Page:The physical training of children (IA 39002011126464.med.yale.edu).pdf/338

 generally occurs in the morning; but, after some time, comes on at night, and gradually throughout the day and the night. Frequently during the early stage of the disease a slight spitting of blood occurs. Now this is a most dangerous symptom; indeed, I may go so far as to say that, as a rule, it is almost a sure sign that the patient is in the first stage of a consumption.

There is usually hoarseness, not constant, but coming on if the patient be tired, or toward the evening; there is also a sense of lassitude and depression, shortness of breathing, a feeling of being quickly wearied—more especially on the slightest exertion. The hair of a consumptive person usually falls off, and what little remains is weak and poor; the joints of the fingers become enlarged, or clubbed as it is sometimes called; the patient loses flesh, and, after some time, night-sweats make their appearance; then we may know that hectic fever has commenced.

Hectic begins with chilliness, which is soon followed by flushings of the face, and by burning heat of the hands and feet, especially of the palms and the soles. This is soon succeeded by perspirations. The patient has generally, during the day, two decided paroxysms of hectic fever—the one at noon, which lasts about five hours, the other in the evening, which is more severe, and ends in violent perspirations, which perspirations continue the whole night through. He may, during the day, have several attacks of hectic flushes of the face, especially after eating; at one moment he complains of being too hot, and rushes to the cool air; the next moment he is too cold, and almost scorches himself by sitting too near the fire. Whenever the circumscribed hectic flush is on the cheek, it looks as though the cheek had been painted with vermilion, then is the time when the palms of the hands are burning hot.