A STUDY IN MORBID AND NORMAL rilYSIOLOGY. 247 



capable, not only of lowering the temperature, but, if uiy interpretation be correct, 

 of absolutely lessening the chemical movements of the body. Then, a<>-;iin, the 

 effect of external cold in at once increasing heat production, as ])roved by Lieber- 

 meister's bath experiments and as borne out by the experiences of everv-chiy life 

 can scarcely be explained otherwise than by an action upon the peripheral nervous 

 system. We are not, however, left to these deductions from clinical facts. Eoehri" 

 and. Huntz (Licbermekter's Uandhnch dcs Fiebcrs, p. 268) have found that mild 

 electrical or chemical irritations of tlie skin increase the bodily temperature. The 

 same observers {Pjliujer's Archiv, Bd. 4, p. 90) discovered that the application of 

 cold to the skin, as well as external irritations by concentrated salt baths, increases 

 the elimination of carbonic acid and the consumption of oxygen. F. Raalzon (Ibid, 

 p. 494) has used mustard plasters as an irritant and found that, when applied to 

 one-tenth of the surface of a rabbit, they produce a very notable increase in the 

 amount of carbonic acid eliminated and of the oxygen consumed. 



For the reasons assigned, the possibility of an irritative fever must still be 

 acknowlcdsjed, althouiih we are warranted in contending that not onlv are such 

 fevers much less frequent than was formerly thought, but tliat all or almost all 

 serious, protracted attacks of fever are due to the absorption into the blood of a 

 poison. 



Fever due to the introduction of a poison into the blood appears, at first sight, 

 to be probably produced by an action of the poison upon the general protoplasm. 

 If, however, we take the most ordinary of all such fevers, the malarial — the chill, 

 the fever, and the sweating in their regular sequence and their periodical occur- 

 rences most plainly bear testimony to a neurotic origin. AMicn it is further 

 remembered that neuralgia, and various local vaso-motor and secretory disturbances 

 (such as intermittent pneunuinia and intermittent diarriiani) sometimes replace the 

 normal paroxysm, it becomes almost inconceivable that the normal paroxysm can 

 be produced by a general action upon the common protoplasm of the body. Again, 

 in rare instances the malarial paroxysm becomes localized in a certain region of 

 the body, which may exhibit the successive phenomena of ''■ a chill," Avhilst the 

 remainder of the organism seems perfectly normal in its functions. The following 

 case recently reported by Dr. Meriwether Lewis, of Lenoir, Tennessee, is cited as 

 an instance of such localized malarial lever. 



In 1877, Mr. G. M., a^t. 30, whilst recovering from an attack of pneumonia, was 

 attacked with chills, which were peculiar in that the sweating stage alone was con- 

 fined strictly to one side of the body. Under appropriate treatment Ui: ]\I. soon 

 convalesced and remained well for nearly a year, when the ague again made its 

 appearance. During the latter part of this attack the febrile paroxysm seemed 

 limited to a prolonged sweating stage, in which the perspiration was absolutely con- 

 fined to the right side, and the temperature of the right axilla was 3^° Fab. greater 

 than that of the left. 



The various irregular cases of intermittent fever, Aiewed in connection with the 

 phenomena of the ordinary malarial fever, are only to be accounted for by the ex- 

 planation that the malarial poison acts in some way upon the nervous system and 

 thereby provokes the febrile reaction. Of course, all the nutritive disturl,ances 



