Vel Ethica, (from habit,) the symptomatic fever; irregular intermittent fever; fever of suppuration; and slow fever. Hippocrates describes this fever under the name of phthisis: But Celsus is the first who speaks of it under that of hectic, and he directs the cure; what were afterwards called slow hectic fevers, were, among the first physicians, called tabid, or long continued fevers, or marasmi. At present by this term is meant slow, but long continued, fevers, which induce consumption, and impair the strength. Dr. Cullen considers hectic always as symptomatic. He describes it a fever returning every day, with meridian and evening accessions; with remissions, but seldom a total freedom from fever; generally attended with night sweats, the urine depositing a lateritious branny sediment. He adds, that as all no-sologists have admitted the hectic amongst the number of fevers, he has given its character; but that he never had observed a fever of this sort except when symptomatic, therefore he could not admit it to be enumerated amongst idiopathic fevers. In many examples given by Sauvages this fever is certainly symptomatic: but to prove a negative is very difficult; and if no internal disease to which it can be traced as a symptom can be discovered, we must allow it to be occasionally idiopathic. It has been called febris remittent chronica non critica, as it has no crisis, and is of long continuance.
On dissecting patients whose death was the consequence of a hectic, abscesses in some of the viscera, scirrhous or steatomatous tumours, are very often found.
Intemperate drinkers, and those who indulge in excess of any kind, are very subject to it; and disordered glands, abscesses, or ulcers in the internal parts, generally induce it: but these abscesses sometimes exist without a hectic, and the liver, sometimes even the lungs are found ulcerated when no fever had been observed.
The matter producing hectic may be formed in any part of the body, though perhaps in the lungs, and the glands of the mysentery, its source may be most commonly traced. A scirrhous gland, in any part, almost constantly produces this fever; particularly a scirrhous liver from hard drinking, or long residence in a warm climate. External accidents will sometimes occasion irregular exacerbations. Even a wound with a fine pointed instrument, according to Dr. Heberden, has produced this effect. Dislocations of the joint often produce shivering and disorders of the stomach; and the introduction of a catheter is attended also with shivering, often followed by the hot fit. A salivation is sometimes the cause.
The hectic arising from external inflammations and suppurations is longer in its attack and slower in its progress, in proportion to the magnitude and importance of the part. Thus in the joints, the usual seats of the disease, suppurations of the ankle, wrist, elbow, and even the shoulder, have often continued long before the constitution has suffered. On the contrary, when the knee, the hip joint, or the loins, are the seat of the disease, hectic soon comes on. During the continuance of wounds it sometimes comes on, and is then attended with every mark ofdebility.
Dr. Reid, in his Essay on the Nature and Cure of the Phthisis, denies that the absorption of the pus is the cause of the fever which attends that disease; but attributes it to the very large quantity of perspirable matter usually discharged from, the surface of the lungs, which is retained when this organ is injured, and only evacuated in the hectic sweats. As the lungs, by the increase of the disease, are less capable of exhaling the usual quantity of gas, exacerbations and the morning sweats are proportionally increased, or the matter falling on the intestines, produces a diarrhoea. From being usually costive, the patient hath frequent motions, and, in proportion to their number, the sweating and expectoration are diminished. The quickness of the pulse between the paroxysms he attributes to the progressive inflammation of the different tubercles. On this opinion we may make some remarks in a future article.
Many other authors have contended that hectics are not owing to the absorption of purulent matter; and their arguments are entitled to considerable attention. Mr. Hunter has urged many facts in opposition to the generally received opinion; and it must be admitted, that should absorption be generally the cause, the lymphatics act very irregularly, at different times, and in different situations. We know, indeed, that fluids exposed to the mouths of the absorbents are sometimes not taken up, and soon afterwards, without any apparent reason, rapidly disappear. Though this caprice may account for some of his observations, yet the facts before stated, where hectic fever follows only suppuration of some of the larger and more important joints, cannot be accounted for in the same way. In some external abscesses also, we find that the hectic begins to appear only when they are opened; and though the suppuration of scrofulous tumours is attended with fever, venereal ones produce no general effect on the constitution. Mr. Hunter concludes that"the hectic is owing to the parts being stimulated to produce an effect beyond their powers, and that this stimulus is sooner or later in taking place, in different cases."
The connection between hectic and suppuration is, however, apparently so close, that we are unwilling to give up our former opinion; and we can perceive, we think, some clue to conduct us through the labyrinth of discordant facts. We would conclude, therefore, that hectic is owing to suppuration of any considerable magnitude arising from constitutional disease; and these constitutional diseases are such as are usually attended with increased irritability, or a broken constitution.
The appearance of hectic resembles that of an irregular intermittent. The pulse rarely becomes natural; but remains quick and weak: the chillness is often violent and long continued; not regularly succeeded either by a dry heat or sweat, though one of these generally follows; and the hot fit sometimes approaches without being preceded by a sensible chillness. The sweat seems to exhaust instead of relieving the patient, and when at an end, the fever will sometimes continue, or in the middle of the fever the chillness will return; a certain sign, according to Dr. Heberden, of the presence of this fever and its pathognomonic symptom. The return of the fits is equally irregular. Sometimes they recur, for a considerable time, at regular periods, and again lose this strictly intermittent form. In the fit, the urine is various, and nothing can be ascertained from its appearances. When an external ulcer is the cause, pains, apparently rheumatic, occur,thoughinapartvery remote from the ulcer; and a sudden swelling of some part of the body is occasionally observed, which soon subsides. Its approach is usually gradual, the skin is dry, the tongue hard and parched, the cheeks flushed, the sleep not refreshing. On the approach of the fit, according to Hippocrates, the whole breast is pained, the breath resembles a whistling through a reed, a cough often attends, a quantity of thin saline saliva is discharged, and, in the progress of the disease, the whole body is emaciated, except the legs, which become tumid. A pathognomonic sign, according to Galen, is an increase of fever after eating and drinking.