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ter, the more strongly. coloured matter may be generally considered as pus; as it is not easy to understand how one portion of the mucus of the lungs can be very considerably changed, while the rest of it is very little so, or remains in its ordinary state.
6, From the admixture of certain substances with the matter thrown out from the lungs. To this purpose we are informed by the experiments of the late Mr. Charles Darwin: (1.) That the vitriolic acid dissolves both mucus and pus, but most readily the former : that if water be added, to such a solution of mucus, this is separated, and either swims on the surface, or, divided into flocculi, is suspended in the liquor ; whereas, when water is added to a like solution of pus, this falls to the bottom, or by agitation is diffused so as to exhibit an uniformly turbid liquor. (2.) That a solution of the caustic fixed alkali, after some time, dissolves mucus, and generally pus; and, if water be added to such solutions, the pus is precipitated, but the mucus is not. From such experiments it is supposed, that pus and mucus may be certainly distinguished from each other.
7, From the expectoration's being attended with a hectic fever. A catarrh, or expectoration of mucus, is often attended with fever ; but never, so far as I have observed, with such a fever as I am presently to describe as a hectic. This, in my opinion, is the most certain mark of a purulent state in some part of the body; and if others have thought differently, I am persuaded that it has been owing to this, that, presuming upon the mortal nature of a confirmed or purulent phthisis, they have considered every case in which a recovery happened, as a catarrh only ; but, that they may have been mistaken in this, shall be shewn hereafter.,
• 857. Having thus considered the first part of the character of the phthisis pulmonalis as a mark of an ulceration of the lungs ; and having just now said, that the other part of the character, that is, the hectic fever, is a mark or indication of the same thing; it is proper now to consider this here, as I had with that view omitted it before, (74).
858. A hectic fever has the form of a remittent; which has exacerbations twice every day. The first of these occurs about noon, sometimes a little sooner or later; and a slight remission of it happens about five afternoon. This last is soon succeeded by another exacerbation, gradually increasing till after midnight: but after two o'clock of the morning a remission takes place, which becomes more and more considerable as the morning advances. The exacerbations are frequently attended with some degree of cold shivering; or at least the patient is exceedingly sensible to any coolness of the air, seeks external heat, and often complains of a sense of cold, when, to the therVOL. I.
mometer, his skin is preternaturally warm. Of these exacerbations, that of the evening is always the most considerable.
859. It has commonly been given as a part of the character of a hectic fever, that an exacerbation of it commonly appears after the taking food : and it is true that dinner, which is taken at noon or after it, does seem to occasion some exacerbation. But this must not make us judge the midday exacerbation to be the effect of eating only; for I have often observed it come on an hour before noon, and often some hours before dinner ; which, in this country at present, is not taken till some time after noon. It is indeed to be observed, that, in almost every person, the taking food occasions some degree of fever ; but I am persuaded this would not appear so considerable in a hectic, were it not that an exacerbation of fever is present from another cause; and accordingly, the taking food in the morning has hardly any sensible effect.
860. I have thus described the general form of hectic fever; but many circumstances attending it are further to be taken notice of. The fever I have described does not commonly subsist long, till the evening exacerbations become attended with sweatings; which continue to recur, and to prove more and more profuse, through the whole course of the disease. Almost from the first appearance of the hectic, the urine is high-coloured, and deposites a copious branny red sediment, which hardly ever falls close to the bottom of the vessel. In the hectic, the appetite for food is generally less impaired than in any other kind of fever. The thirst is seldom considerable; the mouth is commonly moist; and, as the disease advances, the tongue becomes free from all fur ; appears very clean; and, in the advanced stages of the disease, the tongue and fauces appear to be somewhat inflamed, and become more or less covered with aphthæ. As the disease advances, the red vessels of the adnata of the eye disappear, and the whole of the adnata becomes of a pearly white. The face is commonly pale ; but, during the exacerbations, a florid red, and an almost circumscribed spot, appear on each cheek. For some time, in the course of a hectic, the belly is bound ; but, in the advanced stages of it, a diarrhæa almost always comes on, and continues to recur frequently during the rest of the disease, alternating in some measure with the sweatings mentioned above. The disease is always attended with a debility, which gradually increases during the course of it. During the same course an emaciation takes place, and goes to a greater degree than in almost any other case. The falling off of the hairs, and the adunque form of the nails, are also symptoms of the want of nourishment. Towards the end of the disease, the feet are often affected with cedematous swell
ings. The exacerbations of the fever are seldom attended with any headach, and scarcely ever with delirium. The senses and judgment commonly remain entire to the very end of the disease ; and the mind, for the most part, is confident and full of hope. Some days before death, a delirium comes on, and commonly continues to the end.
861. The hectic fever now described, 858,860, as accompanying a purulent state of the lungs, is perhaps the case in which it most frequently appears : but I have never seen it in any case, when there was not evidently, or when I had not ground to suppose, there was a permanent purulency or ulceration in some external or internal part. It was for this reason, that in 74 I concluded it to be a symptomatic fever only. Indeed, it appears to me to be always the effect of an acrimony absorbed from abscesses or ulcers, although it is not equally the effect of every sort of acrimony; for the scor butic and cancerous kinds often subsist long in the body without producing a hectic. What is the precise state of the acrimony producing this, I cannot determine; but it seems to be chiefly that of a vitiated purulency.
862. However this may be, it appears, that the hectic's depending in general upon an acrimony, explains its peculiar circumstances. The febrile state seems to be chiefly an exacerbation of that