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Crisis

The battle between nature and the disease was decided on the day that coction actually took place or failed to take place. The result was recovery, partial or complete, aggravation of the disease, or death. The crisis (κρίς1ις) is "the determination of the disease as it were by a judicial verdict."1

After a crisis there might, or might not, be a relapse (ὑπος1τροφή), which would be followed in due course by another crisis.

The crisis, if favourable, was accompanied by the expulsion of the residue remaining after coction and κρᾶς1ις of the humours had occurred. This expulsion

[p. liii] might take place through any of the ordinary means of evacuation--mouth, bowels, urine, pores--and the evacuated matters were said to be concocted (πέπονα), that is to say, they presented signs that coction had taken place.2

But nature was not always able to use the ordinary means of evacuation. In this case there would be an abscession (ἀπός1τας1ις). When the morbid residue failed to be normally evacuated, it was gathered together to one part of the body and eliminated, sometimes as an eruption or inflammation, sometimes as a gangrene or tumour, sometimes as a swelling at the joints.

An abscession did not necessarily mean recovery ; it might merely be a change from one disease to another. The Hippocratic writers are not clear about the point, but apparently the abscession might fail to accomplish its purpose, and so the disease continued in an altered form.3 In other words there was abscession without real crisis.

To trace the course of a disease through its various stages, and to be able to see what is portended by symptoms in different diseases and at different stages of those diseases, was an art upon which Hippocrates laid great stress. He called it πρόγνως1ις, and it included at least half of the physician's work.

[p. liv]

1 See Dr. E. T. Withington, Classical Review, May-June 1920, p. 65. There is a good definition of κρίς1ις in Affections VIII. (Littré VI. 216) : κρίνες1θαι δέ ἐς1τιν ἐν ταῖς νούς1οις, ὅταν αὔξωνται αἱ νοῦς1οι ματαίνωνται μεταπίπτως1ιν ἐς ἕτερον νός1ημα τελεντῶς1ιν.

2 The chief signs of coction were greater consistency, darker colour, and "ripeness" or "mellowness."

3 The most important passages are:-- (a) οὐδὲ γὰρ αἱ γιγνόμεναι τούτοις ὰπος1τάς1ιες ἔκρινον ὥς1περ ἐπὶ τοῖς ἄλλοις (Epidemics III. XII.).

b) ἀπος1τάς1ιες ἐγένοντο, μέζους ὥς1τε ὑποφέρειν μὴ δύνας1θαι, μείους ὥς1τε μηδὲν ὠφελεῖν ἀλλὰ ταχὺ παλινδρομεῖν κ.τ.λ. (Epidemics I. VIII.).

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