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Those who have adopted Dr. Cullen's opinion, have Gen. III.
e Spec. III. usually contemplated it as a mere effect of absorbed pus.
Epanetus Dr. Heberden seems to think it dependent upon a local Hectica. cause, but that irritability in any diseased organ, which
fever. cannot be brought into a healthy state, will excite it as ef
By some fectually as pus introduced into the system.
merely a Galen, on the contrary, Mr. John Hunter, and Dr.
Dr. symptomaWillan, contend, that hectic may be, and often is, a tic or se
condary strictly idiopathic affection. The second of these valu- discas able writers regards hectic fever as of two sorts, sympto- By others matic and idiopathic *. The first he ascribes entirely as an idio
pathic afto local irritability, and opposes the idea that it is ever fection. produced by absorbed pus. His argument is, that if Supposed absorbed pus be capable of producing it in one instance, it ought in every instance: but this we know is not the derived
from both case; for we have had large buboes and even empyemas
us sources. removed by absorption suddenly, and yet no hectic has Why not taken place. He does not think that more pus is ab- always prosorbed during the existence of hectic fever than when no absorbed such fever is present: but, admitting that this should be pus. the case, he would rather ascribe the increased absorption to the hectic constitution, operating upon the abscess or sore, than to the abscess or sore operating upon the constitution; in which case the hectic diathesis is the cause, and the increased absorption is only the effect. So that even here, he regards the hectic as a primary or constitutional disease.
As a symptomatic affection, however, he refers it to a When symgeneral irritability of the constitution, produced by sympathy, in consequence of “some incurable local disease by general
irritability, of a vital part, or of a common part when of some magnitude"; and which becomes incurable from two causes ; firstly, because, though the local irritation is small, the constitution is bad, and does not dispose the parts to a healing state: and secondly, because, though the constitution is good, the local irritation is so considerable that it cannot muster up a sufficiency of remedial energy
* On Blood, Part in. Chap. ix. Sect 1.
Gen. III. to subdue it; and hence, while sympathizing in the irriSpec. III.
table action, falls a prey to its own efforts. Epanetus Hectica.
Yet, says he, it is possible for hectic fever to be an Hectic
original disease of the constitution; for the constitution fever.
may fall into the same mode of action, without any local cause whatever, at least that we know of. And in this manner he accounts for its existence as an idiopathic affection. And, in effect, nothing is more common than for hectic fever to exist in patients in which we can trace no local cause whatever : and in all such cases we must either indulge in a gratuitous hypothesis, and throw our suspicions at random upon the lungs, or the liver, or the kidneys, or the heart, or the mesenteric glands, or whatever other organ a few casual symptoms may suggest to the fancy; or we must at least act upon the principle of its being an idiopathic affection, even though we should
refuse, in terms, to admit that it is so.. Idiopathic “I willingly subscribe”, says Dr. Perceval of Dublin, hectic admitted by
in his manuscript comment upon the author's Nosology, Perceval.
“ to idiopathic hectic; and have known it to last three months without any pulmonary affection, and then to
break out in the lungs.” Habitus
There seems, indeed, great reason for admitting with phthisicorum of
Dr. Stoll, a habitus phthisicorum *, a hectic diathesis or Stoll.
temperament; the features of which are for the most part strongly marked, and are to be found in a fair skin,
blue eyes, yellow hair, lax fibre, and sanguine disposiMost of the tion. And, wherever this exists, it is probable that most
of of the causes of other fevers, operating upon it, will profevers produce it, duce a hectic. And we can hence readily account for where this
the examples brought by different authors of its being exists;
excited by diseased actions or affections of the heart, stomach, mesentery, liver, pancreas, lungs, or brain; by a suppression of various exanthems or other eruptions, or of various habitual discharges natural or morbid; by other fevers; by chronic inflammations or abscesses. It is well known to be a common sequel to the measles, oc
* Prælect. p. 19.
casionally so to the small-pox, and in a few instances to Gen. III. rosalia or scarlet fever. It may hence be a result of dys. pepsy; and one case is said to have been produced by Hectica. eating bacon, which remained undigested in the stomach
Hectic for a term of eighteen months, when it was disgorged by and henc sickness, and the hectic symptoms disappeared * And a frequent it is hence possible that hectic fever may occasionally whicus spring like other remittents from febrile miasm. anthems. The character of the disease is well given by Mr.
produced John Hunter in the following words : “Hectic may be by dyssaid to be a slow mode of dissolution; the general sym- pepsy.
1. Probably ptoms are those of a low or slow fever, attended with
by febrile weakness, but more with the action of weakness than miasm. real weakness; for, upon the removal of the hectic cause, General the action of strength is immediately produced, as well of the dis. as every natural function, however much it was decreased ease. before. The particular symptoms are debility; a small, quick, and sharp pulse; the blood forsaking the skin ; loss of appetite ; often rejection of all aliment by the stomach; wasting; a great readiness to be thrown into sweats; sweating spontaneously when in bed; frequently a constitutional purging.”—To which he adds, “the water clear". There is, in reality, much difference of Whether opinion upon this last point. Dr. Heberden has observ. pellucid.
urine be a ed that the same irregularity which accompanies most symptom. other symptoms of the disease attends this also; that the urine is equally clear or turbid in the exacerbations and the intervals; sometimes clear in the first, and turbid in the second; and sometimes turbid in the first, and clear in the second ; while Dr. Duncan, from long and assiduous attention, asserts that the urine is peculiarly distinguished by a natural furfuraceous separation. Such is the character it has usually exhibited in my own practice : though wheré authorities thus clash, it is not a symptom to be depended upon as a pathognomic.
From the frequent approaches which the hectic makes How distowards a perfect apyrexy, it is sometimes apt to be con- tinguished
from an ina
termittent. Arnold. Diss de Hecticâ Stomachiâ, 1743. VOL. II,
Gen. III. founded with an intermittent; but there is rarely any reSpec. III.
mission in which the pulse is not at least ten strokes in Epanetus Hectica. a minute quicker than it ought to be; and by this it is Hectic fever.
sufficiently distinguishable, as it is also by the greater irregularity of its different stages, and indeed of all its
symptoms. Stages of It is owing to this last feature that, sometimes, the exthe disease irregular in
acerbation commences with a chilly fit, and sometimes their order. without; and that, where there is a chilly fit, sometimes
it is immediately succeeded by heat, but sometimes by perspiration, without any intervening hot fit; while
occasionally the cold fit only leads to heat, or even terExacerba minates singly without either heat or perspiration. Hence tions irre
the exacerbations must vary in duration : but even where their dura- every stage is present and succeeds in regular order, the
duration of the entire exacerbation is almost equally uncertain, insomuch that it is seldom that three exacerbations of equal length recur in succession. The remissions will sometimes extend to ten or twelve days, without a single intervening pyrectic symptom : and sometimes the cold or the hot fit, or the sweating, will be renewed several times in the same day. Yet, let the perspiration appear whenever it may, the patient is never relieved by it: but is as anxious and restless during its
continuance as in the heat or chill. Sometimes - Dr. Heberden * tells us that he has sometimes seen a
ud- hectic attack persons who seemed in tolerable health, in dewly and violently. a sudden and violent manner, like a common inflamma
tory fever: and, like that, in a little time bring them into imminent danger of their lives; after which it has abated, and afforded hopes of recovery. But the hopes have been deceitful, for the hectic has still been fed by some lurking mischief; and, resisting the power of medicine, hạs gradually undermined the patient's health
and destroyed him. More com- More commonly, however, hectic fever commences monly
slowly and insidiously, and is not suspected for some insidiously,
• Trans, of the College, Vol. 11. Art. 1. p. 6.
months : and the only symptoms noticeable are, lassi- Gen. III. tude upon slight exercise, loss of appetite, and a wasting of the flesh. But if these symptoms be connected with Hectica. a general increase of pulse, so that the artery beats from ninety to a hundred or a hundred and twenty strokes in a minute, there will be real ground for apprehension.
This is one of many diseases in which the art of me- Remedial dicine has hitherto laboured in vain to strike into any Loubtful. direct track of cure. The real cause is commonly involved in great and impenetrable obscurity, and we can do little more than attack single symptoms as they make their appearance.
Where the disease is evidently symptomatic, the case Irritable must depend upon curing, or, if incurable, upon removing, when this can be accomplished, the part affected. bated. Where idiopathic, we must combat, as far as we are able, the irritable diathesis; and above all things endeavour to strengthen, without increasing, the action of the machine. The best sedatives as well as tonics are acids, Acids as
sedatives and of these the vegetable will usually be found prefer- and tonics. able to the mineral, since, on account of their corrosive property, the latter can only be taken in small quantities. They abate the febrile heat, diminish the restlessness, and frequently succeed in checking the night-sweats. And if, as is often the case, the patient be tormented with pains in the limbs or joints, resembling rheumatism, and preventing him from sleeping, we may combine the acids with opium. The bowels must be kept regular by Occasional gentle laxatives, and the neutral salts seem to answer
aperients, this purpose better than most others. It will, however, be convenient to vary them occasionally, and sometimes to exchange them for the senna confection, or some other aperient. Stimulants rarely answer any good purpose; and in Myrrh the
only stimumany instances evidently heighten and accelerate the ex- i acerbation. The Peruvian balsam has been given ad- ventured vantageously with nitre; but myrrh is a medicine of fairer promise; and beyond these we can scarcely ever venture to proceed.
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