A STUDY IX MORBID AND NORMAL PHYSIOLOGY. 



245 



tlien that fever may be called, with scientific strictness, hfcmic. Suppose, however, 

 for a moment, there were a fever centre in the nervous system, and tliat irritation 

 of a peripheral nerve were capable of causing fever by atfecting that centre, such 

 fever would certainly be a neurosis. Granting the existence of a "fever centre" of 

 this kind the laws of life teach us that there must be poisons capable of acting upon 

 it directly, so as to produce fever. Such a fever would certainly be neurotic, although 

 produced through the blood, the vital fluid acting simply as a "common carrier." 

 With this understanding of the terms, distinct, clear proof is at present wanting, 

 that the fever even of pyoemia, of the exanthemata, or of any so-called blood-poison- 

 ing is strictly ha?mic, since such toxic fever may be due to an action of the poison 

 upon the central nervous system. 



There are numerous febrile reactions, whose origin would appear to be due to a 

 peripheral irritation. Such are the so-called "irritative fevers." Of these the 

 most frequent are those caused by inflammations. These inflammatory fevers have 

 however been the subject of very careful and ingenious study by Prof Billroth and 

 other observers, with the result of at least making it very probable tluit they are 

 preceded by the formation in the affected part of a poison by whose absorption the 

 febrile reaction is brought about. The memoirs of Dr. Billroth were published in 

 Langenbeck's Archlv fiir Klin. Chirtirgie, Bde. vi., ix. xiii., and demand lierc a 

 somewhat extended notice. The theory of Billroth in these papers is based upon the 

 following facts and argument. It was first clearly proven that fresh pus, /. e., the 

 material formed by the inflammatory process, is Avhen injected into the blood 

 entirely capable of inducing severe fever. It was next noted that in wound-fever 

 a sufficient length of time usually elapses between the reception of the wound and 

 the development ot the fever for the dissipation of inflammatory products, and that 

 there are many cases of severe wounds in which no febrile reaction occurs, and 

 that these cases are notably those in which inflammatory products are scanty. To 

 these arguments drawn from clinical and experimental observation, Dr. Billroth 

 adds his failure to produce in dogs distinct immediate fever by peripheral irritations 

 of sensitive nerves, or of the vaso-motor nerves. These irritations were made 

 by him in various ways : by forcible injections of air or of water into the subcuta- 

 neous tissues, by suspending weights to nerve trunks, by rubbing the skui of the 

 ears of dogs with croton oil, by irritating nerve trunks with ammonia, by rubbing 

 and tearing the inner coats of vessels with canula? or dilating tents of sea-tangle, 

 by injecting powders into the blood so as to form emboli, etc. (op. cit., p. 379). 

 This failure to produce fever in dogs by peripheral irritation does not seem to 

 me of overpowering force as evidence, because all fever in dogs is caused with 

 difficulty. The experiments of Drs. J. Bremer and J. Chrobak {3M. Jahrk, 

 Bd. XIV., p. 1) are of greater weight. In these experiments were used dogs in all 

 respects normal, and others in which all nervous connection had been severed 

 between a specifled joint and the central nervous system. Tlie investigators found, 

 what I have myself frequently noted, that traumatic fever is developed with diffi- 

 culty in dogs. They therefore opened and crushed the joints operated upon, and 

 injected them with irritants, such as tincture of iodine, ammonia, oil of mustard 

 Under these circumstances they found that fever was developed as soon, where all 



