o:,4 FEVKU. 



IIaviii<r rnu'lifd this point, it sornis to mo tliat fit last we arc in a position to 

 (IfttTiuiuc tlic theory of fever, hut hefore during this it may be best to marshal 

 the facts whicli are at our disposal. 



1st. In health there is in man a fixed mean and a normal variation of tempera- 

 ture having a regular rhytliin, and this variation is luyoinl the eontrol of all dis- 

 tui;l>ing causes which do not force the organism beyond the condition of health. 



'2d. The maintenance of the normal temj)erature and its rhythm is d<'pondent 

 upon the nervous system, which within certain limits controls both the production 

 and dissipation of animal iicat. 



3d. So far as our jiresent knowledge goes tiic chief factor in controlling heat 

 dissipation is the vuso-motor nerves, including in man such nerves as control sweat 

 secretion ; these nerves being able by contracting the capillaries of the stirface of 

 the body and by drying the secretion of the skin to reduce the loss of heat to 

 n minimum, and i»y a reverse action to increase it to a maximum. 



4th. The only lUTve centre proven to exist capable of influencing the heat 

 production without affecting the general circulation is situated in the pons or 

 above it, and whilst it may be a muscular vaso-motor centre, it is more probably 

 on " inhil)itory heat centre:" of whichever nature it may be, it must act through 

 subordinate centres situated in the spinal cord. 



ijth. l*'evcr is a nutritive disturbance in which there is an elevation of the bodily 

 temperature and also -an increase of the production of heat by an increase of the 

 chemical movements in the accumulated material of the body ; this increase being 

 sometimes sufl'icient, sometimes insufficient to comj)ensate for tlie loss of that heat 

 which is derived directly from tlie destruction of tiie surplus food in the body, very 

 little or no food being taken in severe fever. The rise of temperature in fever is, 

 therefore, not dependent altogether upon increased heat jiroduction, as in fever 

 there certainly is sometimes less production of heat in the organism than there is 

 at other times when the bpdily tcmiierature remains normal; also excessive heat 

 production may occur even at the expense of the accumulated materials of the 

 organism without elevation of the bodily temperature. 



Gtli. In fever a «laily tem|)erature variation occurs which is parallel to that seen 

 in health, and differs from the normal variation only in having a higher mean. 



"th. In fever vaso-niotor ]>aralysis when produced is followed by an immediate 

 fail of temperature similar to but greater than that which "is produced by a like 

 disturbance in health. 



8th. The decrease of hetit production which follows section of the cord is much 

 greater in the fevered than in the normal animal. 



!Mh. The so-called inhiliitory heat nervous system is imt [iinily/ed in fever, but 

 is h'ss capable than in health of answering ])romptly ami powerfully to suitable 

 stimuli, in othet wonls, it is in a condition of paresis or partial palsy. 



lOth. The clinical succession and jdienomena of a f«'brile paroxysm, such as 

 that of on intermittent, seem jdainly to depend upon the nervous system for their 

 nrranjjcment and relation. 



11th. In most cases of fever, and prnl>alily in all cases of sirious fever, there 



