The hectic fever is not only seated in the fluids and spirits, but also
in the solid parts. It is unaccompanied with pain, and those affected
with this fever imagine that they have no fever at all, for they are
sensible of no heat, all the parts being heated equally. There are two
kinds of hectic fevers, the one for the most part supervening upon ardent
fevers which have been protracted so long as to consume in time all the
juices in the body of the heart; the other may come on while it remains
plentiful. The former constitute not only hectic but marasmus. Those that
come on while the juices of the heart remain, seize upon the body of the
heart, and hence the febrile flame is kindled, like the flame of a lamp
from its wick. This is one of the modes of formation. The other mode is,
when they make their attack originally, commencing like ephemeral fevers,
from grief, anger, or much fatigue attended with heat. These may be cured
without difficulty; but those of them which have terminated in marasmus,
it is impossible to cure. A hectic fever which is running into marasmus
may be easily recognized. You may see the patients’ eyes immeasurably
hollow, dry rheums determined to them, and they have a certain squalid
appearance. The vital bloom of their colour is gone; their forehead is
parched and stretched; they constantly wink as if asleep, and yet the
affection is not sleep, but an inability to keep awake; their temples
are collapsed; and what remains, but the bones and skin alone? If you
lay bare, and examine the parts about the abdomen, you will fancy that
none of the entrails and intestines remain, and that the hypochondrium
is forcibly drawn upwards. The skin is parched in the last extreme, the
pulse slender, dense, and hard. The heat on the first application of the
hand seems faint, but soon afterwards feels acrid and pungent. While,
therefore, any of the natural moisture remains, the fever is only hectic;
but when the humidity runs the risk of being altogether consumed, a true
marasmus is formed.
* * * * *
COMMENTARY. Our author has copied from Oribasius (Synops. vi, 21), who in
his turn is indebted to Galen (de Diff. Feb. i, 11.) A similar account
is given in somewhat fuller terms by Aëtius (v, 92.) See also Alexander
(xii, 4.) We shall merely give his explanation of the characters of
the pulse. It is hard and small, because the vessels have become dry
and contracted; it is dense (frequent?) because the necessities of
the system require it to be so, (namely, in order to make up for the
reduced expansion of the artery); it is feeble, owing to the weakness
of the vital powers; and slender, because the vessel does not admit of
being stretched in breadth. Nonnus and Actuarius derive their views
from Galen. According to the latter, hectic fever is a very dangerous
disease when it arises from the conversion of any other fever, but when
connected with inflammation or scirrhus of any vital organ it is almost
incurable. Palladius says that the hectic is an unceasing fever, wasting
and consuming the natural humidity of all the members, and supervening
for the most part upon acute and ardent fevers, but sometimes arising
from sympathy with some vital organ. He states it as a characteristic of
the hectic fever, that food increases the febrile heat, in like manner
as water poured upon unslacked lime enkindles heat. This comparison
is borrowed from Galen, and is repeated also by Alexander and Nonnus.
Palladius, like our author, represents marasmus as the termination of the
hectic fever. It is distinguished, he says, by prostration of the natural
faculties, aridity, and wasting of the body, which becomes dried and
parched like a tree deprived of its juices by exposure to excessive heat.
According to Haly Abbas, hectic fevers commonly arise either from the
conversion of semi-tertians, or from abscesses of the lungs, whence
heat is sent to the heart, and from it is diffused over the system.
(Theor. viii, 7.) Alsaharavius states that hectic fevers arise from
protracted ephemeral or putrid fevers, or from sympathy of the system
with ulceration of the lungs, bladder, or liver, or from any chronic and
prolonged disease. (Pract. xxxii.) Averrhoes represents the hectic as
supervening upon ephemeral and putrid fevers. He ridicules the comparison
of the effects of food on the febrile heat to those of water poured upon
lime. (Collig. iv, 33.) Avenzoar gives the same account of hectic as our
author. (iii. 3, c. 13.) Serapion’s account, although borrowed from the
Greeks, is distinct and curious (vi, 11.) See also Rhases (ad Mansor.
x, 3, _alibique_.) He and Haly Abbas repeat the graphic delineation
of a person in the last stage of hectic fever, borrowed by our author
from Galen, who seems to have had in view a similar description of a
person sinking of consumption, given by Aretæus. (De Morb. Chron. i, 8.)
Avicenna’s account of the nature and causes of hectic fevers is so ample,
that we regret our limits will not permit us to do justice to it. The
principal causes of them which he enumerates are ephemeral and putrid
fevers, and abscesses of the lungs and liver. The pulse, he says, is
hard, small, frequent, and weak, and may become _myurus_, if the fever
pass into the state of marasmus. He gives, principally from Galen (de
Marasmo), an interesting description of what he calls the _hectic of old
age_, but which Galen calls _old age from disease_. Its symptoms, as
described by these authors, are coldness and aridity of the body; the
pulse slow, small, and rare, unless very weak; the urine white, thin, and
watery. (iv, 1, 3.) Franciscus de Pedemontio, a writer of the fourteenth
century, in like manner pronounces the hectic of old age to be a dry
intemperament of the system, and recommends for it a calefacient and
moistening regimen.