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GEN. III.

SPEC. III.

Those who have adopted Dr. Cullen's opinion, have 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 cannot be brought into a healthy state, will excite it as effectually as pus introduced into the system.

Hectic

fever.

By some regarded as merely a symptoma

tic or sediscase.

condary

pathic af

ter to be

from both sources.

Galen, on the contrary, Mr. John Hunter, and Dr. Willan, contend, that hectic may be, and often is, a strictly idiopathic affection. The second of these valuable writers regards hectic fever as of two sorts, sympto- By others matic and idiopathic *. The first he ascribes entirely as an idioto 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, by J. Hunit ought in every instance: but this we know is not the derived case; for we have had large buboes and even empyemas removed by absorption suddenly, and yet no hectic has taken place. He does not think that more pus is absorbed during the existence of hectic fever than when no absorbed such fever is present: but, admitting that this should be 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.

Why not always pro

duced from

pus.

ptomatic,

As a symptomatic affection, however, he refers it to a When symgeneral irritability of the constitution, produced by sym- produced pathy, 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 11. Chap. IX. Sect 1.

GEN. III.
SPEC. III.

Epanetus
Hectica.
Hectic
fever.

Idiopathic hectic admitted by Perceval.

Habitus phthisicorum of Stoll.

causes of

to subdue it; and hence, while sympathizing in the irritable action, falls a prey to its own efforts.

Yet, says he, it is possible for hectic fever to be an original disease of the constitution; for the constitution 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.

"I willingly subscribe", says Dr. Perceval of Dublin, in his manuscript comment upon the author's Nosology, "to idiopathic hectic; and have known it to last three months without any pulmonary affection, and then to break out in the lungs."

There seems, indeed, great reason for admitting with Dr. Stoll, a habitus phthisicorum*, a hectic diathesis or 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 the causes of other fevers, operating upon it, will produce a hectic. And we can hence readily account for the examples brought by different authors of its being 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

fevers produce it, where this exists;

* Prælect. p. 19.

SPEC. III.

Hectic

various ex

sequel of

anthems.

Has been

produced

by dyspepsy.

Probably by febrile

General

character

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-netus pepsy; and one case is said to have been produced by Hectica. eating bacon, which remained undigested in the stomach fever. for a term of eighteen months, when it was disgorged by and hence sickness, and the hectic symptoms disappeared *. And a frequent it is hence possible that hectic fever may occasionally spring like other remittents from febrile miasm. The character of the disease is well given by Mr. John Hunter in the following words: "Hectic may be said to be a slow mode of dissolution; the general symptoms are those of a low or slow fever, attended with weakness, but more with the action of weakness than miasm. real weakness; for, upon the removal of the hectic cause, 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 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 where authorities thus clash, it is not a symptom to be depended upon as a pathognomic.

From the frequent approaches which the hectic makes towards a perfect apyrexy, it is sometimes apt to be con

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urine be a

How distinguished

from an intermittent.

}

SPEC. III.

Epanetus
Hectica.

GEN. III. founded with an intermittent; but there is rarely any remission in which the pulse is not at least ten strokes in a minute quicker than it ought to be; and by this it is sufficiently distinguishable, as it is also by the greater irregularity of its different stages, and indeed of all its symptoms.

Hectic fever.

Stages of the disease

irregular in their order.

Exacerba

tions irregular in

their dura

tion.

Sometimes

denly and

violently.

It is owing to this last feature that, sometimes, the exacerbation commences with a chilly fit, and sometimes 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 terminates singly without either heat or perspiration. Hence the exacerbations must vary in duration : but even where 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.

Dr. Heberden* tells us that he has sometimes seen a attacks sud- hectic attack persons who seemed in tolerable health, in a sudden and violent manner, like a common inflammatory 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, has gradually undermined the patient's health and destroyed him.

More com

More commonly, however, hectic fever commences slowly and slowly and insidiously, and is not suspected for some

monly

insidiously.

Trans. of the College, Vol. 11. Art. 1. p. 6.

SPEC. III.

months and the only symptoms noticeable are, lassi- GEN. III. tude upon slight exercise, loss of appetite, and a wasting Epanetus of the flesh. But if these symptoms be connected with Hectica. a general increase of pulse, so that the artery beats from Hectic ninety to a hundred or a hundred and twenty strokes in a minute, there will be real ground for apprehension.

fever.

process

This is one of many diseases in which the art of me- Remedial Idicine has hitherto laboured in vain to strike into any doubtful. 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.

diathesis

to be com

Acids as

sedatives

and tonics.

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, and of these the vegetable will usually be found preferable 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 aperients. gentle laxatives, and the neutral salts seem to answer 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.

only stimu

Stimulants rarely answer any good purpose; and in Myrrh the many instances evidently heighten and accelerate the exacerbation. 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.

upon.

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