
but, although bright and tranfparent when difeharged, 
if allowed to remain for fome time it is obferved to grow 
turbid, as if containing a quantity of a yellowilh-red 
powder, and at length to depofit flaky cryftals of a dirty 
red colour, commonly termed a lateritious fediment. 
Tumours, which were diminilhed during the cold, and 
more painful in the hot, ftage, return to their ufual fize 
during the fweat, and ulcers again begin to difeharge 
matter. Theintelleftnal funftions are alfo reftored during 
the erifis ; the attention of the patient is no longer ab- 
forbed by his uneafy feelings, the confufion of his head 
is relieved, and he is not ha raffed by the perpetual re¬ 
cti rre nee of diftrelfing images to the mind, efpecially in 
his (lumbers; a difpofition to calm deep returns; and 
the countenance relumes its natural expreflion. 
It was remarked by Hippocrates, and the majority of 
the ancient phyficians, that tliefe crifes occurred more 
frequently on particular days of the fever, which they, 
therefore, obferved with great care, as affording both 
particular indications in praftice, and the means of 
prognofticating the phenomena of the fubfequent periods 
of the difeafe. Hence they called thefe days critical days. 
Tliefe periodical changes, happening on particular days, 
are however feldom diftinftjy noticed in this country ; 
they feem to occur more decidedly in warm climates, 
where all fevers have a greater tendency to affume the 
Vol. XIX. No. 1297. 
remittent form. Dr. Cullen, who believed that even in 
this country thefe critical days were obfervable, though 
lefs diftinftly than in hot climates, explained their occur¬ 
rence upon the principle, that continued fevers were in 
fome degree difpofed to take on the types of intermit¬ 
tent’s ; and in this principle he has been followed by Dr. 
Fordyce. (See Cullen, Firft Lines, § cxix. Fordyce, 
Third Differt. on Fever, p. 120.) But it mull be re¬ 
marked, that the doftrine of critical days, as taught by 
Hippocrates, was ridiculed by Afclepiades and Celfus p 
who praftifed in the fame climate with Hippocrates, and 
in the fame city with Galen ; and Herophilus altogether 
denied its truth. 
In this country, and in cold climates in general, con¬ 
tinued fevers are feldom terminated by erifis. Some 
praftitioners have maintained, that a erifis never takes 
place, whilft others have infilled that crifes happen in all 
continued fevers. Dr. Fordyce juftly remarks, that 
thefe extremes of opinion are both inconfiftent with cor¬ 
rect obfervation. It is admitted, however, that crifes 
occur much lefs frequently in this climate than in hotter 
countries; and we think that the phyfician juft men¬ 
tioned confiderably over-rated the proportion when lie 
fays, that “ not above one-third part of the fevers which 
happen in London are terminated by a erifis.” (Loc. 
cit. p. 126.) We believe the proportion to be very far 
below this ftatement. In the great number of inllances 
of fever, no erifis takes place 5 but the difeafe terminates 
in a more flow recovery, or in death. 
The fymptoms before enumerated increafe gradually 
to the end of the firft, or middle of the fecond, week ; 
fometimes by the feventh day the fymptoms have at¬ 
tained their greateft feverity; fometimes, too, the fecond 
week is gone through without very fevere fymptoms, and 
in other cafes fymptoms of the greateft diftrefs and 
danger then occur; and there are all gradations between 
thefe extremes. The appearances in the fecond week, 
when the fever is not extremely fevere, are often as fol¬ 
lows. The pulfe is frequent, beating from 100 to 120 
in the evening, and in the morning fomewhat lefs; the 
Ik in continues dry and hot, in various degrees; the 
tongue is covered with a brownilh fur; the appetite is 
often totally loft; thirft continues, but is often com¬ 
plained of lefs during the fecond than during the firft 
week ; and the depreffion of ftrength is confiderable. 
The deep is difturbed and fiiort, and the delirium is ma- 
nifefted in the intervals by the incoherence of the obfer- 
vations of the patient, until he is completely roufed by 
fome ftrong imprelfion on the fenfes. In the morning 
the delirium is lefs than in the early part of the night, 
and the deep fometimes tolerably quiet; even during the 
day there is confiderable confufion, and occafionalSy 
much flownefs of intelleft. Hence perhaps the thirft, as 
well as the head-ache, and pains of the back and limbs, 
are lefs complained of, rather than from aftual relief or 
diminution of thefe fymptoms. The eyes have a dull and 
confufed appearance, and commonly fome degree of red- 
nefs, from a number of fmall veffels diftended with 
blood. Sometimes a degree of ftupor comes on in tire 
morning, and continues till the more aftive delirium of 
the night. If this ftate (hould remain. Dr. Fordyce ob- 
ferves, till about the fourteenth day, the evening attacks 
become by degrees lefs, but the ftupor continues, with 
deafnefs, and inattention to external objefts ; and thefe 
appearances remain the very laft fymptoms of the difeafe. 
Very frequently about the end of the fecond week, and 
often fooner, the fymptoms begin gradually to diminilh 
in feverity. The firft appearance of this abatement is 
not uncommonly a cleannefs and healthy look about 
the edges of the tongue ; fometimes, although not very 
generally, fweating takes place all over the body, and 
the Ikin afterwards continues moift; more commonly the 
moifture and foftnefs of the Ikin appear in a lefs marked 
manner. The delirium abates altogether in the day, and 
3 G returns 
